|
HC SOM OLIGOCLONAL BANDS SERUM
|
Facility
IP
|
$22.86
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
900912657
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$17.14 |
| Rate for Payer: Adventist Health Commercial |
$4.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.70
|
| Rate for Payer: Cash Price |
$10.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.48
|
| Rate for Payer: Heritage Provider Network Senior |
$15.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$17.14
|
|
|
HC SOM OPATU DRUG SCRN OXYCDN
|
Facility
IP
|
$13.93
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
900915279
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Adventist Health Commercial |
$2.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.57
|
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.43
|
| Rate for Payer: Heritage Provider Network Senior |
$9.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.48
|
| Rate for Payer: Multiplan Commercial |
$10.45
|
|
|
HC SOM OPATU DRUG SCRN OXYCDN
|
Facility
OP
|
$13.93
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
900915279
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$156.20 |
| Rate for Payer: Adventist Health Commercial |
$2.79
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.20
|
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.84
|
| Rate for Payer: Dignity Health Senior |
$11.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.62
|
| Rate for Payer: Heritage Provider Network Senior |
$8.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.48
|
| Rate for Payer: Multiplan Commercial |
$10.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.84
|
| Rate for Payer: Vantage Medical Group Senior |
$11.84
|
|
|
HC SOM ORGANIC ACID SCREEN
|
Facility
IP
|
$40.00
|
|
|
Service Code
|
CPT 83919
|
| Hospital Charge Code |
900911179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.48
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.08
|
| Rate for Payer: Heritage Provider Network Senior |
$27.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
|
|
HC SOM ORGANIC ACID SCREEN
|
Facility
OP
|
$40.00
|
|
|
Service Code
|
CPT 83919
|
| Hospital Charge Code |
900911179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$137.16 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.16
|
| Rate for Payer: Blue Shield of California Commercial |
$128.57
|
| Rate for Payer: Blue Shield of California EPN |
$100.51
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.10
|
| Rate for Payer: Dignity Health Senior |
$16.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.76
|
| Rate for Payer: Heritage Provider Network Senior |
$24.76
|
| Rate for Payer: Humana Medicare |
$16.45
|
| Rate for Payer: IEHP Medi-Cal |
$22.82
|
| Rate for Payer: IEHP Medicare Advantage |
$16.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.73
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.45
|
| Rate for Payer: TriValley Medical Group Senior |
$16.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.10
|
| Rate for Payer: Vantage Medical Group Senior |
$16.45
|
|
|
HC SOM ORG REFER FOR ID, AEROBIC
|
Facility
OP
|
$17.20
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912887
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$67.56 |
| Rate for Payer: Adventist Health Commercial |
$3.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.56
|
| Rate for Payer: Blue Shield of California Commercial |
$63.11
|
| Rate for Payer: Blue Shield of California EPN |
$49.34
|
| Rate for Payer: Cash Price |
$7.74
|
| Rate for Payer: Cash Price |
$7.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.65
|
| Rate for Payer: Heritage Provider Network Senior |
$10.65
|
| Rate for Payer: Humana Medicare |
$8.08
|
| Rate for Payer: IEHP Medi-Cal |
$10.37
|
| Rate for Payer: IEHP Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$12.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC SOM ORG REFER FOR ID, AEROBIC
|
Facility
IP
|
$17.20
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912887
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$12.90 |
| Rate for Payer: Adventist Health Commercial |
$3.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.82
|
| Rate for Payer: Cash Price |
$7.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.64
|
| Rate for Payer: Heritage Provider Network Senior |
$11.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.30
|
| Rate for Payer: Multiplan Commercial |
$12.90
|
|
|
HC SOM ORG REFER FOR ID, ANAEROB
|
Facility
IP
|
$23.74
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
900912889
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$17.80 |
| Rate for Payer: Adventist Health Commercial |
$4.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.31
|
| Rate for Payer: Cash Price |
$10.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.07
|
| Rate for Payer: Heritage Provider Network Senior |
$16.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.94
|
| Rate for Payer: Multiplan Commercial |
$17.80
|
|
|
HC SOM ORG REFER FOR ID, ANAEROB
|
Facility
OP
|
$23.74
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
900912889
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$105.43 |
| Rate for Payer: Adventist Health Commercial |
$4.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.43
|
| Rate for Payer: Blue Shield of California Commercial |
$63.11
|
| Rate for Payer: Blue Shield of California EPN |
$49.34
|
| Rate for Payer: Cash Price |
$10.68
|
| Rate for Payer: Cash Price |
$10.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.43
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.70
|
| Rate for Payer: Heritage Provider Network Senior |
$14.70
|
| Rate for Payer: Humana Medicare |
$8.08
|
| Rate for Payer: IEHP Medi-Cal |
$11.20
|
