|
HC SOM BCR ABL MUTAT ASPE
|
Facility
|
OP
|
$435.08
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914536
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$1,420.92 |
| Rate for Payer: Adventist Health Commercial |
$87.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$268.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,420.92
|
| Rate for Payer: Blue Shield of California Commercial |
$265.40
|
| Rate for Payer: Blue Shield of California EPN |
$212.32
|
| Rate for Payer: Cash Price |
$435.08
|
| Rate for Payer: Cash Price |
$435.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$282.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$185.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$185.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$269.31
|
| Rate for Payer: Heritage Provider Network Senior |
$269.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$185.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$207.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$212.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$248.17
|
| Rate for Payer: Multiplan Commercial |
$326.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$185.20
|
| Rate for Payer: TriValley Medical Group Senior |
$185.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$200.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$200.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Vantage Medical Group Senior |
$185.20
|
|
|
HC SOM BCR/ABL P210 QN MON
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
900914648
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$128.80
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.40
|
| Rate for Payer: Heritage Provider Network Senior |
$135.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
|
|
HC SOM BCR/ABL P210 QN MON
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
900914648
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$383.47 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$383.47
|
| Rate for Payer: Blue Shield of California Commercial |
$122.00
|
| Rate for Payer: Blue Shield of California EPN |
$97.60
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.80
|
| Rate for Payer: Heritage Provider Network Senior |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$95.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$219.71
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$163.96
|
| Rate for Payer: TriValley Medical Group Senior |
$163.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$177.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$177.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.36
|
| Rate for Payer: Vantage Medical Group Senior |
$163.96
|
|
|
HC SOM BENZODIAZEPINE CONFIRM, U
|
Facility
|
IP
|
$36.96
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900912915
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.69 |
| Max. Negotiated Rate |
$27.72 |
| Rate for Payer: Adventist Health Commercial |
$7.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.80
|
| Rate for Payer: Cash Price |
$36.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.02
|
| Rate for Payer: Heritage Provider Network Senior |
$25.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$27.72
|
|
|
HC SOM BENZODIAZEPINE CONFIRM, U
|
Facility
|
OP
|
$36.96
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900912915
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.69 |
| Max. Negotiated Rate |
$168.43 |
| Rate for Payer: Adventist Health Commercial |
$7.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.43
|
| Rate for Payer: Cash Price |
$36.96
|
| Rate for Payer: Cash Price |
$36.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.88
|
| Rate for Payer: Heritage Provider Network Senior |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.87
|
| Rate for Payer: Multiplan Commercial |
$27.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.42
|
| Rate for Payer: Vantage Medical Group Senior |
$31.42
|
|
|
HC SOM BETA 2 MICROGLOBULIN CSF
|
Facility
|
IP
|
$55.83
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900911369
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.11 |
| Max. Negotiated Rate |
$41.87 |
| Rate for Payer: Adventist Health Commercial |
$11.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.95
|
| Rate for Payer: Cash Price |
$55.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.80
|
| Rate for Payer: Heritage Provider Network Senior |
$37.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.96
|
| Rate for Payer: Multiplan Commercial |
$41.87
|
|
|
HC SOM BETA 2 MICROGLOBULIN CSF
|
Facility
|
OP
|
$55.83
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900911369
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.11 |
| Max. Negotiated Rate |
$153.67 |
| Rate for Payer: Adventist Health Commercial |
$11.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.67
|
| Rate for Payer: Blue Shield of California Commercial |
$130.23
|
| Rate for Payer: Blue Shield of California EPN |
$104.46
|
| Rate for Payer: Cash Price |
$55.83
|
| Rate for Payer: Cash Price |
$55.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.56
|
| Rate for Payer: Heritage Provider Network Senior |
$34.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$26.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.68
|
| Rate for Payer: Multiplan Commercial |
$41.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.18
|
| Rate for Payer: TriValley Medical Group Senior |
$16.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Vantage Medical Group Senior |
$16.18
|
|
|
HC SOM BETA-2 MICROGLOBULINS
|
Facility
|
OP
|
$17.90
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900914717
