|
HC SOM ADENOSINE DEAMINASE
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900911409
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Adventist Health Commercial |
$29.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$89.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.41
|
| Rate for Payer: Blue Shield of California Commercial |
$56.28
|
| Rate for Payer: Blue Shield of California EPN |
$45.14
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$94.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$89.75
|
| Rate for Payer: Heritage Provider Network Senior |
$89.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$69.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.85
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.10
|
| Rate for Payer: TriValley Medical Group Senior |
$8.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Vantage Medical Group Senior |
$8.10
|
|
|
HC SOM ADENOSINE DEAMINASE
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900911409
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Adventist Health Commercial |
$29.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$93.38
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$98.17
|
| Rate for Payer: Heritage Provider Network Senior |
$98.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.25
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
|
|
HC SOM ADENOVIRUS DNA PCR
|
Facility
|
IP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912712
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$37.70 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.37
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.03
|
| Rate for Payer: Heritage Provider Network Senior |
$34.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.57
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
|
|
HC SOM ADENOVIRUS DNA PCR
|
Facility
|
OP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912712
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.42
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.66
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.12
|
| Rate for Payer: Heritage Provider Network Senior |
$31.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM ADENOVIRUS DNA PCR NON-BLOOD
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900910713
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.20
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.85
|
| Rate for Payer: Heritage Provider Network Senior |
$33.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
|
|
HC SOM ADENOVIRUS DNA PCR NON-BLOOD
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900910713
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.42
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM ADENOVIRUS DNA PCR QUANT
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912781
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$57.96
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.93
|
| Rate for Payer: Heritage Provider Network Senior |
$60.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
|
|
HC SOM ADENOVIRUS DNA PCR QUANT
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912781
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$344.74 |
| Rate for Payer: EPIC Health Plan Commercial |
$53.10
|
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.65
|
| Rate for Payer: Blue Shield of California Commercial |
$344.74
|
| Rate for Payer: Blue Shield of California EPN |
$276.51
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.71
|
| Rate for Payer: Heritage Provider Network Senior |
$55.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$42.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.84
|
| Rate for Payer: TriValley Medical Group Senior |
$42.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC SOM AF CULT GENE TEST CELLS
|
Facility
|
OP
|
$210.92
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900915286
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.18 |
| Max. Negotiated Rate |
$1,185.06 |
| Rate for Payer: EPIC Health Plan Medicare |
$150.30
|
| Rate for Payer: Adventist Health Commercial |
$42.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$130.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,048.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1,185.06
|
| Rate for Payer: Blue Shield of California EPN |
$950.52
|
| Rate for Payer: Cash Price |
$210.92
|
| Rate for Payer: Cash Price |
$210.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$137.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$130.56
|
| Rate for Payer: Heritage Provider Network Senior |
$130.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$100.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$172.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$201.40
|
| Rate for Payer: Multiplan Commercial |
$158.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$150.30
|
| Rate for Payer: TriValley Medical Group Senior |
$150.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$162.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$162.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Vantage Medical Group Senior |
$150.30
|
|
|
HC SOM AF CULT GENE TEST CELLS
|
Facility
|
IP
|
$210.92
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900915286
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.18 |
| Max. Negotiated Rate |
$158.19 |
| Rate for Payer: Adventist Health Commercial |
$42.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$135.83
|
| Rate for Payer: Cash Price |
$210.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.79
|
| Rate for Payer: Heritage Provider Network Senior |
$142.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.73
|
| Rate for Payer: Multiplan Commercial |
$158.19
|
|
|
HC SOM AF CULT GENE TEST CRYO
|
Facility
|
IP
|
$14.46
|
|
|
Service Code
|
CPT 88240
|
| Hospital Charge Code |
900915289
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$10.85 |
| Rate for Payer: Adventist Health Commercial |
$2.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.31
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.79
|
| Rate for Payer: Heritage Provider Network Senior |
$9.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.62
|
| Rate for Payer: Multiplan Commercial |
$10.85
|
|
|
HC SOM AF CULT GENE TEST CRYO
|
Facility
|
OP
|
$14.46
|
|
|
Service Code
|
CPT 88240
|
| Hospital Charge Code |
900915289
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$43.34 |
| Rate for Payer: Adventist Health Commercial |
$2.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.34
|
| Rate for Payer: Blue Shield of California Commercial |
$36.92
|
| Rate for Payer: Blue Shield of California EPN |
$29.61
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.95
|
| Rate for Payer: Heritage Provider Network Senior |
$8.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.51
|
| Rate for Payer: Multiplan Commercial |
$10.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.07
|
| Rate for Payer: TriValley Medical Group Senior |
$13.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.38
|
| Rate for Payer: Vantage Medical Group Senior |
$13.07
|
|
|
HC SOM AFP & TOTAL AFT, SERUM
|
Facility
|
IP
|
$107.08
|
|
|
Service Code
|
CPT 82107
|
| Hospital Charge Code |
900913812
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$80.31 |
| Rate for Payer: Adventist Health Commercial |
$21.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.96
|
| Rate for Payer: Cash Price |
$107.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$72.49
|
| Rate for Payer: Heritage Provider Network Senior |
$72.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.77
|
| Rate for Payer: Multiplan Commercial |
