|
HC SOM BPAB IMMUNOASSAY NONANTIBODY
|
Facility
|
IP
|
$62.50
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900915527
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$46.88 |
| Rate for Payer: Adventist Health Commercial |
$12.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.25
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.31
|
| Rate for Payer: Heritage Provider Network Senior |
$42.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.62
|
| Rate for Payer: Multiplan Commercial |
$46.88
|
|
|
HC SOM BRUCELLA AB CONFIRMATION
|
Facility
|
IP
|
$21.06
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
900912841
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Adventist Health Commercial |
$4.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.56
|
| Rate for Payer: Cash Price |
$21.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.26
|
| Rate for Payer: Heritage Provider Network Senior |
$14.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.26
|
| Rate for Payer: Multiplan Commercial |
$15.79
|
|
|
HC SOM BRUCELLA AB CONFIRMATION
|
Facility
|
OP
|
$21.06
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
900912841
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$76.58 |
| Rate for Payer: Adventist Health Commercial |
$4.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.58
|
| Rate for Payer: Blue Shield of California Commercial |
$70.16
|
| Rate for Payer: Blue Shield of California EPN |
$56.27
|
| Rate for Payer: Cash Price |
$21.06
|
| Rate for Payer: Cash Price |
$21.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.43
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.04
|
| Rate for Payer: Heritage Provider Network Senior |
$13.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.97
|
| Rate for Payer: Multiplan Commercial |
$15.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.93
|
| Rate for Payer: TriValley Medical Group Senior |
$8.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.82
|
| Rate for Payer: Vantage Medical Group Senior |
$8.93
|
|
|
HC SOM BRUCELLA AB IGG
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
900911628
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$76.58 |
| 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 |
$13.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.58
|
| Rate for Payer: Blue Shield of California Commercial |
$70.16
|
| Rate for Payer: Blue Shield of California EPN |
$56.27
|
| 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 |
$13.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.93
|
| 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 |
$8.93
|
| 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 |
$10.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.97
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.93
|
| Rate for Payer: TriValley Medical Group Senior |
$8.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.82
|
| Rate for Payer: Vantage Medical Group Senior |
$8.93
|
|
|
HC SOM BRUCELLA AB IGG
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
900911628
|
|
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 BRUCELLA AB IGM
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
900912667
|
|
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 BRUCELLA AB IGM
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
900912667
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$76.58 |
| 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 |
$13.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.58
|
| Rate for Payer: Blue Shield of California Commercial |
$70.16
|
| Rate for Payer: Blue Shield of California EPN |
$56.27
|
| 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 |
$13.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.93
|
| 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 |
$8.93
|
| 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 |
$10.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.97
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.93
|
| Rate for Payer: TriValley Medical Group Senior |
$8.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.82
|
| Rate for Payer: Vantage Medical Group Senior |
$8.93
|
|
|
HC SOM C-1 ESTERASE INHIBITOR ACTIVIT
|
Facility
|
IP
|
$21.92
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900911175
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$16.44 |
| Rate for Payer: Adventist Health Commercial |
$4.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.12
|
| Rate for Payer: Cash Price |
$21.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.84
|
| Rate for Payer: Heritage Provider Network Senior |
$14.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.48
|
| Rate for Payer: Multiplan Commercial |
$16.44
|
|
|
HC SOM C-1 ESTERASE INHIBITOR ACTIVIT
|
Facility
|
OP
|
$21.92
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900911175
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$129.25 |
| Rate for Payer: EPIC Health Plan Medicare |
$13.60
|
| Rate for Payer: Adventist Health Commercial |
$4.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.55
|
| 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 |
$21.92
|
| Rate for Payer: Cash Price |
$21.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.25
|
| 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 |
$12.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.57
|
| Rate for Payer: Heritage Provider Network Senior |
$13.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.22
|
| Rate for Payer: Multiplan Commercial |
$16.44
|
| 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 C1 EXTERASE INHIBITOR FUNCTION
