|
HC SOM B-CELL LYMPH FISH INTERP
|
Facility
|
IP
|
$254.50
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914116
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$46.06 |
| Max. Negotiated Rate |
$190.88 |
| Rate for Payer: Adventist Health Commercial |
$50.90
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.30
|
| Rate for Payer: Heritage Provider Network Senior |
$172.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.62
|
| Rate for Payer: Multiplan Commercial |
$190.88
|
|
|
HC SOM BCR ABL MUTAT ASPE
|
Facility
|
OP
|
$435.08
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914536
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$1,366.26 |
| Rate for Payer: Adventist Health Commercial |
$87.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$232.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$298.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,366.26
|
| Rate for Payer: Blue Shield of California Commercial |
$265.40
|
| Rate for Payer: Blue Shield of California EPN |
$212.32
|
| Rate for Payer: Cash Price |
$435.08
|
| Rate for Payer: Cash Price |
$435.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$282.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.72
|
| Rate for Payer: Dignity Health Senior |
$185.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$185.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$269.31
|
| Rate for Payer: Heritage Provider Network Senior |
$269.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$300.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$185.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$207.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$212.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$233.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$233.35
|
| Rate for Payer: Multiplan Commercial |
$326.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$185.20
|
| Rate for Payer: TriValley Medical Group Senior |
$185.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$200.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$200.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Vantage Medical Group Senior |
$185.20
|
|
|
HC SOM BCR ABL MUTAT ASPE
|
Facility
|
IP
|
$435.08
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914536
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$326.31 |
| Rate for Payer: Adventist Health Commercial |
$87.02
|
| Rate for Payer: Cash Price |
$435.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$294.55
|
| Rate for Payer: Heritage Provider Network Senior |
$294.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.77
|
| Rate for Payer: Multiplan Commercial |
$326.31
|
|
|
HC SOM BCR/ABL P210 QN MON
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
900914648
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$200.00
|
| 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 BCR/ABL P210 QN MON
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
900914648
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$368.72 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$106.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$368.72
|
| Rate for Payer: Blue Shield of California Commercial |
$122.00
|
| Rate for Payer: Blue Shield of California EPN |
$97.60
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.36
|
| Rate for Payer: Dignity Health Senior |
$163.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.80
|
| Rate for Payer: Heritage Provider Network Senior |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$140.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$95.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.59
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$163.96
|
| Rate for Payer: TriValley Medical Group Senior |
$163.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$177.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$177.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.36
|
| Rate for Payer: Vantage Medical Group Senior |
$163.96
|
|
|
HC SOM BENZODIAZEPINE CONFIRM, U
|
Facility
|
IP
|
$36.96
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900912915
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.69 |
| Max. Negotiated Rate |
$27.72 |
| Rate for Payer: Adventist Health Commercial |
$7.39
|
| Rate for Payer: Cash Price |
$36.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.02
|
| Rate for Payer: Heritage Provider Network Senior |
$25.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$27.72
|
|
|
HC SOM BENZODIAZEPINE CONFIRM, U
|
Facility
|
OP
|
$36.96
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900912915
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.69 |
| Max. Negotiated Rate |
$161.96 |
| Rate for Payer: Adventist Health Commercial |
$7.39
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.96
|
| Rate for Payer: Cash Price |
$36.96
|
| Rate for Payer: Cash Price |
$36.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.42
|
| Rate for Payer: Dignity Health Senior |
$31.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.88
|
| Rate for Payer: Heritage Provider Network Senior |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.87
|
| Rate for Payer: Multiplan Commercial |
$27.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.42
|
| Rate for Payer: Vantage Medical Group Senior |
$31.42
|
|
|
HC SOM BETA 2 MICROGLOBULIN CSF
|
Facility
|
OP
|
$220.67
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900911369
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.18 |
| Max. Negotiated Rate |
$165.50 |
| Rate for Payer: Adventist Health Commercial |
$44.13
|
| Rate for Payer: Aetna of CA Gatekeeper |
$117.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$151.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.76
|
| Rate for Payer: Blue Shield of California Commercial |
$130.23
|
| Rate for Payer: Blue Shield of California EPN |
$104.46
|
| Rate for Payer: Cash Price |
$220.67
|
| Rate for Payer: Cash Price |
