|
HC SOM CAH DEHYDROEPIANDROSTERONE
|
Facility
|
IP
|
$66.41
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
900912774
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.02 |
| Max. Negotiated Rate |
$49.81 |
| Rate for Payer: Adventist Health Commercial |
$13.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.77
|
| Rate for Payer: Cash Price |
$66.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.96
|
| Rate for Payer: Heritage Provider Network Senior |
$44.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.60
|
| Rate for Payer: Multiplan Commercial |
$49.81
|
|
|
HC SOM CAH DEHYDROEPIANDROSTERONE
|
Facility
|
OP
|
$66.41
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
900912774
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.02 |
| Max. Negotiated Rate |
$239.96 |
| Rate for Payer: Adventist Health Commercial |
$13.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.96
|
| Rate for Payer: Blue Shield of California Commercial |
$203.39
|
| Rate for Payer: Blue Shield of California EPN |
$163.13
|
| Rate for Payer: Cash Price |
$66.41
|
| Rate for Payer: Cash Price |
$66.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.11
|
| Rate for Payer: Heritage Provider Network Senior |
$41.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$31.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33.86
|
| Rate for Payer: Multiplan Commercial |
$49.81
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.27
|
| Rate for Payer: TriValley Medical Group Senior |
$25.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.80
|
| Rate for Payer: Vantage Medical Group Senior |
$25.27
|
|
|
HC SOM CAH DEOXYCORTICOSTERONE
|
Facility
|
IP
|
$81.42
|
|
|
Service Code
|
CPT 82633
|
| Hospital Charge Code |
900912773
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.74 |
| Max. Negotiated Rate |
$61.06 |
| Rate for Payer: Adventist Health Commercial |
$16.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.43
|
| Rate for Payer: Cash Price |
$81.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.12
|
| Rate for Payer: Heritage Provider Network Senior |
$55.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.36
|
| Rate for Payer: Multiplan Commercial |
$61.06
|
|
|
HC SOM CAH DEOXYCORTICOSTERONE
|
Facility
|
OP
|
$81.42
|
|
|
Service Code
|
CPT 82633
|
| Hospital Charge Code |
900912773
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.74 |
| Max. Negotiated Rate |
$284.58 |
| Rate for Payer: Adventist Health Commercial |
$16.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.58
|
| Rate for Payer: Blue Shield of California Commercial |
$249.29
|
| Rate for Payer: Blue Shield of California EPN |
$199.95
|
| Rate for Payer: Cash Price |
$81.42
|
| Rate for Payer: Cash Price |
$81.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$52.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$30.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.40
|
| Rate for Payer: Heritage Provider Network Senior |
$50.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$38.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41.51
|
| Rate for Payer: Multiplan Commercial |
$61.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$30.98
|
| Rate for Payer: TriValley Medical Group Senior |
$30.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$33.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$33.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.08
|
| Rate for Payer: Vantage Medical Group Senior |
$30.98
|
|
|
HC SOM CAH PROGESTERONE
|
Facility
|
OP
|
$54.83
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
900912777
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$198.09 |
| Rate for Payer: Adventist Health Commercial |
$10.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$198.09
|
| Rate for Payer: Blue Shield of California Commercial |
$167.90
|
| Rate for Payer: Blue Shield of California EPN |
$134.67
|
| Rate for Payer: Cash Price |
$54.83
|
| Rate for Payer: Cash Price |
$54.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.94
|
| Rate for Payer: Heritage Provider Network Senior |
$33.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$26.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.95
|
| Rate for Payer: Multiplan Commercial |
$41.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.86
|
| Rate for Payer: TriValley Medical Group Senior |
$20.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Vantage Medical Group Senior |
$20.86
|
|
|
HC SOM CAH PROGESTERONE
|
Facility
|
IP
|
$54.83
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
900912777
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$41.12 |
| Rate for Payer: Adventist Health Commercial |
$10.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.31
|
| Rate for Payer: Cash Price |
$54.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.12
|
| Rate for Payer: Heritage Provider Network Senior |
$37.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.71
|
| Rate for Payer: Multiplan Commercial |
$41.12
|
|
|
HC SOM CAH TESTOSTERONE
|
Facility
|
IP
|
$67.83
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900912779
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$50.87 |
| Rate for Payer: Adventist Health Commercial |
$13.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.68
|
| Rate for Payer: Cash Price |
$67.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.92
|
| Rate for Payer: Heritage Provider Network Senior |
$45.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.96
|
| Rate for Payer: Multiplan Commercial |
$50.87
|
|
|
HC SOM CAH TESTOSTERONE