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912844
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$122.92 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.25
|
| 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 |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.40
|
| 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 |
$21.24
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.28
|
| Rate for Payer: Heritage Provider Network Senior |
$22.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| 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 C1 EXTERASE INHIBITOR FUNCTION
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912844
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.18
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.37
|
| Rate for Payer: Heritage Provider Network Senior |
$24.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
|
|
HC SOM CA 27.29
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
900911430
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$197.46 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.42
|
| 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 |
$197.46
|
| 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 |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.80
|
| 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 |
$7.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.43
|
| Rate for Payer: Heritage Provider Network Senior |
$7.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.89
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| 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 CA 27.29
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
900911430
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.73
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.12
|
| Rate for Payer: Heritage Provider Network Senior |
$8.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
|
|
HC SOM CADMIUM WHOLE BLOOD
|
Facility
|
IP
|
$21.93
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
900911051
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$16.45 |
| Rate for Payer: Adventist Health Commercial |
$4.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.12
|
| Rate for Payer: Cash Price |
$21.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.85
|
| Rate for Payer: Heritage Provider Network Senior |
$14.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.48
|
| Rate for Payer: Multiplan Commercial |
$16.45
|
|
|
HC SOM CADMIUM WHOLE BLOOD
|
Facility
|
OP
|
$21.93
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
900911051
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$219.64 |
| Rate for Payer: Adventist Health Commercial |
$4.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.64
|
| Rate for Payer: Blue Shield of California Commercial |
$186.22
|
| Rate for Payer: Blue Shield of California EPN |
$149.36
|
| Rate for Payer: Cash Price |
$21.93
|
| Rate for Payer: Cash Price |
$21.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$23.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.57
|
| Rate for Payer: Heritage Provider Network Senior |
$13.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$16.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.64
|
| Rate for Payer: TriValley Medical Group Senior |
$23.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.00
|
| Rate for Payer: Vantage Medical Group Senior |
$23.64
|
|
|
HC SOM CAH 11-DESOXYCORTISOL
|
Facility
|
OP
|
$76.96
|
|
|
Service Code
|
CPT 82634
|
| Hospital Charge Code |
900912775
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.93 |
| Max. Negotiated Rate |
$277.87 |
| Rate for Payer: Adventist Health Commercial |
$15.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$277.87
|
| Rate for Payer: Blue Shield of California Commercial |
$235.58
|
| Rate for Payer: Blue Shield of California EPN |
$188.96
|
| Rate for Payer: Cash Price |
$76.96
|
| Rate for Payer: Cash Price |
$76.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$29.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.64
|
| Rate for Payer: Heritage Provider Network Senior |
$47.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$36.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39.24
|
| Rate for Payer: Multiplan Commercial |
$57.72
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.28
|
| Rate for Payer: TriValley Medical Group Senior |
$29.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Vantage Medical Group Senior |
$29.28
|
|
|
HC SOM CAH 11-DESOXYCORTISOL
|
Facility
|
IP
|
$76.96
|
|
|
Service Code
|
CPT 82634
|
| Hospital Charge Code |
900912775
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.93 |
| Max. Negotiated Rate |
$57.72 |
| Rate for Payer: Adventist Health Commercial |
$15.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.56
|
| Rate for Payer: Cash Price |
$76.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.10
|
| Rate for Payer: Heritage Provider Network Senior |
$52.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.24
|
| Rate for Payer: Multiplan Commercial |
$57.72
|
|
|
HC SOM CAH 17-ALPHA-OH PROGESTERONE
|
Facility
|
OP
|
$71.41
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
900912778
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.93 |
| Max. Negotiated Rate |
$257.93 |
| Rate for Payer: Adventist Health Commercial |
$14.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.93
|
| Rate for Payer: Blue Shield of California Commercial |
$218.59
|
| Rate for Payer: Blue Shield of California EPN |
$175.33
|
| Rate for Payer: Cash Price |
$71.41
|
| Rate for Payer: Cash Price |
$71.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.13
