|
HC SOM PHENOBARBITAL LEVEL
|
Facility
OP
|
$16.25
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
900912658
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$95.68 |
| Rate for Payer: Adventist Health Commercial |
$3.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.68
|
| Rate for Payer: Blue Shield of California Commercial |
$89.50
|
| Rate for Payer: Blue Shield of California EPN |
$69.96
|
| Rate for Payer: Cash Price |
$7.31
|
| Rate for Payer: Cash Price |
$7.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.83
|
| Rate for Payer: Dignity Health Senior |
$15.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.06
|
| Rate for Payer: Heritage Provider Network Senior |
$10.06
|
| Rate for Payer: Humana Medicare |
$15.30
|
| Rate for Payer: IEHP Medi-Cal |
$13.10
|
| Rate for Payer: IEHP Medicare Advantage |
$15.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$12.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.30
|
| Rate for Payer: TriValley Medical Group Senior |
$15.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
HC SOM PHOSPHOLIPID AB IGA
|
Facility
OP
|
$24.10
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
900914172
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$143.61 |
| Rate for Payer: Adventist Health Commercial |
$4.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.87
|
| Rate for Payer: Blue Shield of California Commercial |
$143.61
|
| Rate for Payer: Blue Shield of California EPN |
$112.27
|
| Rate for Payer: Cash Price |
$10.85
|
| Rate for Payer: Cash Price |
$10.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.00
|
| Rate for Payer: Dignity Health Senior |
$25.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.66
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.92
|
| Rate for Payer: Heritage Provider Network Senior |
$14.92
|
| Rate for Payer: Humana Medicare |
$25.45
|
| Rate for Payer: IEHP Medi-Cal |
$27.80
|
| Rate for Payer: IEHP Medicare Advantage |
$25.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$48.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.07
|
| Rate for Payer: Multiplan Commercial |
$18.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.45
|
| Rate for Payer: TriValley Medical Group Senior |
$25.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Vantage Medical Group Senior |
$25.45
|
|
|
HC SOM PHOSPHOLIPID AB IGA
|
Facility
IP
|
$24.10
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
900914172
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$18.08 |
| Rate for Payer: Adventist Health Commercial |
$4.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.56
|
| Rate for Payer: Cash Price |
$10.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.32
|
| Rate for Payer: Heritage Provider Network Senior |
$16.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.02
|
| Rate for Payer: Multiplan Commercial |
$18.08
|
|
|
HC SOM PI-LINKD AG FLOW EA ADD'L
|
Facility
IP
|
$22.32
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
900914176
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Adventist Health Commercial |
$4.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.33
|
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.11
|
| Rate for Payer: Heritage Provider Network Senior |
$15.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.58
|
| Rate for Payer: Multiplan Commercial |
$16.74
|
|
|
HC SOM PI-LINKD AG FLOW EA ADD'L
|
Facility
OP
|
$22.32
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
900914176
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$160.43 |
| Rate for Payer: Adventist Health Commercial |
$4.46
|
| Rate for Payer: Aetna of CA Gatekeeper |
$111.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.43
|
| Rate for Payer: Blue Shield of California Commercial |
$13.86
|
| Rate for Payer: Blue Shield of California EPN |
$13.10
|
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.97
|
| Rate for Payer: Dignity Health Senior |
$18.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.82
|
| Rate for Payer: Heritage Provider Network Senior |
$13.82
|
| Rate for Payer: IEHP Medi-Cal |
$32.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.58
|
| Rate for Payer: Multiplan Commercial |
$16.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.97
|
| Rate for Payer: Vantage Medical Group Senior |
$18.97
|
|
|
HC SOM PI-LINKD AG FLOW TC 1 MRKR
|
Facility
IP
|
$451.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914173
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$81.63 |
| Max. Negotiated Rate |
$338.25 |
| Rate for Payer: Adventist Health Commercial |
$90.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$309.84
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$305.33
|
| Rate for Payer: Heritage Provider Network Senior |
$305.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.75
|
| Rate for Payer: Multiplan Commercial |
$338.25
|
|
|
HC SOM PI-LINKD AG FLOW TC 1 MRKR
|
Facility
OP
|
$451.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914173
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$853.31 |
| Rate for Payer: Adventist Health Commercial |
$90.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$186.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$309.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$449.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$326.50
|
| Rate for Payer: Blue Shield of California Commercial |
$280.07
|
| Rate for Payer: Blue Shield of California EPN |
$264.74
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$293.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$494.02
|
| Rate for Payer: Dignity Health Senior |
$449.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$449.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$279.17
|
| Rate for Payer: Heritage Provider Network Senior |
$279.17
|
| Rate for Payer: Humana Medicare |
$449.11
|
| Rate for Payer: IEHP Medi-Cal |
$65.80
|
