|
HC SOM 9INHE FACTOR IX ACTIVITY ASSAY
|
Facility
|
IP
|
$35.72
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
900915513
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Adventist Health Commercial |
$7.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.00
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.18
|
| Rate for Payer: Heritage Provider Network Senior |
$24.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.93
|
| Rate for Payer: Multiplan Commercial |
$26.79
|
|
|
HC SOM 9INHE FACTOR IX INHIB TECH INTERP
|
Facility
|
OP
|
$29.04
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900915514
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Adventist Health Commercial |
$5.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.96
|
| Rate for Payer: Blue Shield of California Commercial |
$41.59
|
| Rate for Payer: Blue Shield of California EPN |
$33.36
|
| Rate for Payer: Cash Price |
$29.04
|
| Rate for Payer: Cash Price |
$29.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.98
|
| Rate for Payer: Heritage Provider Network Senior |
$17.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.74
|
| Rate for Payer: Multiplan Commercial |
$21.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.48
|
| Rate for Payer: TriValley Medical Group Senior |
$15.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Vantage Medical Group Senior |
$15.48
|
|
|
HC SOM 9INHE FACTOR IX INHIB TECH INTERP
|
Facility
|
IP
|
$29.04
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900915514
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$21.78 |
| Rate for Payer: Adventist Health Commercial |
$5.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.70
|
| Rate for Payer: Cash Price |
$29.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.66
|
| Rate for Payer: Heritage Provider Network Senior |
$19.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.26
|
| Rate for Payer: Multiplan Commercial |
$21.78
|
|
|
HC SOM ACETYLCHOLINE RECPT AB BINDING
|
Facility
|
OP
|
$45.75
|
|
|
Service Code
|
CPT 86041
|
| Hospital Charge Code |
900911205
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$105.98 |
| Rate for Payer: Adventist Health Commercial |
$9.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.16
|
| Rate for Payer: Blue Shield of California Commercial |
$105.98
|
| Rate for Payer: Blue Shield of California EPN |
$85.01
|
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.99
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.32
|
| Rate for Payer: Heritage Provider Network Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$34.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.40
|
| Rate for Payer: TriValley Medical Group Senior |
$18.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM ACETYLCHOLINE RECPT AB BINDING
|
Facility
|
IP
|
$45.75
|
|
|
Service Code
|
CPT 86041
|
| Hospital Charge Code |
900911205
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$34.31 |
| Rate for Payer: Adventist Health Commercial |
$9.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.46
|
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.97
|
| Rate for Payer: Heritage Provider Network Senior |
$30.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.44
|
| Rate for Payer: Multiplan Commercial |
$34.31
|
|
|
HC SOM ACETYLCHOLINESTERASE
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 82482
|
| Hospital Charge Code |
900910948
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.47
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.73
|
| Rate for Payer: Heritage Provider Network Senior |
$25.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
|
|
HC SOM ACETYLCHOLINESTERASE
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 82482
|
| Hospital Charge Code |
900910948
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$72.94 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.94
|
| Rate for Payer: Blue Shield of California Commercial |
$61.86
|
| Rate for Payer: Blue Shield of California EPN |
$49.62
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.52
|
| Rate for Payer: Heritage Provider Network Senior |
$23.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.15
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.81
|
| Rate for Payer: TriValley Medical Group Senior |
$9.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.79
|
| Rate for Payer: Vantage Medical Group Senior |
$9.81
|
|
|
HC SOM ACH RECEPTOR BINDING AB
|
Facility
|
OP
|
$45.75
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900912583
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$128.29 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.27
|
| Rate for Payer: Adventist Health Commercial |
$9.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.29
|
| Rate for Payer: Blue Shield of California Commercial |
$108.75
|
| Rate for Payer: Blue Shield of California EPN |
$87.23
|
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.99
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.32
|
| Rate for Payer: Heritage Provider Network Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$34.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.40
|
| Rate for Payer: TriValley Medical Group Senior |
$18.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM ACH RECEPTOR BINDING AB
|
Facility
|
IP
|
$45.75
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900912583
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$34.31 |
| Rate for Payer: Adventist Health Commercial |
$9.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.46
|
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.97