$220.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$143.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.80
|
| Rate for Payer: Dignity Health Senior |
$16.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.44
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$136.59
|
| Rate for Payer: Heritage Provider Network Senior |
$136.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$105.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.39
|
| Rate for Payer: Multiplan Commercial |
$165.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.18
|
| Rate for Payer: TriValley Medical Group Senior |
$16.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Vantage Medical Group Senior |
$16.18
|
|
|
HC SOM BETA 2 MICROGLOBULIN CSF
|
Facility
|
IP
|
$220.67
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900911369
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.94 |
| Max. Negotiated Rate |
$165.50 |
| Rate for Payer: Adventist Health Commercial |
$44.13
|
| Rate for Payer: Cash Price |
$220.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$149.39
|
| Rate for Payer: Heritage Provider Network Senior |
$149.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.17
|
| Rate for Payer: Multiplan Commercial |
$165.50
|
|
|
HC SOM BETA-2 MICROGLOBULINS
|
Facility
|
OP
|
$17.90
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900914717
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$147.76 |
| Rate for Payer: Adventist Health Commercial |
$3.58
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.76
|
| Rate for Payer: Blue Shield of California Commercial |
$130.23
|
| Rate for Payer: Blue Shield of California EPN |
$104.46
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.80
|
| Rate for Payer: Dignity Health Senior |
$16.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.08
|
| Rate for Payer: Heritage Provider Network Senior |
$11.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.39
|
| Rate for Payer: Multiplan Commercial |
$13.43
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.18
|
| Rate for Payer: TriValley Medical Group Senior |
$16.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Vantage Medical Group Senior |
$16.18
|
|
|
HC SOM BETA-2 MICROGLOBULINS
|
Facility
|
IP
|
$17.90
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900914717
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$13.43 |
| Rate for Payer: Adventist Health Commercial |
$3.58
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.12
|
| Rate for Payer: Heritage Provider Network Senior |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.47
|
| Rate for Payer: Multiplan Commercial |
$13.43
|
|
|
HC SOM BETA 2 MICROGLOBULIN URINE
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900911370
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.28
|
| Rate for Payer: Heritage Provider Network Senior |
$18.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
|
|
HC SOM BETA 2 MICROGLOBULIN URINE
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900911370
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$147.76 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.76
|
| Rate for Payer: Blue Shield of California Commercial |
$130.23
|
| Rate for Payer: Blue Shield of California EPN |
$104.46
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.80
|
| Rate for Payer: Dignity Health Senior |
$16.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.71
|
| Rate for Payer: Heritage Provider Network Senior |
$16.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.39
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.18
|
| Rate for Payer: TriValley Medical Group Senior |
$16.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Vantage Medical Group Senior |
$16.18
|
|
|
HC SOM BETA 2 TRANSFERRIN (TAU)
|
Facility
|
IP
|
$78.02
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
900911443
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$58.52 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Cash Price |
$78.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.82
|
| Rate for Payer: Heritage Provider Network Senior |
$52.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$58.52
|
|
|
HC SOM BETA 2 TRANSFERRIN (TAU)
|
Facility
|
OP
|
$78.02
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
900911443
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$236.16 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.04
|
| Rate for Payer: Blue Shield of California Commercial |
$236.16
|
| Rate for Payer: Blue Shield of California EPN |
$189.42
|
| Rate for Payer: Cash Price |
$78.02
|
| Rate for Payer: Cash Price |
$78.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.28
|
| Rate for Payer: Dignity Health Senior |
$29.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.71
|
| Rate for Payer: EPIC Health Plan Medicare |
$29.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.29
|
| Rate for Payer: Heritage Provider Network Senior |
$48.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$37.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.98
|
| Rate for Payer: Multiplan Commercial |
$58.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.35
|
| Rate for Payer: TriValley Medical Group Senior |
$29.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.28
|
| Rate for Payer: Vantage Medical Group Senior |
$29.35
|
|
|
HC SOM BETA GALACTOSIDASE
|
Facility
|
OP
|
$573.70
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900912511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.17 |
| Max. Negotiated Rate |
$430.27 |
| Rate for Payer: Adventist Health Commercial |
$114.74
|
| Rate for Payer: Aetna of CA Gatekeeper |
$306.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$394.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.17
|
| Rate for Payer: Blue Shield of California Commercial |
$145.32
|
| Rate for Payer: Blue Shield of California EPN |
$116.56
|
| Rate for Payer: Cash Price |
$573.70
|