|
Facility
|
OP
|
$67.83
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900912779
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$245.08 |
| Rate for Payer: Adventist Health Commercial |
$13.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.08
|
| Rate for Payer: Blue Shield of California Commercial |
$207.82
|
| Rate for Payer: Blue Shield of California EPN |
$166.69
|
| Rate for Payer: Cash Price |
$67.83
|
| Rate for Payer: Cash Price |
$67.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.02
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.99
|
| Rate for Payer: Heritage Provider Network Senior |
$41.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$32.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.59
|
| Rate for Payer: Multiplan Commercial |
$50.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.81
|
| Rate for Payer: TriValley Medical Group Senior |
$25.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Vantage Medical Group Senior |
$25.81
|
|
|
HC SOM CALCITONIN
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
900911003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.17
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.89
|
| Rate for Payer: Heritage Provider Network Senior |
$14.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
|
|
HC SOM CALCITONIN
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
900911003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$254.28 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$254.28
|
| Rate for Payer: Blue Shield of California Commercial |
$215.48
|
| Rate for Payer: Blue Shield of California EPN |
$172.83
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.98
|
| Rate for Payer: EPIC Health Plan Medicare |
$26.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.62
|
| Rate for Payer: Heritage Provider Network Senior |
$13.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.90
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$26.79
|
| Rate for Payer: TriValley Medical Group Senior |
$26.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.47
|
| Rate for Payer: Vantage Medical Group Senior |
$26.79
|
|
|
HC SOM CALPROTECTIN
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
900912938
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$186.33 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$186.33
|
| Rate for Payer: Blue Shield of California Commercial |
$157.94
|
| Rate for Payer: Blue Shield of California EPN |
$126.68
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.14
|
| Rate for Payer: Heritage Provider Network Senior |
$37.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26.30
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.63
|
| Rate for Payer: TriValley Medical Group Senior |
$19.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.59
|
| Rate for Payer: Vantage Medical Group Senior |
$19.63
|
|
|
HC SOM CALPROTECTIN
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
900912938
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.64
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.62
|
| Rate for Payer: Heritage Provider Network Senior |
$40.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
|
|
HC SOM CANDIDA AURIS SURV PCR
|
Facility
|
IP
|
$200.39
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
900915483
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.27 |
| Max. Negotiated Rate |
$150.29 |
| Rate for Payer: Adventist Health Commercial |
$40.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.05
|
| Rate for Payer: Cash Price |
$200.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.66
|
| Rate for Payer: Heritage Provider Network Senior |
$135.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.10
|
| Rate for Payer: Multiplan Commercial |
$150.29
|
|
|
HC SOM CANDIDA AURIS SURV PCR
|
Facility
|
OP
|
$200.39
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
900915483
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$40.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.42
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$200.39
|
| Rate for Payer: Cash Price |
$200.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$124.04
|
| Rate for Payer: Heritage Provider Network Senior |
$124.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$95.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$150.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM CARBAPEN MOD HODGE TEST
|
Facility
|
IP
|
$164.70
|
|
|
Service Code
|
CPT 87185
|
| Hospital Charge Code |
900914208
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.81 |
| Max. Negotiated Rate |
$123.53 |
| Rate for Payer: Adventist Health Commercial |
$32.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.07
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.50
|
| Rate for Payer: Heritage Provider Network Senior |
$111.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.17
|
| Rate for Payer: Multiplan Commercial |
$123.53
|
|
|
HC SOM CARBAPEN MOD HODGE TEST
|
Facility
|
OP
|
$164.70
|
|
|
Service Code
|
CPT 87185
|
| Hospital Charge Code |
900914208
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$123.53 |
| Rate for Payer: Adventist Health Commercial |
$32.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$101.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.36
|
| Rate for Payer: Blue Shield of California Commercial |
$23.16
|
| Rate for Payer: Blue Shield of California EPN |
$18.57
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$107.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.17
