|
HC SOM COXIELLA BURNETTI AB PANEL
|
Facility
OP
|
$10.02
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900911769
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$105.66 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.66
|
| Rate for Payer: Blue Shield of California Commercial |
$94.69
|
| Rate for Payer: Blue Shield of California EPN |
$74.03
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.33
|
| Rate for Payer: Dignity Health Senior |
$12.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.51
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.20
|
| Rate for Payer: Heritage Provider Network Senior |
$6.20
|
| Rate for Payer: Humana Medicare |
$12.12
|
| Rate for Payer: IEHP Medi-Cal |
$16.82
|
| Rate for Payer: IEHP Medicare Advantage |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.27
|
| Rate for Payer: Multiplan Commercial |
$7.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.12
|
| Rate for Payer: TriValley Medical Group Senior |
$12.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.12
|
|
|
HC SOM C-PEPTIDE
|
Facility
IP
|
$12.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
900911116
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.12
|
| Rate for Payer: Heritage Provider Network Senior |
$8.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
|
|
HC SOM C-PEPTIDE
|
Facility
OP
|
$12.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
900911116
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$143.22 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$60.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.95
|
| Rate for Payer: Blue Shield of California Commercial |
$143.22
|
| Rate for Payer: Blue Shield of California EPN |
$111.96
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Senior |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.43
|
| Rate for Payer: Heritage Provider Network Senior |
$7.43
|
| Rate for Payer: Humana Medicare |
$20.81
|
| Rate for Payer: IEHP Medi-Cal |
$27.81
|
| Rate for Payer: IEHP Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$39.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.22
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.81
|
| Rate for Payer: TriValley Medical Group Senior |
$20.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC SOM C PNEUMONIA IGG
|
Facility
OP
|
$6.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
900911125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$108.02 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$34.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.02
|
| Rate for Payer: Blue Shield of California Commercial |
$92.35
|
| Rate for Payer: Blue Shield of California EPN |
$72.19
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.00
|
| Rate for Payer: Dignity Health Senior |
$11.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.71
|
| Rate for Payer: Heritage Provider Network Senior |
$3.71
|
| Rate for Payer: Humana Medicare |
$11.82
|
| Rate for Payer: IEHP Medi-Cal |
$16.40
|
| Rate for Payer: IEHP Medicare Advantage |
$11.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.89
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.82
|
| Rate for Payer: TriValley Medical Group Senior |
$11.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11.82
|
|
|
HC SOM C PNEUMONIA IGG
|
Facility
IP
|
$6.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
900911125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.06
|
| Rate for Payer: Heritage Provider Network Senior |
$4.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
|
|
HC SOM C. PNEUMONIA IGM
|
Facility
IP
|
$6.00
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912797
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.06
|
| Rate for Payer: Heritage Provider Network Senior |
$4.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
|
|
HC SOM C. PNEUMONIA IGM
|
Facility
OP
|
$6.00
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912797
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$108.02 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$36.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.02
|
| Rate for Payer: Blue Shield of California Commercial |
$99.17
|
| Rate for Payer: Blue Shield of California EPN |
$77.52
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.95
|
| Rate for Payer: Dignity Health Senior |
$12.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.71
|
| Rate for Payer: Heritage Provider Network Senior |
$3.71
|
| Rate for Payer: Humana Medicare |
$12.68
|
| Rate for Payer: IEHP Medi-Cal |
$17.60
|
| Rate for Payer: IEHP Medicare Advantage |
$12.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.98
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.68
|
| Rate for Payer: TriValley Medical Group Senior |
$12.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.95
|
| Rate for Payer: Vantage Medical Group Senior |
$12.68
|
|
|
HC SOM C. PSITTACI IGG
|
Facility
OP
|
$7.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
900912800
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$108.02 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$34.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.02
|
| Rate for Payer: Blue Shield of California Commercial |
$92.35
|
| Rate for Payer: Blue Shield of California EPN |
$72.19
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.00
|
| Rate for Payer: Dignity Health Senior |
$11.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.33
|
| Rate for Payer: Heritage Provider Network Senior |
$4.33
|
| Rate for Payer: Humana Medicare |
$11.82
|
| Rate for Payer: IEHP Medi-Cal |
$16.40
|
| Rate for Payer: IEHP Medicare Advantage |
$11.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.89
|
| Rate for Payer: Multiplan Commercial |
$5.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.82
|