$80.31
|
|
|
HC SOM AFP & TOTAL AFT, SERUM
|
Facility
|
OP
|
$107.08
|
|
|
Service Code
|
CPT 82107
|
| Hospital Charge Code |
900913812
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$598.25 |
| Rate for Payer: Adventist Health Commercial |
$21.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$598.25
|
| Rate for Payer: Blue Shield of California Commercial |
$518.34
|
| Rate for Payer: Blue Shield of California EPN |
$415.75
|
| Rate for Payer: Cash Price |
$107.08
|
| Rate for Payer: Cash Price |
$107.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$69.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$64.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.28
|
| Rate for Payer: Heritage Provider Network Senior |
$66.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$51.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$74.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$86.31
|
| Rate for Payer: Multiplan Commercial |
$80.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$64.41
|
| Rate for Payer: TriValley Medical Group Senior |
$64.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$69.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$69.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.85
|
| Rate for Payer: Vantage Medical Group Senior |
$64.41
|
|
|
HC SOM ALBUMIN LEVEL BODY FLUID
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
900914481
|
|
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 |
$6.44
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.77
|
| Rate for Payer: Heritage Provider Network Senior |
$6.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
|
|
HC SOM ALBUMIN LEVEL BODY FLUID
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
900914481
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$49.09 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.09
|
| Rate for Payer: Blue Shield of California Commercial |
$41.64
|
| Rate for Payer: Blue Shield of California EPN |
$33.40
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.19
|
| Rate for Payer: Heritage Provider Network Senior |
$6.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.43
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| 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 ALDOLASE
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
CPT 82085
|
| Hospital Charge Code |
900910218
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$6.75 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.80
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.09
|
| Rate for Payer: Heritage Provider Network Senior |
$6.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
|
|
HC SOM ALDOLASE
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
CPT 82085
|
| Hospital Charge Code |
900910218
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$92.18 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.18
|
| Rate for Payer: Blue Shield of California Commercial |
$78.11
|
| Rate for Payer: Blue Shield of California EPN |
$62.65
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.57
|
| Rate for Payer: Heritage Provider Network Senior |
$5.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.01
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.71
|
| Rate for Payer: TriValley Medical Group Senior |
$9.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Vantage Medical Group Senior |
$9.71
|
|
|
HC SOM ALDOSTERONE
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
900910965
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.66
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.15
|
| Rate for Payer: Heritage Provider Network Senior |
$10.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
|
|
HC SOM ALDOSTERONE
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
900910965
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$386.98 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$386.98
|
| Rate for Payer: Blue Shield of California Commercial |
$327.97
|
| Rate for Payer: Blue Shield of California EPN |
$263.06
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$40.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.29
|
| Rate for Payer: Heritage Provider Network Senior |
$9.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$40.75
|
| Rate for Payer: TriValley Medical Group Senior |
$40.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$44.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.83
|
| Rate for Payer: Vantage Medical Group Senior |
$40.75
|
|
|
HC SOM ALDOSTERONE URINE
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
900910945
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$386.98 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$386.98
|
| Rate for Payer: Blue Shield of California Commercial |
$327.97
|
| Rate for Payer: Blue Shield of California EPN |
$263.06
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.86
|
| Rate for Payer: EPIC Health Plan Medicare |
$40.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.43
|
| Rate for Payer: Heritage Provider Network Senior |
$33.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$25.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$40.75
|
| Rate for Payer: TriValley Medical Group Senior |
$40.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$44.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.83
|
| Rate for Payer: Vantage Medical Group Senior |
$40.75
|
|
|
HC SOM ALDOSTERONE URINE
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
900910945
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.78
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.56
|
| Rate for Payer: Heritage Provider Network Senior |
$36.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
|
|
HC SOM ALKALINE PHOSPHATSE ISO
|
Facility
|
OP
|
$16.34
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
900911249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$140.44 |
| Rate for Payer: Adventist Health Commercial |
$3.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.44
|
| Rate for Payer: Blue Shield of California Commercial |
$119.00
|
| Rate for Payer: Blue Shield of California EPN |
$95.45
|
| Rate for Payer: Cash Price |
$16.34
|
| Rate for Payer: Cash Price |
$16.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.64
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.11
|
| Rate for Payer: Heritage Provider Network Senior |
$10.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.81
|
| Rate for Payer: Multiplan Commercial |
$12.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.78
|
| Rate for Payer: TriValley Medical Group Senior |
$14.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14.78
|
|
|
HC SOM ALKALINE PHOSPHATSE ISO
|
Facility
|
IP
|
$16.34
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
900911249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$12.26 |
| Rate for Payer: Adventist Health Commercial |
$3.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.52
|
| Rate for Payer: Cash Price |
$16.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.06
|
| Rate for Payer: Heritage Provider Network Senior |
$11.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Multiplan Commercial |
$12.26
|
|
|
HC SOM ALK PHOS TOTAL (SO)
|
Facility
|
IP
|
$5.73
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
900912824
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$4.30 |
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.69
|
| Rate for Payer: Cash Price |
$5.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.88
|
| Rate for Payer: Heritage Provider Network Senior |
$3.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: Multiplan Commercial |
$4.30
|
|
