|
HC SOM ANTI-NEUTROPHIL AB
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
900911211
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$142.93 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.93
|
| Rate for Payer: Blue Shield of California Commercial |
$121.13
|
| Rate for Payer: Blue Shield of California EPN |
$97.16
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.57
|
| Rate for Payer: Heritage Provider Network Senior |
$44.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$34.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.17
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.05
|
| Rate for Payer: TriValley Medical Group Senior |
$15.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
HC SOM ANTI-NEUTROPHIL CYTOPLASM ANTI
|
Facility
|
OP
|
$23.15
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
900910287
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$69.41 |
| Rate for Payer: Adventist Health Commercial |
$4.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.22
|
| Rate for Payer: Blue Shield of California Commercial |
$69.41
|
| Rate for Payer: Blue Shield of California EPN |
$55.67
|
| Rate for Payer: Cash Price |
$23.15
|
| Rate for Payer: Cash Price |
$23.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.66
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.33
|
| Rate for Payer: Heritage Provider Network Senior |
$14.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$17.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ANTI-NEUTROPHIL CYTOPLASM ANTI
|
Facility
|
IP
|
$23.15
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
900910287
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$17.36 |
| Rate for Payer: Adventist Health Commercial |
$4.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.91
|
| Rate for Payer: Cash Price |
$23.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.67
|
| Rate for Payer: Heritage Provider Network Senior |
$15.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.79
|
| Rate for Payer: Multiplan Commercial |
$17.36
|
|
|
HC SOM ANTINUCLEAR AB,HEP-2 SUB,S
|
Facility
|
OP
|
$8.50
|
|
|
Service Code
|
CPT 86039
|
| Hospital Charge Code |
900912903
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$105.85 |
| Rate for Payer: Adventist Health Commercial |
$1.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.85
|
| Rate for Payer: Blue Shield of California Commercial |
$89.86
|
| Rate for Payer: Blue Shield of California EPN |
$72.07
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.01
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.26
|
| Rate for Payer: Heritage Provider Network Senior |
$5.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.95
|
| Rate for Payer: Multiplan Commercial |
$6.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.16
|
| Rate for Payer: TriValley Medical Group Senior |
$11.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.28
|
| Rate for Payer: Vantage Medical Group Senior |
$11.16
|
|
|
HC SOM ANTINUCLEAR AB,HEP-2 SUB,S
|
Facility
|
IP
|
$8.50
|
|
|
Service Code
|
CPT 86039
|
| Hospital Charge Code |
900912903
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Adventist Health Commercial |
$1.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.47
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.75
|
| Rate for Payer: Heritage Provider Network Senior |
$5.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.12
|
| Rate for Payer: Multiplan Commercial |
$6.38
|
|
|
HC SOM ANTINUCLEAR ANTIBODY(MULTI
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 86039
|
| Hospital Charge Code |
900912906
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.13 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.77
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.44
|
| Rate for Payer: Heritage Provider Network Senior |
$116.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
|
|
HC SOM ANTINUCLEAR ANTIBODY(MULTI
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 86039
|
| Hospital Charge Code |
900912906
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.85
|
| Rate for Payer: Blue Shield of California Commercial |
$89.86
|
| Rate for Payer: Blue Shield of California EPN |
$72.07
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$111.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.47
|
| Rate for Payer: Heritage Provider Network Senior |
$106.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$82.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.95
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.16
|
| Rate for Payer: TriValley Medical Group Senior |
$11.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.28
|
| Rate for Payer: Vantage Medical Group Senior |
$11.16
|
|
|
HC SOM ANTI-SMOOTH MUSCLE
|
Facility
|
IP
|
$11.50
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
900911176
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$8.62 |
| Rate for Payer: Adventist Health Commercial |
$2.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.41
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.79
|
| Rate for Payer: Heritage Provider Network Senior |
$7.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$8.62
|
|
|
HC SOM ANTI-SMOOTH MUSCLE
|
Facility
|
OP
|
$11.50
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
900911176
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$66.41 |
| Rate for Payer: Adventist Health Commercial |
$2.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.75
|
| Rate for Payer: Blue Shield of California Commercial |
$66.41