| Rate for Payer: IEHP Medicare Advantage |
$449.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$853.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$529.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$565.88
|
| Rate for Payer: Multiplan Commercial |
$338.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$449.11
|
| Rate for Payer: TriValley Medical Group Senior |
$449.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$321.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$321.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Vantage Medical Group Senior |
$449.11
|
|
|
HC SOM PIPERACILLIN LEVEL BA
|
Facility
IP
|
$106.40
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900914693
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.26 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Adventist Health Commercial |
$21.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$73.10
|
| Rate for Payer: Cash Price |
$47.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$72.03
|
| Rate for Payer: Heritage Provider Network Senior |
$72.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.60
|
| Rate for Payer: Multiplan Commercial |
$79.80
|
|
|
HC SOM PIPERACILLIN LEVEL BA
|
Facility
OP
|
$106.40
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900914693
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.26 |
| Max. Negotiated Rate |
$90.44 |
| Rate for Payer: Adventist Health Commercial |
$21.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$73.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$90.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$79.80
|
| Rate for Payer: Blue Shield of California Commercial |
$66.07
|
| Rate for Payer: Blue Shield of California EPN |
$62.46
|
| Rate for Payer: Cash Price |
$47.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$69.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.44
|
| Rate for Payer: Dignity Health Senior |
$90.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.86
|
| Rate for Payer: Heritage Provider Network Senior |
$65.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$51.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.60
|
| Rate for Payer: Multiplan Commercial |
$79.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.44
|
| Rate for Payer: Vantage Medical Group Senior |
$90.44
|
|
|
HC SOM PKHD1 GENE
|
Facility
OP
|
$1,525.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900914705
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$276.02 |
| Max. Negotiated Rate |
$1,296.25 |
| Rate for Payer: Adventist Health Commercial |
$305.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$815.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,047.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$838.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,143.75
|
| Rate for Payer: Blue Shield of California Commercial |
$947.02
|
| Rate for Payer: Blue Shield of California EPN |
$895.18
|
| Rate for Payer: Cash Price |
$686.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$991.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,296.25
|
| Rate for Payer: Dignity Health Senior |
$1,296.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$991.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$943.98
|
| Rate for Payer: Heritage Provider Network Senior |
$943.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$735.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.25
|
| Rate for Payer: Multiplan Commercial |
$1,143.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,296.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,296.25
|
|
|
HC SOM PKHD1 GENE
|
Facility
IP
|
$1,525.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900914705
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$276.02 |
| Max. Negotiated Rate |
$1,143.75 |
| Rate for Payer: Adventist Health Commercial |
$305.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,047.68
|
| Rate for Payer: Cash Price |
$686.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,032.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1,032.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.25
|
| Rate for Payer: Multiplan Commercial |
$1,143.75
|
|
|
HC SOM PLASMINOGEN ACTIVITY
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
CPT 85420
|
| Hospital Charge Code |
900911325
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$54.77 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.77
|
| Rate for Payer: Blue Shield of California Commercial |
$51.04
|
| Rate for Payer: Blue Shield of California EPN |
$39.90
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.18
|
| Rate for Payer: Dignity Health Senior |
$6.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Humana Medicare |
$6.53
|
| Rate for Payer: IEHP Medi-Cal |
$9.06
|
| Rate for Payer: IEHP Medicare Advantage |
$6.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.23
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.53
|
| Rate for Payer: TriValley Medical Group Senior |
$6.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.18
|
| Rate for Payer: Vantage Medical Group Senior |
$6.53
|
|
|
HC SOM PLASMINOGEN ACTIVITY
|
Facility
IP
|
$50.00
|
|
|
Service Code
|
CPT 85420
|
| Hospital Charge Code |
900911325
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.35
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.85
|
| Rate for Payer: Heritage Provider Network Senior |
$33.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
|
|
HC SOM PML/RARA QUANT, PCR
|
Facility
OP
|
$255.94
|
|
|
Service Code
|
CPT 81315
|
| Hospital Charge Code |
900913891
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$46.33 |
| Max. Negotiated Rate |
$446.92 |
| Rate for Payer: Adventist Health Commercial |
$51.19
|
| Rate for Payer: Aetna of CA Gatekeeper |