| Rate for Payer: IEHP Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$17.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC SOM OROT 83921
|
Facility
IP
|
$23.58
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900914729
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$17.68 |
| Rate for Payer: Adventist Health Commercial |
$4.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.20
|
| Rate for Payer: Cash Price |
$10.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.96
|
| Rate for Payer: Heritage Provider Network Senior |
$15.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.90
|
| Rate for Payer: Multiplan Commercial |
$17.68
|
|
|
HC SOM OROT 83921
|
Facility
OP
|
$23.58
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900914729
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$137.72 |
| Rate for Payer: Adventist Health Commercial |
$4.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.72
|
| Rate for Payer: Blue Shield of California Commercial |
$128.57
|
| Rate for Payer: Blue Shield of California EPN |
$100.51
|
| Rate for Payer: Cash Price |
$10.61
|
| Rate for Payer: Cash Price |
$10.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.33
|
| Rate for Payer: Dignity Health Senior |
$21.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.33
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.60
|
| Rate for Payer: Heritage Provider Network Senior |
$14.60
|
| Rate for Payer: Humana Medicare |
$21.21
|
| Rate for Payer: IEHP Medi-Cal |
$22.90
|
| Rate for Payer: IEHP Medicare Advantage |
$21.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$40.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.72
|
| Rate for Payer: Multiplan Commercial |
$17.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.21
|
| Rate for Payer: TriValley Medical Group Senior |
$21.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.33
|
| Rate for Payer: Vantage Medical Group Senior |
$21.21
|
|
|
HC SOM ORTHOPOXVIRUS DNA - LABCORP
|
Facility
IP
|
$77.00
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
900915424
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$57.75 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.90
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.13
|
| Rate for Payer: Heritage Provider Network Senior |
$52.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
|
|
HC SOM ORTHOPOXVIRUS DNA - LABCORP
|
Facility
OP
|
$77.00
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
900915424
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$124.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$65.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$57.75
|
| Rate for Payer: Blue Shield of California Commercial |
$47.82
|
| Rate for Payer: Blue Shield of California EPN |
$45.20
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.45
|
| Rate for Payer: Dignity Health Senior |
$65.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.66
|
| Rate for Payer: Heritage Provider Network Senior |
$47.66
|
| Rate for Payer: IEHP Medi-Cal |
$54.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$37.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.45
|
| Rate for Payer: Vantage Medical Group Senior |
$65.45
|
|
|
HC SOM OSTEOCALCIN
|
Facility
OP
|
$41.00
|
|
|
Service Code
|
CPT 83937
|
| Hospital Charge Code |
900911399
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$98.83 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$82.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$44.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.99
|
| Rate for Payer: Blue Shield of California Commercial |
$98.83
|
| Rate for Payer: Blue Shield of California EPN |
$77.26
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.84
|
| Rate for Payer: Dignity Health Senior |
$29.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$29.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.38
|
| Rate for Payer: Heritage Provider Network Senior |
$25.38
|
| Rate for Payer: Humana Medicare |
$29.85
|
| Rate for Payer: IEHP Medicare Advantage |
$29.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$56.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.61
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.85
|
| Rate for Payer: TriValley Medical Group Senior |
$29.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$32.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.84
|
| Rate for Payer: Vantage Medical Group Senior |
$29.85
|
|
|
HC SOM OSTEOCALCIN
|
Facility
IP
|
$41.00
|
|
|
Service Code
|
CPT 83937
|
| Hospital Charge Code |
900911399
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.17
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.76
|
| Rate for Payer: Heritage Provider Network Senior |
$27.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
|
|
HC SOM OXALATE
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
900911124
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$107.74 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.74
|
| Rate for Payer: Blue Shield of California Commercial |
$100.56
|
| Rate for Payer: Blue Shield of California EPN |
$78.62
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.90
|
| Rate for Payer: Dignity Health Senior |
$14.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Humana Medicare |
$14.45
|
| Rate for Payer: IEHP Medi-Cal |
$18.03
|
| Rate for Payer: IEHP Medicare Advantage |
$14.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.21
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.45
|
| Rate for Payer: TriValley Medical Group Senior |
$14.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.90
|
| Rate for Payer: Vantage Medical Group Senior |
$14.45
|
|
|
HC SOM OXALATE
|
Facility
IP
|
$20.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
