|
HC SOM ALK PHOS TOTAL (SO)
|
Facility
|
OP
|
$5.73
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
900912824
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$49.09 |
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| 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 |
$5.73
|
| Rate for Payer: Cash Price |
$5.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.55
|
| Rate for Payer: Heritage Provider Network Senior |
$3.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$4.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC SOM ALPHA-1-ANTITRYPSIN PHENO A1AT
|
Facility
|
OP
|
$13.61
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
900912818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$127.46 |
| Rate for Payer: Adventist Health Commercial |
$2.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.46
|
| Rate for Payer: Blue Shield of California Commercial |
$108.12
|
| Rate for Payer: Blue Shield of California EPN |
$86.72
|
| Rate for Payer: Cash Price |
$13.61
|
| Rate for Payer: Cash Price |
$13.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.03
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.42
|
| Rate for Payer: Heritage Provider Network Senior |
$8.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.01
|
| Rate for Payer: Multiplan Commercial |
$10.21
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.44
|
| Rate for Payer: TriValley Medical Group Senior |
$13.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.78
|
| Rate for Payer: Vantage Medical Group Senior |
$13.44
|
|
|
HC SOM ALPHA-1-ANTITRYPSIN PHENO A1AT
|
Facility
|
IP
|
$13.61
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
900912818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$10.21 |
| Rate for Payer: Adventist Health Commercial |
$2.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.76
|
| Rate for Payer: Cash Price |
$13.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.21
|
| Rate for Payer: Heritage Provider Network Senior |
$9.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$10.21
|
|
|
HC SOM ALPHA 1-ANTITRYPSIN PHENOTYPE
|
Facility
|
OP
|
$14.64
|
|
|
Service Code
|
CPT 82104
|
| Hospital Charge Code |
900911068
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$137.24 |
| Rate for Payer: Adventist Health Commercial |
$2.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.24
|
| Rate for Payer: Blue Shield of California Commercial |
$116.35
|
| Rate for Payer: Blue Shield of California EPN |
$93.32
|
| Rate for Payer: Cash Price |
$14.64
|
| Rate for Payer: Cash Price |
$14.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.64
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.06
|
| Rate for Payer: Heritage Provider Network Senior |
$9.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.38
|
| Rate for Payer: Multiplan Commercial |
$10.98
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.46
|
| Rate for Payer: TriValley Medical Group Senior |
$14.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.91
|
| Rate for Payer: Vantage Medical Group Senior |
$14.46
|
|
|
HC SOM ALPHA 1-ANTITRYPSIN PHENOTYPE
|
Facility
|
IP
|
$14.64
|
|
|
Service Code
|
CPT 82104
|
| Hospital Charge Code |
900911068
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$10.98 |
| Rate for Payer: Adventist Health Commercial |
$2.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.43
|
| Rate for Payer: Cash Price |
$14.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.91
|
| Rate for Payer: Heritage Provider Network Senior |
$9.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.66
|
| Rate for Payer: Multiplan Commercial |
$10.98
|
|
|
HC SOM ALPHA-1-ANTITRYPSIN, STOOL
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
900910858
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$127.46 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.46
|
| Rate for Payer: Blue Shield of California Commercial |
$108.12
|
| Rate for Payer: Blue Shield of California EPN |
$86.72
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.47
|
| Rate for Payer: Heritage Provider Network Senior |
$15.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.01
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.44
|
| Rate for Payer: TriValley Medical Group Senior |
$13.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.78
|
| Rate for Payer: Vantage Medical Group Senior |
$13.44
|
|
|
HC SOM ALPHA-1-ANTITRYPSIN, STOOL
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
900910858
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.10
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.93
|
| Rate for Payer: Heritage Provider Network Senior |
$16.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SOM ALPHA-2-MACROGLOBULIN
|
Facility
|
OP
|
$26.07
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900911487
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$129.25 |
| Rate for Payer: Adventist Health Commercial |
$5.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.25
|
| Rate for Payer: Blue Shield of California Commercial |
$109.44
|
| Rate for Payer: Blue Shield of California EPN |
$87.78
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.14
|
| Rate for Payer: Heritage Provider Network Senior |
$16.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.22
|
| Rate for Payer: Multiplan Commercial |
$19.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.60
|
| Rate for Payer: TriValley Medical Group Senior |
$13.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Vantage Medical Group Senior |
$13.60
|
|
|
HC SOM ALPHA-2-MACROGLOBULIN
|
Facility
|
IP
|
$26.07
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900911487
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$19.55 |
| Rate for Payer: Adventist Health Commercial |
$5.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.79
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.65
|
| Rate for Payer: Heritage Provider Network Senior |
$17.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.52
|
| Rate for Payer: Multiplan Commercial |
$19.55
|
|
|
HC SOM ALPHA-FETOPROTEIN, AMNIOTIC FL
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 82106
|
| Hospital Charge Code |
900910946
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$159.29 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.29
|
| Rate for Payer: Blue Shield of California Commercial |
$135.01
|
| Rate for Payer: Blue Shield of California EPN |
$108.29
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.00
|
| Rate for Payer: Heritage Provider Network Senior |
$26.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.78
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.00
|
| Rate for Payer: TriValley Medical Group Senior |
$17.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.70
|
| Rate for Payer: Vantage Medical Group Senior |
$17.00
|
|
|
HC SOM ALPHA-FETOPROTEIN, AMNIOTIC FL
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 82106
|
| Hospital Charge Code |
900910946
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.05
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.43
|
| Rate for Payer: Heritage Provider Network Senior |
$28.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
|
|
HC SOM ALPHA FETOPROTEIN CSF
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
900910585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.88
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC SOM ALPHA FETOPROTEIN CSF
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
900910585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$197.58 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.58
|
| Rate for Payer: Blue Shield of California Commercial |
$167.44
|
| Rate for Payer: Blue Shield of California EPN |
$134.30
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.89