| Rate for Payer: TriValley Medical Group Senior |
$11.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11.82
|
|
|
HC SOM C. PSITTACI IGG
|
Facility
IP
|
$7.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
900912800
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.81
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.74
|
| Rate for Payer: Heritage Provider Network Senior |
$4.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$5.25
|
|
|
HC SOM C. PSITTACI IGM
|
Facility
IP
|
$7.00
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912798
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.81
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.74
|
| Rate for Payer: Heritage Provider Network Senior |
$4.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$5.25
|
|
|
HC SOM C. PSITTACI IGM
|
Facility
OP
|
$7.00
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912798
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$108.02 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$36.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.02
|
| Rate for Payer: Blue Shield of California Commercial |
$99.17
|
| Rate for Payer: Blue Shield of California EPN |
$77.52
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.95
|
| Rate for Payer: Dignity Health Senior |
$12.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.33
|
| Rate for Payer: Heritage Provider Network Senior |
$4.33
|
| Rate for Payer: Humana Medicare |
$12.68
|
| Rate for Payer: IEHP Medi-Cal |
$17.60
|
| Rate for Payer: IEHP Medicare Advantage |
$12.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.98
|
| Rate for Payer: Multiplan Commercial |
$5.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.68
|
| Rate for Payer: TriValley Medical Group Senior |
$12.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.95
|
| Rate for Payer: Vantage Medical Group Senior |
$12.68
|
|
|
HC SOM CRYOFIBRINOGEN
|
Facility
IP
|
$10.00
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
900911373
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.87
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.77
|
| Rate for Payer: Heritage Provider Network Senior |
$6.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
|
|
HC SOM CRYOFIBRINOGEN
|
Facility
OP
|
$10.00
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
900911373
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$71.79 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.79
|
| Rate for Payer: Blue Shield of California Commercial |
$66.97
|
| Rate for Payer: Blue Shield of California EPN |
$52.35
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.55
|
| Rate for Payer: Dignity Health Senior |
$14.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.19
|
| Rate for Payer: Heritage Provider Network Senior |
$6.19
|
| Rate for Payer: Humana Medicare |
$14.14
|
| Rate for Payer: IEHP Medi-Cal |
$14.57
|
| Rate for Payer: IEHP Medicare Advantage |
$14.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.82
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.14
|
| Rate for Payer: TriValley Medical Group Senior |
$14.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.55
|
| Rate for Payer: Vantage Medical Group Senior |
$14.14
|
|
|
HC SOM CRYOFIBRINOGEN CRYOGLOBULIN
|
Facility
IP
|
$10.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
900912819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.87
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.77
|
| Rate for Payer: Heritage Provider Network Senior |
$6.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
|
|
HC SOM CRYOFIBRINOGEN CRYOGLOBULIN
|
Facility
OP
|
$10.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
900912819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.74
|
| Rate for Payer: Blue Shield of California Commercial |
$50.53
|
| Rate for Payer: Blue Shield of California EPN |
$39.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.19
|
| Rate for Payer: Heritage Provider Network Senior |
$6.19
|
| Rate for Payer: Humana Medicare |
$6.47
|
| Rate for Payer: IEHP Medi-Cal |
$8.30
|
| Rate for Payer: IEHP Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.15
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC SOM CRYPTOSPORIDIUM AG, F
|
Facility
OP
|
$40.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
900912939
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$75.23 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.23
|
| Rate for Payer: Blue Shield of California Commercial |
$72.56
|
| Rate for Payer: Blue Shield of California EPN |
$56.72
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.20
|
| Rate for Payer: Dignity Health Senior |
$13.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.76
|
| Rate for Payer: Heritage Provider Network Senior |
$24.76
|
| Rate for Payer: Humana Medicare |
$13.82
|
| Rate for Payer: IEHP Medi-Cal |
$13.45
|
| Rate for Payer: IEHP Medicare Advantage |
$13.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.41
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.82
|
| Rate for Payer: TriValley Medical Group Senior |
$13.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.20
|
| Rate for Payer: Vantage Medical Group Senior |
$13.82
|
|
|
HC SOM CRYPTOSPORIDIUM AG, F
|
Facility
IP
|
$40.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
900912939
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.48
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.08
|
| Rate for Payer: Heritage Provider Network Senior |
$27.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
|
|
HC SOM CSF IGG INDEX ALB CSF
|
Facility
IP
|
$8.66
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
900914411
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Adventist Health Commercial |
$1.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.95
|
| Rate for Payer: Cash Price |