900911124
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC SOM OXALATE PLASMA
|
Facility
IP
|
$72.24
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
900910579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$54.18 |
| Rate for Payer: Adventist Health Commercial |
$14.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.63
|
| Rate for Payer: Cash Price |
$32.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.91
|
| Rate for Payer: Heritage Provider Network Senior |
$48.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.06
|
| Rate for Payer: Multiplan Commercial |
$54.18
|
|
|
HC SOM OXALATE PLASMA
|
Facility
OP
|
$72.24
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
900910579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$107.74 |
| Rate for Payer: Adventist Health Commercial |
$14.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.74
|
| Rate for Payer: Blue Shield of California Commercial |
$100.56
|
| Rate for Payer: Blue Shield of California EPN |
$78.62
|
| Rate for Payer: Cash Price |
$32.51
|
| Rate for Payer: Cash Price |
$32.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.90
|
| Rate for Payer: Dignity Health Senior |
$14.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.72
|
| Rate for Payer: Heritage Provider Network Senior |
$44.72
|
| Rate for Payer: Humana Medicare |
$14.45
|
| Rate for Payer: IEHP Medi-Cal |
$18.03
|
| Rate for Payer: IEHP Medicare Advantage |
$14.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.21
|
| Rate for Payer: Multiplan Commercial |
$54.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.45
|
| Rate for Payer: TriValley Medical Group Senior |
$14.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.90
|
| Rate for Payer: Vantage Medical Group Senior |
$14.45
|
|
|
HC SOM OXCARBAZEPINE LEVEL
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
900912537
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$101.12 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.72
|
| Rate for Payer: Blue Shield of California Commercial |
$101.12
|
| Rate for Payer: Blue Shield of California EPN |
$79.05
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.58
|
| Rate for Payer: Dignity Health Senior |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Humana Medicare |
$13.25
|
| Rate for Payer: IEHP Medi-Cal |
$18.38
|
| Rate for Payer: IEHP Medicare Advantage |
$13.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.70
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.25
|
| Rate for Payer: TriValley Medical Group Senior |
$13.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.58
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
|
HC SOM OXCARBAZEPINE LEVEL
|
Facility
IP
|
$20.00
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
900912537
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC SOM PANCREATIC ELASTASE/STOOL
|
Facility
IP
|
$80.00
|
|
|
Service Code
|
CPT 82653
|
| Hospital Charge Code |
900912993
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Adventist Health Commercial |
$16.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.96
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.16
|
| Rate for Payer: Heritage Provider Network Senior |
$54.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
|
|
HC SOM PANCREATIC ELASTASE/STOOL
|
Facility
OP
|
$80.00
|
|
|
Service Code
|
CPT 82653
|
| Hospital Charge Code |
900912993
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$128.40 |
| Rate for Payer: Adventist Health Commercial |
$16.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.10
|
| Rate for Payer: Blue Shield of California Commercial |
$128.40
|
| Rate for Payer: Blue Shield of California EPN |
$100.38
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$52.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.27
|
| Rate for Payer: Dignity Health Senior |
$22.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.52
|
| Rate for Payer: Heritage Provider Network Senior |
$49.52
|
| Rate for Payer: Humana Medicare |
$22.97
|
| Rate for Payer: IEHP Medi-Cal |
$35.83
|
| Rate for Payer: IEHP Medicare Advantage |
$22.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.94
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.97
|
| Rate for Payer: TriValley Medical Group Senior |
$22.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.27
|
| Rate for Payer: Vantage Medical Group Senior |
$22.97
|
|
|
HC SOM PANCREATIC POLYPEPTIDE
|
Facility
OP
|
$165.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911326
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$113.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.10
|
| Rate for Payer: Blue Shield of California Commercial |
$105.54
|
| Rate for Payer: Blue Shield of California EPN |
$82.51
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$107.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Senior |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.14
|
| Rate for Payer: Heritage Provider Network Senior |
$102.14
|
| Rate for Payer: Humana Medicare |
$18.40
|
| Rate for Payer: IEHP Medi-Cal |
$19.14
|
| Rate for Payer: IEHP Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.18
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.40
|
| Rate for Payer: TriValley Medical Group Senior |
$18.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM PANCREATIC POLYPEPTIDE
|
Facility
IP
|
$165.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911326
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.86 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$113.36
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.70
|
| Rate for Payer: Heritage Provider Network Senior |
$111.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.25
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
|