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| 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 |
$31.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC SOM ALPHA GALACTOSIDASE
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900910718
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.91 |
| Max. Negotiated Rate |
$161.25 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$138.46
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.56
|
| Rate for Payer: Heritage Provider Network Senior |
$145.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.75
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
|
|
HC SOM ALPHA GALACTOSIDASE
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900910718
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.17 |
| Max. Negotiated Rate |
$170.74 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$132.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.74
|
| Rate for Payer: Blue Shield of California Commercial |
$145.32
|
| Rate for Payer: Blue Shield of California EPN |
$116.56
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$139.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.09
|
| Rate for Payer: Heritage Provider Network Senior |
$133.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$102.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.71
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.17
|
| Rate for Payer: TriValley Medical Group Senior |
$22.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22.17
|
|
|
HC SOM ALUMINUM
|
Facility
|
OP
|
$19.99
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
900911262
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$241.94 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.94
|
| Rate for Payer: Blue Shield of California Commercial |
$205.06
|
| Rate for Payer: Blue Shield of California EPN |
$164.47
|
| Rate for Payer: Cash Price |
$19.99
|
| Rate for Payer: Cash Price |
$19.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.37
|
| Rate for Payer: Heritage Provider Network Senior |
$12.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.14
|
| Rate for Payer: Multiplan Commercial |
$14.99
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.48
|
| Rate for Payer: TriValley Medical Group Senior |
$25.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.03
|
| Rate for Payer: Vantage Medical Group Senior |
$25.48
|
|
|
HC SOM ALUMINUM
|
Facility
|
IP
|
$19.99
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
900911262
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$14.99 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.87
|
| Rate for Payer: Cash Price |
$19.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.53
|
| Rate for Payer: Heritage Provider Network Senior |
$13.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$14.99
|
|
|
HC SOM AMEBIASIS AB TITER
|
Facility
|
IP
|
$31.86
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
900911754
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.77 |
| Max. Negotiated Rate |
$23.89 |
| Rate for Payer: Adventist Health Commercial |
$6.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.52
|
| Rate for Payer: Cash Price |
$31.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.57
|
| Rate for Payer: Heritage Provider Network Senior |
$21.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.96
|
| Rate for Payer: Multiplan Commercial |
$23.89
|
|
|
HC SOM AMEBIASIS AB TITER
|
Facility
|
OP
|
$31.86
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
900911754
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.77 |
| Max. Negotiated Rate |
$116.47 |
| Rate for Payer: Adventist Health Commercial |
$6.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.47
|
| Rate for Payer: Blue Shield of California Commercial |
$99.76
|
| Rate for Payer: Blue Shield of California EPN |
$80.02
|
| Rate for Payer: Cash Price |
$31.86
|
| Rate for Payer: Cash Price |
$31.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.72
|
| Rate for Payer: Heritage Provider Network Senior |
$19.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$15.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.60
|
| Rate for Payer: Multiplan Commercial |
$23.89
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.39
|
| Rate for Payer: TriValley Medical Group Senior |
$12.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.63
|
| Rate for Payer: Vantage Medical Group Senior |
$12.39
|
|
|
HC SOM AMINO ACID QUANT UR RANDOM
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
900911210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$159.42 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.35
|
| 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 |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.75
|
| 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 |
$44.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.42
|
| Rate for Payer: Heritage Provider Network Senior |
$46.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$35.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| 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 AMINO ACID QUANT UR RANDOM
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
900911210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.30
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.77
|
| Rate for Payer: Heritage Provider Network Senior |
$50.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
|
|
HC SOM AMINO ACIDS PLASMA
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
900910486
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.30
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.77
|
| Rate for Payer: Heritage Provider Network Senior |
$50.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
|
|
HC SOM AMINO ACIDS PLASMA
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
900910486
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$159.42 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.35
|
| 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 |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.75
|
| 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 |
$44.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.42
|
| Rate for Payer: Heritage Provider Network Senior |
$46.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$35.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| 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 AMIODARONE
|
Facility
|
IP
|
$22.56
|
|
|
Service Code
|
CPT 80151
|
| Hospital Charge Code |
900911286
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$16.92 |
| Rate for Payer: Adventist Health Commercial |
$4.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.53
|
| Rate for Payer: Cash Price |
$22.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.27
|
| Rate for Payer: Heritage Provider Network Senior |
$15.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.64
|
| Rate for Payer: Multiplan Commercial |
$16.92
|
|
|
HC SOM AMIODARONE
|
Facility
|
OP
|
$22.56
|
|
|
Service Code
|
CPT 80151
|
| Hospital Charge Code |
900911286
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$107.37 |
| Rate for Payer: Adventist Health Commercial |
$4.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.94
|
| 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 |
$62.64
|
| Rate for Payer: Blue Shield of California Commercial |
$107.37
|
| Rate for Payer: Blue Shield of California EPN |
$86.12
|
| Rate for Payer: Cash Price |
$22.56
|
| Rate for Payer: Cash Price |
$22.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.66
|
| 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 |
$13.31
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.96
|
| Rate for Payer: Heritage Provider Network Senior |
$13.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$16.92
|
| 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
|
|