|
| Rate for Payer: Blue Shield of California EPN |
$53.27
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.12
|
| Rate for Payer: Heritage Provider Network Senior |
$7.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$8.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ANTI-STRIATED MUSCLE AB
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900911368
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.46
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.25
|
| Rate for Payer: Heritage Provider Network Senior |
$16.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
|
|
HC SOM ANTI-STRIATED MUSCLE AB
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900911368
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$122.92 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.83
|
| 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 |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.60
|
| 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 |
$14.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.86
|
| Rate for Payer: Heritage Provider Network Senior |
$14.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| 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 APOLIPOPROTEIN A-1
|
Facility
|
IP
|
$23.38
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
900910800
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$17.54 |
| Rate for Payer: Adventist Health Commercial |
$4.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.06
|
| Rate for Payer: Cash Price |
$23.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.83
|
| Rate for Payer: Heritage Provider Network Senior |
$15.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.84
|
| Rate for Payer: Multiplan Commercial |
$17.54
|
|
|
HC SOM APOLIPOPROTEIN A-1
|
Facility
|
OP
|
$23.38
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
900910800
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$120.27 |
| Rate for Payer: Adventist Health Commercial |
$4.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.42
|
| Rate for Payer: Blue Shield of California Commercial |
$120.27
|
| Rate for Payer: Blue Shield of California EPN |
$96.47
|
| Rate for Payer: Cash Price |
$23.38
|
| Rate for Payer: Cash Price |
$23.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.47
|
| Rate for Payer: Heritage Provider Network Senior |
$14.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.26
|
| Rate for Payer: Multiplan Commercial |
$17.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.09
|
| Rate for Payer: TriValley Medical Group Senior |
$21.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.20
|
| Rate for Payer: Vantage Medical Group Senior |
$21.09
|
|
|
HC SOM APOLIPOPROTEIN B
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
900910801
|
|
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 APOLIPOPROTEIN B
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
900910801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$120.27 |
| 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 |
$31.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.42
|
| Rate for Payer: Blue Shield of California Commercial |
$120.27
|
| Rate for Payer: Blue Shield of California EPN |
$96.47
|
| 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 |
$31.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.09
|
| 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 |
$21.09
|
| 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 |
$24.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.26
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.09
|
| Rate for Payer: TriValley Medical Group Senior |
$21.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.20
|
| Rate for Payer: Vantage Medical Group Senior |
$21.09
|
|
|
HC SOM APOLIPOPROTEIN E GENOTYPING
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
900914646
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.73 |
| Max. Negotiated Rate |
$168.75 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.90
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$152.32
|
| Rate for Payer: Heritage Provider Network Senior |
$152.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
|
|
HC SOM APOLIPOPROTEIN E GENOTYPING
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
900914646
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.73 |
| Max. Negotiated Rate |
$300.43 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$139.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$300.43
|
| Rate for Payer: Blue Shield of California Commercial |
$137.25
|
| Rate for Payer: Blue Shield of California EPN |
$109.80
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$146.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$139.28
|
| Rate for Payer: Heritage Provider Network Senior |
$139.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$107.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$157.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$183.58
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.00
|
| Rate for Payer: TriValley Medical Group Senior |
$137.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$147.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$147.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.00
|
|
|
HC SOM ARSENIC BLOOD
|
Facility
|
OP
|
$29.50
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
900910563
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.34 |
| Max. Negotiated Rate |
$180.13 |
| Rate for Payer: Adventist Health Commercial |