|
| Rate for Payer: EPIC Health Plan Medicare |
$27.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.20
|
| Rate for Payer: Heritage Provider Network Senior |
$44.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$34.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36.41
|
| Rate for Payer: Multiplan Commercial |
$53.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.17
|
| Rate for Payer: TriValley Medical Group Senior |
$27.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.89
|
| Rate for Payer: Vantage Medical Group Senior |
$27.17
|
|
|
HC SOM CAH 17-ALPHA-OH PROGESTERONE
|
Facility
|
IP
|
$71.41
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
900912778
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.93 |
| Max. Negotiated Rate |
$53.56 |
| Rate for Payer: Adventist Health Commercial |
$14.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.99
|
| Rate for Payer: Cash Price |
$71.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.34
|
| Rate for Payer: Heritage Provider Network Senior |
$48.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.85
|
| Rate for Payer: Multiplan Commercial |
$53.56
|
|
|
HC SOM CAH 17-OH PREGNENOLONE
|
Facility
|
OP
|
$59.95
|
|
|
Service Code
|
CPT 84143
|
| Hospital Charge Code |
900912776
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$216.70 |
| Rate for Payer: Adventist Health Commercial |
$11.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$216.70
|
| Rate for Payer: Blue Shield of California Commercial |
$183.69
|
| Rate for Payer: Blue Shield of California EPN |
$147.33
|
| Rate for Payer: Cash Price |
$59.95
|
| Rate for Payer: Cash Price |
$59.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.37
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.11
|
| Rate for Payer: Heritage Provider Network Senior |
$37.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30.57
|
| Rate for Payer: Multiplan Commercial |
$44.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.81
|
| Rate for Payer: TriValley Medical Group Senior |
$22.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.09
|
| Rate for Payer: Vantage Medical Group Senior |
$22.81
|
|
|
HC SOM CAH 17-OH PREGNENOLONE
|
Facility
|
IP
|
$59.95
|
|
|
Service Code
|
CPT 84143
|
| Hospital Charge Code |
900912776
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$44.96 |
| Rate for Payer: Adventist Health Commercial |
$11.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.61
|
| Rate for Payer: Cash Price |
$59.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.59
|
| Rate for Payer: Heritage Provider Network Senior |
$40.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.99
|
| Rate for Payer: Multiplan Commercial |
$44.96
|
|
|
HC SOM CAH ANDROSTENEDIONE
|
Facility
|
OP
|
$76.95
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
900912771
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.93 |
| Max. Negotiated Rate |
$277.87 |
| Rate for Payer: Adventist Health Commercial |
$15.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$277.87
|
| Rate for Payer: Blue Shield of California Commercial |
$235.58
|
| Rate for Payer: Blue Shield of California EPN |
$188.96
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$29.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.63
|
| Rate for Payer: Heritage Provider Network Senior |
$47.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$36.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39.24
|
| Rate for Payer: Multiplan Commercial |
$57.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.28
|
| Rate for Payer: TriValley Medical Group Senior |
$29.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Vantage Medical Group Senior |
$29.28
|
|
|
HC SOM CAH ANDROSTENEDIONE
|
Facility
|
IP
|
$76.95
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
900912771
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.93 |
| Max. Negotiated Rate |
$57.71 |
| Rate for Payer: Adventist Health Commercial |
$15.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.56
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.10
|
| Rate for Payer: Heritage Provider Network Senior |
$52.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.24
|
| Rate for Payer: Multiplan Commercial |
$57.71
|
|
|
HC SOM CAH CORTISOL
|
Facility
|
OP
|
$42.84
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
900912772
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$154.95 |
| Rate for Payer: Adventist Health Commercial |
$8.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.95
|
| Rate for Payer: Blue Shield of California Commercial |
$131.21
|
| Rate for Payer: Blue Shield of California EPN |
$105.24
|
| Rate for Payer: Cash Price |
$42.84
|
| Rate for Payer: Cash Price |
$42.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.52
|
| Rate for Payer: Heritage Provider Network Senior |
$26.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.84
|
| Rate for Payer: Multiplan Commercial |
$32.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.30
|
| Rate for Payer: TriValley Medical Group Senior |
$16.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$16.30
|
|
|
HC SOM CAH CORTISOL
|
Facility
|
IP
|
$42.84
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
900912772
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Adventist Health Commercial |
$8.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.59
|
| Rate for Payer: Cash Price |
$42.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.00
|
| Rate for Payer: Heritage Provider Network Senior |
$29.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.71
|
| Rate for Payer: Multiplan Commercial |
$32.13
|
|