| Rate for Payer: Cash Price |
$573.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$372.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.39
|
| Rate for Payer: Dignity Health Senior |
$22.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$355.12
|
| Rate for Payer: Heritage Provider Network Senior |
$355.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$273.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.93
|
| Rate for Payer: Multiplan Commercial |
$430.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.17
|
| Rate for Payer: TriValley Medical Group Senior |
$22.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22.17
|
|
|
HC SOM BETA GALACTOSIDASE
|
Facility
|
IP
|
$573.70
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900912511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$103.84 |
| Max. Negotiated Rate |
$430.27 |
| Rate for Payer: Adventist Health Commercial |
$114.74
|
| Rate for Payer: Cash Price |
$573.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$388.39
|
| Rate for Payer: Heritage Provider Network Senior |
$388.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.43
|
| Rate for Payer: Multiplan Commercial |
$430.27
|
|
|
HC SOM BETA GLYCOPROTEIN AB IGA
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
900912615
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$232.15 |
| 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 |
$38.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.15
|
| Rate for Payer: Blue Shield of California Commercial |
$147.97
|
| Rate for Payer: Blue Shield of California EPN |
$118.69
|
| 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 |
$38.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.00
|
| Rate for Payer: Dignity Health Senior |
$25.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.45
|
| 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 |
$33.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.45
|
| 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 |
$29.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.07
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.45
|
| Rate for Payer: TriValley Medical Group Senior |
$25.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Vantage Medical Group Senior |
$25.45
|
|
|
HC SOM BETA GLYCOPROTEIN AB IGA
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
900912615
|
|
Hospital Revenue Code
|
302
|
| 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 BETA GLYCOPROTEIN AB IGG
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
900910565
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$232.15 |
| 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 |
$38.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.15
|
| Rate for Payer: Blue Shield of California Commercial |
$147.97
|
| Rate for Payer: Blue Shield of California EPN |
$118.69
|
| 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 |
$38.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.00
|
| Rate for Payer: Dignity Health Senior |
$25.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.45
|
| 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 |
$33.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.45
|
| 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 |
$29.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.07
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.45
|
| Rate for Payer: TriValley Medical Group Senior |
$25.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Vantage Medical Group Senior |
$25.45
|
|
|
HC SOM BETA GLYCOPROTEIN AB IGG
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
900910565
|
|
Hospital Revenue Code
|
302
|
| 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 BETA GLYCOPROTEIN AB IGM
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
900912616
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$232.15 |
| 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 |
$38.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.15
|
| Rate for Payer: Blue Shield of California Commercial |
$147.97
|
| Rate for Payer: Blue Shield of California EPN |
$118.69
|
| 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 |
$38.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.00
|
| Rate for Payer: Dignity Health Senior |
$25.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.45
|
| 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 |
$33.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.45
|
| 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 |
$29.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.07
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.45
|
| Rate for Payer: TriValley Medical Group Senior |
$25.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Vantage Medical Group Senior |
$25.45
|
|
|
HC SOM BETA GLYCOPROTEIN AB IGM
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
900912616
|
|
Hospital Revenue Code
|
302
|
| 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 BETA HCG CSF
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
900910726
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$35.00
|
| 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 |
$6.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
|
|
HC SOM BETA HCG CSF
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
900910726
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$131.53 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.05
|
| 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 |
$131.53
|
| 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 |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.75
|
| 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 |
$22.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.66
|
| Rate for Payer: Heritage Provider Network Senior |
$21.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| 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 |
$26.25
|
| 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
|
|