|
| Rate for Payer: Heritage Provider Network Senior |
$30.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.44
|
| Rate for Payer: Multiplan Commercial |
$34.31
|
|
|
HC SOM ACID PHOSPHATASE TOTAL
|
Facility
|
OP
|
$21.15
|
|
|
Service Code
|
CPT 84066
|
| Hospital Charge Code |
900910217
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$91.86 |
| Rate for Payer: Adventist Health Commercial |
$4.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.86
|
| Rate for Payer: Blue Shield of California Commercial |
$77.76
|
| Rate for Payer: Blue Shield of California EPN |
$62.37
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.09
|
| Rate for Payer: Heritage Provider Network Senior |
$13.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.94
|
| Rate for Payer: Multiplan Commercial |
$15.86
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.66
|
| Rate for Payer: TriValley Medical Group Senior |
$9.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.63
|
| Rate for Payer: Vantage Medical Group Senior |
$9.66
|
|
|
HC SOM ACID PHOSPHATASE TOTAL
|
Facility
|
IP
|
$21.15
|
|
|
Service Code
|
CPT 84066
|
| Hospital Charge Code |
900910217
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$15.86 |
| Rate for Payer: Adventist Health Commercial |
$4.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.62
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.32
|
| Rate for Payer: Heritage Provider Network Senior |
$14.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.29
|
| Rate for Payer: Multiplan Commercial |
$15.86
|
|
|
HC SOM ACTIVATED PROTEIN C RESISTANCE
|
Facility
|
OP
|
$45.50
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
900912508
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$145.42 |
| Rate for Payer: Adventist Health Commercial |
$9.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.42
|
| Rate for Payer: Blue Shield of California Commercial |
$123.32
|
| Rate for Payer: Blue Shield of California EPN |
$98.91
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.84
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.16
|
| Rate for Payer: Heritage Provider Network Senior |
$28.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.53
|
| Rate for Payer: Multiplan Commercial |
$34.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.32
|
| Rate for Payer: TriValley Medical Group Senior |
$15.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Vantage Medical Group Senior |
$15.32
|
|
|
HC SOM ACTIVATED PROTEIN C RESISTANCE
|
Facility
|
IP
|
$45.50
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
900912508
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$34.12 |
| Rate for Payer: Adventist Health Commercial |
$9.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.30
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.80
|
| Rate for Payer: Heritage Provider Network Senior |
$30.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.38
|
| Rate for Payer: Multiplan Commercial |
$34.12
|
|
|
HC SOM ACYCLOVIR
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910711
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$138.26 |
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.26
|
| Rate for Payer: Blue Shield of California Commercial |
$110.19
|
| Rate for Payer: Blue Shield of California EPN |
$88.38
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$109.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.99
|
| Rate for Payer: Heritage Provider Network Senior |
$103.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$80.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.64
|
| Rate for Payer: TriValley Medical Group Senior |
$18.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM ACYCLOVIR
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910711
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.41 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$108.19
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.74
|
| Rate for Payer: Heritage Provider Network Senior |
$113.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
|
|
HC SOM ACYLCARNITINE PROFILE(PKU CARD
|
Facility
|
IP
|
$54.62
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
900911486
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$40.97 |
| Rate for Payer: Adventist Health Commercial |
$10.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.18
|
| Rate for Payer: Cash Price |
$54.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.98
|
| Rate for Payer: Heritage Provider Network Senior |
$36.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.65
|
| Rate for Payer: Multiplan Commercial |
$40.97
|
|
|
HC SOM ACYLCARNITINE PROFILE(PKU CARD
|
Facility
|
OP
|
$54.62
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
900911486
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$159.42 |
| Rate for Payer: Adventist Health Commercial |
$10.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.42
|
| Rate for Payer: Blue Shield of California Commercial |
$135.76
|
| Rate for Payer: Blue Shield of California EPN |
$108.89
|
| Rate for Payer: Cash Price |
$54.62
|
| Rate for Payer: Cash Price |
$54.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.23
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.81
|
| Rate for Payer: Heritage Provider Network Senior |
$33.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$26.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$40.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.87
|
| Rate for Payer: TriValley Medical Group Senior |