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$153.67 |
| Rate for Payer: Adventist Health Commercial |
$3.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.67
|
| Rate for Payer: Blue Shield of California Commercial |
$130.23
|
| Rate for Payer: Blue Shield of California EPN |
$104.46
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.08
|
| Rate for Payer: Heritage Provider Network Senior |
$11.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.68
|
| Rate for Payer: Multiplan Commercial |
$13.43
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.18
|
| Rate for Payer: TriValley Medical Group Senior |
$16.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Vantage Medical Group Senior |
$16.18
|
|
|
HC SOM BETA-2 MICROGLOBULINS
|
Facility
|
IP
|
$17.90
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900914717
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$13.43 |
| Rate for Payer: Adventist Health Commercial |
$3.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.53
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.12
|
| Rate for Payer: Heritage Provider Network Senior |
$12.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.47
|
| Rate for Payer: Multiplan Commercial |
$13.43
|
|
|
HC SOM BETA 2 MICROGLOBULIN URINE
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900911370
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.96
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.99
|
| Rate for Payer: Heritage Provider Network Senior |
$20.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
|
|
HC SOM BETA 2 MICROGLOBULIN URINE
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900911370
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$153.67 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.67
|
| Rate for Payer: Blue Shield of California Commercial |
$130.23
|
| Rate for Payer: Blue Shield of California EPN |
$104.46
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.29
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.19
|
| Rate for Payer: Heritage Provider Network Senior |
$19.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.68
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.18
|
| Rate for Payer: TriValley Medical Group Senior |
$16.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Vantage Medical Group Senior |
$16.18
|
|
|
HC SOM BETA 2 TRANSFERRIN (TAU)
|
Facility
|
OP
|
$85.98
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
900911443
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$236.16 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.13
|
| Rate for Payer: Blue Shield of California Commercial |
$236.16
|
| Rate for Payer: Blue Shield of California EPN |
$189.42
|
| Rate for Payer: Cash Price |
$85.98
|
| Rate for Payer: Cash Price |
$85.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.73
|
| Rate for Payer: EPIC Health Plan Medicare |
$29.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.22
|
| Rate for Payer: Heritage Provider Network Senior |
$53.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$41.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39.33
|
| Rate for Payer: Multiplan Commercial |
$64.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.35
|
| Rate for Payer: TriValley Medical Group Senior |
$29.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.28
|
| Rate for Payer: Vantage Medical Group Senior |
$29.35
|
|
|
HC SOM BETA 2 TRANSFERRIN (TAU)
|
Facility
|
IP
|
$85.98
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
900911443
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$64.48 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.37
|
| Rate for Payer: Cash Price |
$85.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.21
|
| Rate for Payer: Heritage Provider Network Senior |
$58.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Multiplan Commercial |
$64.48
|
|
|
HC SOM BETA GALACTOSIDASE
|
Facility
|
IP
|
$119.58
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900912511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$89.69 |
| Rate for Payer: Adventist Health Commercial |
$23.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.01
|
| Rate for Payer: Cash Price |
$119.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$80.96
|
| Rate for Payer: Heritage Provider Network Senior |
$80.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.89
|
| Rate for Payer: Multiplan Commercial |
$89.69
|
|
|
HC SOM BETA GALACTOSIDASE
|
Facility
|
OP
|
$119.58
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900912511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$170.74 |
| Rate for Payer: Adventist Health Commercial |
$23.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$73.90
|
| 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 |
$119.58
|
| Rate for Payer: Cash Price |
$119.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$77.73
|
| 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 |
$70.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.02
|
| Rate for Payer: Heritage Provider Network Senior |
$74.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$57.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.71
|
| Rate for Payer: Multiplan Commercial |
$89.69
|
| 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 BETA GLYCOPROTEIN AB IGA
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
900912615
|
|
Hospital Revenue Code
|
302
|
| 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 BETA GLYCOPROTEIN AB IGA
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
900912615
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$241.43 |