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.95
|
| Rate for Payer: Heritage Provider Network Senior |
$101.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$78.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$123.53
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.75
|
| Rate for Payer: TriValley Medical Group Senior |
$4.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC SOM CARB DEF TRANS CONGENITAL
|
Facility
|
IP
|
$49.93
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
900912514
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$37.45 |
| Rate for Payer: Adventist Health Commercial |
$9.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.15
|
| Rate for Payer: Cash Price |
$49.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.80
|
| Rate for Payer: Heritage Provider Network Senior |
$33.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.48
|
| Rate for Payer: Multiplan Commercial |
$37.45
|
|
|
HC SOM CARB DEF TRANS CONGENITAL
|
Facility
|
OP
|
$49.93
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
900912514
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$145.32 |
| Rate for Payer: Adventist Health Commercial |
$9.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.33
|
| 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 |
$49.93
|
| Rate for Payer: Cash Price |
$49.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.46
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.91
|
| Rate for Payer: Heritage Provider Network Senior |
$30.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$37.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.06
|
| Rate for Payer: TriValley Medical Group Senior |
$18.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.87
|
| Rate for Payer: Vantage Medical Group Senior |
$18.06
|
|
|
HC SOM CARB DEF TRANSFERRIN ADULT
|
Facility
|
OP
|
$49.93
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
900912717
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$145.32 |
| Rate for Payer: Adventist Health Commercial |
$9.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.33
|
| 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 |
$49.93
|
| Rate for Payer: Cash Price |
$49.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.46
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.91
|
| Rate for Payer: Heritage Provider Network Senior |
$30.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$37.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.06
|
| Rate for Payer: TriValley Medical Group Senior |
$18.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.87
|
| Rate for Payer: Vantage Medical Group Senior |
$18.06
|
|
|
HC SOM CARB DEF TRANSFERRIN ADULT
|
Facility
|
IP
|
$49.93
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
900912717
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$37.45 |
| Rate for Payer: Adventist Health Commercial |
$9.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.15
|
| Rate for Payer: Cash Price |
$49.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.80
|
| Rate for Payer: Heritage Provider Network Senior |
$33.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.48
|
| Rate for Payer: Multiplan Commercial |
$37.45
|
|
|
HC SOM CARBOXYHEMOGLOBIN
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
900911041
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.84
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.47
|
| Rate for Payer: Heritage Provider Network Senior |
$74.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
|
|
HC SOM CARBOXYHEMOGLOBIN
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
900911041
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$117.04 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.04
|
| Rate for Payer: Blue Shield of California Commercial |
$99.19
|
| Rate for Payer: Blue Shield of California EPN |
$79.56
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.09
|
| Rate for Payer: Heritage Provider Network Senior |
$68.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$52.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.51
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.32
|
| Rate for Payer: TriValley Medical Group Senior |
$12.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.55
|
| Rate for Payer: Vantage Medical Group Senior |
$12.32
|
|
|
HC SOM CARBOXY-THC CONFIRMATION, U
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
900915422
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$215.74 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$215.74
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.66
|
| Rate for Payer: Heritage Provider Network Senior |
$21.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.75
|
| Rate for Payer: Vantage Medical Group Senior |
$29.75
|
|
|
HC SOM CARBOXY-THC CONFIRMATION, U
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
900915422
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.54
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.70
|
| Rate for Payer: Heritage Provider Network Senior |
$23.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
|
|
HC SOM CARNITINE PLASMA
|
Facility
|
IP
|
$29.01
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
900911103
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$21.76 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.68
|
| Rate for Payer: Cash Price |
$29.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.64
|
| Rate for Payer: Heritage Provider Network Senior |
$19.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Multiplan Commercial |
$21.76
|
|