$16.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Vantage Medical Group Senior |
$16.87
|
|
|
HC SOM ADALIMUMAB AB
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900915312
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.28
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.24
|
| Rate for Payer: Heritage Provider Network Senior |
$81.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
|
|
HC SOM ADALIMUMAB AB
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900915312
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$134.17 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.17
|
| Rate for Payer: Blue Shield of California Commercial |
$113.70
|
| Rate for Payer: Blue Shield of California EPN |
$91.20
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.28
|
| Rate for Payer: Heritage Provider Network Senior |
$74.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$57.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.92
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.12
|
| Rate for Payer: TriValley Medical Group Senior |
$14.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Vantage Medical Group Senior |
$14.12
|
|
|
HC SOM ADALIMUMAB AB REFLEX
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900915465
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.28
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.24
|
| Rate for Payer: Heritage Provider Network Senior |
$81.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
|
|
HC SOM ADALIMUMAB AB REFLEX
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900915465
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$122.92 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.16
|
| 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 |
$122.92
|
| 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 |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.28
|
| Rate for Payer: Heritage Provider Network Senior |
$74.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$57.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| 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 ADALIMUMAB, QUANT
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 80145
|
| Hospital Charge Code |
900915311
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.77 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$109.48
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.09
|
| Rate for Payer: Heritage Provider Network Senior |
$115.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.50
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
|
|
HC SOM ADALIMUMAB, QUANT
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 80145
|
| Hospital Charge Code |
900915311
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.77 |
| Max. Negotiated Rate |
$222.16 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$105.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.76
|
| Rate for Payer: Blue Shield of California Commercial |
$222.16
|
| Rate for Payer: Blue Shield of California EPN |
$178.19
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$110.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$38.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.23
|
| Rate for Payer: Heritage Provider Network Senior |
$105.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$81.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51.68
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$38.57
|
| Rate for Payer: TriValley Medical Group Senior |
$38.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$41.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$41.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Vantage Medical Group Senior |
$38.57
|
|
|
HC SOM ADAMTS13 ACTIVITY ASSAY
|
Facility
|
OP
|
$136.58
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
900915523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.72 |
| Max. Negotiated Rate |
$217.21 |
| Rate for Payer: Adventist Health Commercial |
$27.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$84.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.21
|
| Rate for Payer: Blue Shield of California Commercial |
$193.02
|
| Rate for Payer: Blue Shield of California EPN |
$154.82
|
| Rate for Payer: Cash Price |
$136.58
|
| Rate for Payer: Cash Price |
$136.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$88.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$30.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.54
|
| Rate for Payer: Heritage Provider Network Senior |
$84.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$65.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41.35
|
| Rate for Payer: Multiplan Commercial |
$102.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$30.86
|
| Rate for Payer: TriValley Medical Group Senior |
$30.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$33.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$33.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.95
|
| Rate for Payer: Vantage Medical Group Senior |
$30.86
|
|
|
HC SOM ADAMTS13 ACTIVITY ASSAY
|
Facility
|
IP
|
$136.58
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
900915523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.72 |
| Max. Negotiated Rate |
$102.44 |
| Rate for Payer: Adventist Health Commercial |
$27.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.96
|
| Rate for Payer: Cash Price |
$136.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.46
|
| Rate for Payer: Heritage Provider Network Senior |
$92.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.15
|
| Rate for Payer: Multiplan Commercial |
$102.44
|
|