| 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 |
$38.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.43
|
| Rate for Payer: Blue Shield of California Commercial |
$147.97
|
| Rate for Payer: Blue Shield of California EPN |
$118.69
|
| 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 |
$38.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.45
|
| 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 |
$25.45
|
| 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 |
$29.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.10
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.45
|
| Rate for Payer: TriValley Medical Group Senior |
$25.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Vantage Medical Group Senior |
$25.45
|
|
|
HC SOM BETA GLYCOPROTEIN AB IGG
|
Facility
|
IP
|
$36.02
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
900910565
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$27.02 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.20
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.39
|
| Rate for Payer: Heritage Provider Network Senior |
$24.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.01
|
| Rate for Payer: Multiplan Commercial |
$27.02
|
|
|
HC SOM BETA GLYCOPROTEIN AB IGG
|
Facility
|
OP
|
$36.02
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
900910565
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$241.43 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.43
|
| Rate for Payer: Blue Shield of California Commercial |
$147.97
|
| Rate for Payer: Blue Shield of California EPN |
$118.69
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.30
|
| Rate for Payer: Heritage Provider Network Senior |
$22.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.10
|
| Rate for Payer: Multiplan Commercial |
$27.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.45
|
| Rate for Payer: TriValley Medical Group Senior |
$25.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Vantage Medical Group Senior |
$25.45
|
|
|
HC SOM BETA GLYCOPROTEIN AB IGM
|
Facility
|
IP
|
$36.02
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
900912616
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$27.02 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.20
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.39
|
| Rate for Payer: Heritage Provider Network Senior |
$24.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.01
|
| Rate for Payer: Multiplan Commercial |
$27.02
|
|
|
HC SOM BETA GLYCOPROTEIN AB IGM
|
Facility
|
OP
|
$36.02
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
900912616
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$241.43 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.43
|
| Rate for Payer: Blue Shield of California Commercial |
$147.97
|
| Rate for Payer: Blue Shield of California EPN |
$118.69
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.30
|
| Rate for Payer: Heritage Provider Network Senior |
$22.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.10
|
| Rate for Payer: Multiplan Commercial |
$27.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.45
|
| Rate for Payer: TriValley Medical Group Senior |
$25.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Vantage Medical Group Senior |
$25.45
|
|
|
HC SOM BETA HCG CSF
|
Facility
|
OP
|
$43.10
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
900910726
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$136.79 |
| Rate for Payer: Adventist Health Commercial |
$8.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.64
|
| 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 |
$136.79
|
| 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 |
$43.10
|
| Rate for Payer: Cash Price |
$43.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.02
|
| 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 |
$25.43
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.68
|
| Rate for Payer: Heritage Provider Network Senior |
$26.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.17
|
| Rate for Payer: Multiplan Commercial |
$32.33
|
| 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 BETA HCG CSF
|
Facility
|
IP
|
$43.10
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
900910726
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$32.33 |
| Rate for Payer: Adventist Health Commercial |
$8.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.76
|
| Rate for Payer: Cash Price |
$43.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.18
|
| Rate for Payer: Heritage Provider Network Senior |
$29.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.78
|
| Rate for Payer: Multiplan Commercial |
$32.33
|
|
|
HC SOM BICARBONATE URINE
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
900910363
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.07
|
| Rate for Payer: Blue Shield of California Commercial |
$39.34
|
| Rate for Payer: Blue Shield of California EPN |
$31.55
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.23
|
| Rate for Payer: Heritage Provider Network Senior |
$53.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$41.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.54
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.88
|
| Rate for Payer: TriValley Medical Group Senior |
$4.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: Vantage Medical Group Senior |
$4.88
|
|
|
HC SOM BICARBONATE URINE
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
900910363
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.38
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.22
|
| Rate for Payer: Heritage Provider Network Senior |
$58.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
|