$5.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.13
|
| Rate for Payer: Blue Shield of California Commercial |
$152.70
|
| Rate for Payer: Blue Shield of California EPN |
$122.48
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.26
|
| Rate for Payer: Heritage Provider Network Senior |
$18.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.42
|
| Rate for Payer: Multiplan Commercial |
$22.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.97
|
| Rate for Payer: TriValley Medical Group Senior |
$18.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.87
|
| Rate for Payer: Vantage Medical Group Senior |
$18.97
|
|
|
HC SOM ARSENIC BLOOD
|
Facility
|
IP
|
$29.50
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
900910563
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.34 |
| Max. Negotiated Rate |
$22.12 |
| Rate for Payer: Adventist Health Commercial |
$5.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.00
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.97
|
| Rate for Payer: Heritage Provider Network Senior |
$19.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.38
|
| Rate for Payer: Multiplan Commercial |
$22.12
|
|
|
HC SOM ARSENIC SPECIATION, RAND, U
|
Facility
|
IP
|
$93.89
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
900915369
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$70.42 |
| Rate for Payer: Adventist Health Commercial |
$18.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.47
|
| Rate for Payer: Cash Price |
$93.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.56
|
| Rate for Payer: Heritage Provider Network Senior |
$63.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.47
|
| Rate for Payer: Multiplan Commercial |
$70.42
|
|
|
HC SOM ARSENIC SPECIATION, RAND, U
|
Facility
|
OP
|
$93.89
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
900915369
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$180.13 |
| Rate for Payer: Adventist Health Commercial |
$18.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.13
|
| Rate for Payer: Blue Shield of California Commercial |
$152.70
|
| Rate for Payer: Blue Shield of California EPN |
$122.48
|
| Rate for Payer: Cash Price |
$93.89
|
| Rate for Payer: Cash Price |
$93.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.12
|
| Rate for Payer: Heritage Provider Network Senior |
$58.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.42
|
| Rate for Payer: Multiplan Commercial |
$70.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.97
|
| Rate for Payer: TriValley Medical Group Senior |
$18.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.87
|
| Rate for Payer: Vantage Medical Group Senior |
$18.97
|
|
|
HC SOM ARSENIC URINE QUANT
|
Facility
|
OP
|
$34.56
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
900911289
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$180.13 |
| Rate for Payer: Adventist Health Commercial |
$6.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.13
|
| Rate for Payer: Blue Shield of California Commercial |
$152.70
|
| Rate for Payer: Blue Shield of California EPN |
$122.48
|
| Rate for Payer: Cash Price |
$34.56
|
| Rate for Payer: Cash Price |
$34.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.39
|
| Rate for Payer: Heritage Provider Network Senior |
$21.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.42
|
| Rate for Payer: Multiplan Commercial |
$25.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.97
|
| Rate for Payer: TriValley Medical Group Senior |
$18.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.87
|
| Rate for Payer: Vantage Medical Group Senior |
$18.97
|
|
|
HC SOM ARSENIC URINE QUANT
|
Facility
|
IP
|
$34.56
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
900911289
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$25.92 |
| Rate for Payer: Adventist Health Commercial |
$6.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.26
|
| Rate for Payer: Cash Price |
$34.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.40
|
| Rate for Payer: Heritage Provider Network Senior |
$23.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Multiplan Commercial |
$25.92
|
|
|
HC SOM ARYLSULFATASE A, URINE
|
Facility
|
OP
|
$138.77
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900910723
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Adventist Health Commercial |
$27.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.76
|
| 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 |
$138.77
|
| Rate for Payer: Cash Price |
$138.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$90.20
|
| 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 |
$81.87
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.90
|
| Rate for Payer: Heritage Provider Network Senior |
$85.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$66.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.85
|
| Rate for Payer: Multiplan Commercial |
$104.08
|
| 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 ARYLSULFATASE A, URINE
|
Facility
|
IP
|
$138.77
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900910723
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.12 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Adventist Health Commercial |
$27.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$89.37
|
| Rate for Payer: Cash Price |
$138.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.95
|
| Rate for Payer: Heritage Provider Network Senior |
$93.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.69
|
| Rate for Payer: Multiplan Commercial |
$104.08
|
|