$3.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.86
|
| Rate for Payer: Heritage Provider Network Senior |
$5.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$6.50
|
|
|
HC SOM CSF IGG INDEX ALB CSF
|
Facility
OP
|
$8.66
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
900914411
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$43.28 |
| Rate for Payer: Adventist Health Commercial |
$1.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.28
|
| Rate for Payer: Blue Shield of California Commercial |
$40.42
|
| Rate for Payer: Blue Shield of California EPN |
$31.60
|
| Rate for Payer: Cash Price |
$3.90
|
| Rate for Payer: Cash Price |
$3.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.56
|
| Rate for Payer: Dignity Health Senior |
$7.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.36
|
| Rate for Payer: Heritage Provider Network Senior |
$5.36
|
| Rate for Payer: Humana Medicare |
$7.78
|
| Rate for Payer: IEHP Medi-Cal |
$4.41
|
| Rate for Payer: IEHP Medicare Advantage |
$7.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$6.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.78
|
| Rate for Payer: TriValley Medical Group Senior |
$7.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Vantage Medical Group Senior |
$7.78
|
|
|
HC SOM CSF IGG INDEX ALB S
|
Facility
IP
|
$5.51
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
900914410
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.79
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.73
|
| Rate for Payer: Heritage Provider Network Senior |
$3.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$4.13
|
|
|
HC SOM CSF IGG INDEX ALB S
|
Facility
OP
|
$5.51
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
900914410
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$41.47 |
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.47
|
| Rate for Payer: Blue Shield of California Commercial |
$38.68
|
| Rate for Payer: Blue Shield of California EPN |
$30.24
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.44
|
| Rate for Payer: Dignity Health Senior |
$4.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.58
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.41
|
| Rate for Payer: Heritage Provider Network Senior |
$3.41
|
| Rate for Payer: Humana Medicare |
$4.95
|
| Rate for Payer: IEHP Medi-Cal |
$6.27
|
| Rate for Payer: IEHP Medicare Advantage |
$4.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$4.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.95
|
| Rate for Payer: TriValley Medical Group Senior |
$4.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.44
|
| Rate for Payer: Vantage Medical Group Senior |
$4.95
|
|
|
HC SOM CSF IGG INDEX IGG, S
|
Facility
OP
|
$10.35
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900914409
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$72.61 |
| Rate for Payer: Adventist Health Commercial |
$2.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.86
|
| Rate for Payer: Blue Shield of California Commercial |
$72.61
|
| Rate for Payer: Blue Shield of California EPN |
$56.77
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Senior |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.73
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.41
|
| Rate for Payer: Heritage Provider Network Senior |
$6.41
|
| Rate for Payer: Humana Medicare |
$9.30
|
| Rate for Payer: IEHP Medi-Cal |
$9.48
|
| Rate for Payer: IEHP Medicare Advantage |
$9.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.72
|
| Rate for Payer: Multiplan Commercial |
$7.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.30
|
| Rate for Payer: TriValley Medical Group Senior |
$9.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Senior |
$9.30
|
|
|
HC SOM CSF IGG INDEX IGG, S
|
Facility
IP
|
$10.35
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900914409
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: Adventist Health Commercial |
$2.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.11
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.01
|
| Rate for Payer: Heritage Provider Network Senior |
$7.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$7.76
|
|
|
HC SOM C-TELOPEPTIDE
|
Facility
OP
|
$19.34
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
900912783
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$230.64 |
| Rate for Payer: Adventist Health Commercial |
$3.87
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$230.64
|
| Rate for Payer: Blue Shield of California Commercial |
$144.84
|
| Rate for Payer: Blue Shield of California EPN |
$113.23
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.55
|
| Rate for Payer: Dignity Health Senior |
$18.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.57
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.97
|
| Rate for Payer: Heritage Provider Network Senior |
$11.97
|
| Rate for Payer: Humana Medicare |
$18.68
|
| Rate for Payer: IEHP Medi-Cal |
$25.91
|
| Rate for Payer: IEHP Medicare Advantage |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.54
|
| Rate for Payer: Multiplan Commercial |
$14.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.68
|
| Rate for Payer: TriValley Medical Group Senior |
$18.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.55
|
| Rate for Payer: Vantage Medical Group Senior |
$18.68
|
|
|
HC SOM C-TELOPEPTIDE
|
Facility
IP
|
$19.34
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
900912783
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Adventist Health Commercial |
$3.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.29
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.09
|
| Rate for Payer: Heritage Provider Network Senior |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.84
|
| Rate for Payer: Multiplan Commercial |
$14.50
|
|