$165.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$175.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$310.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$228.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$207.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$446.92
|
| Rate for Payer: Blue Shield of California Commercial |
$158.94
|
| Rate for Payer: Blue Shield of California EPN |
$150.24
|
| Rate for Payer: Cash Price |
$115.17
|
| Rate for Payer: Cash Price |
$115.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$166.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$310.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$228.04
|
| Rate for Payer: Dignity Health Senior |
$207.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.36
|
| Rate for Payer: EPIC Health Plan Medicare |
$207.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$158.43
|
| Rate for Payer: Heritage Provider Network Senior |
$158.43
|
| Rate for Payer: Humana Medicare |
$207.31
|
| Rate for Payer: IEHP Medi-Cal |
$146.69
|
| Rate for Payer: IEHP Medicare Advantage |
$207.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$393.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$244.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.21
|
| Rate for Payer: Multiplan Commercial |
$191.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$207.31
|
| Rate for Payer: TriValley Medical Group Senior |
$207.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$223.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$223.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$310.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$228.04
|
| Rate for Payer: Vantage Medical Group Senior |
$207.31
|
|
|
HC SOM PML/RARA QUANT, PCR
|
Facility
IP
|
$255.94
|
|
|
Service Code
|
CPT 81315
|
| Hospital Charge Code |
900913891
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$46.33 |
| Max. Negotiated Rate |
$191.96 |
| Rate for Payer: Adventist Health Commercial |
$51.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$175.83
|
| Rate for Payer: Cash Price |
$115.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$173.27
|
| Rate for Payer: Heritage Provider Network Senior |
$173.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.98
|
| Rate for Payer: Multiplan Commercial |
$191.96
|
|
|
HC SOM PORPHOBILINOGEN QUANT.
|
Facility
IP
|
$30.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
900912570
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.31
|
| Rate for Payer: Heritage Provider Network Senior |
$20.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
|
|
HC SOM PORPHOBILINOGEN QUANT.
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
900912570
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$70.72 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.72
|
| Rate for Payer: Blue Shield of California Commercial |
$65.96
|
| Rate for Payer: Blue Shield of California EPN |
$51.57
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.28
|
| Rate for Payer: Dignity Health Senior |
$8.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.57
|
| Rate for Payer: Heritage Provider Network Senior |
$18.57
|
| Rate for Payer: Humana Medicare |
$8.44
|
| Rate for Payer: IEHP Medi-Cal |
$11.70
|
| Rate for Payer: IEHP Medicare Advantage |
$8.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.63
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.44
|
| Rate for Payer: TriValley Medical Group Senior |
$8.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.28
|
| Rate for Payer: Vantage Medical Group Senior |
$8.44
|
|
|
HC SOM PORPHYRINS FRAC RND U
|
Facility
OP
|
$21.08
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
900914687
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$123.13 |
| Rate for Payer: Adventist Health Commercial |
$4.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.13
|
| Rate for Payer: Blue Shield of California Commercial |
$114.87
|
| Rate for Payer: Blue Shield of California EPN |
$89.80
|
| Rate for Payer: Cash Price |
$9.49
|
| Rate for Payer: Cash Price |
$9.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.18
|
| Rate for Payer: Dignity Health Senior |
$14.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.05
|
| Rate for Payer: Heritage Provider Network Senior |
$13.05
|
| Rate for Payer: Humana Medicare |
$14.71
|
| Rate for Payer: IEHP Medi-Cal |
$20.40
|
| Rate for Payer: IEHP Medicare Advantage |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.53
|
| Rate for Payer: Multiplan Commercial |
$15.81
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.71
|
| Rate for Payer: TriValley Medical Group Senior |
$14.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.18
|
| Rate for Payer: Vantage Medical Group Senior |
$14.71
|
|
|
HC SOM PORPHYRINS FRAC RND U
|
Facility
IP
|
$21.08
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
900914687
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$15.81 |
| Rate for Payer: Adventist Health Commercial |
$4.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.48
|
| Rate for Payer: Cash Price |
$9.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.27
|
| Rate for Payer: Heritage Provider Network Senior |
$14.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.27
|
| Rate for Payer: Multiplan Commercial |
$15.81
|
|
|
HC SOM PORPHYRINS QN RND U
|
Facility
OP
|
$12.09
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
900914686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$70.72 |
| Rate for Payer: Adventist Health Commercial |
$2.42
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.72
|
| Rate for Payer: Blue Shield of California Commercial |
$65.96
|
| Rate for Payer: Blue Shield of California EPN |
$51.57
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.28
|
| Rate for Payer: Dignity Health Senior |
$8.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.86
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.48
|
| Rate for Payer: Heritage Provider Network Senior |
$7.48
|
| Rate for Payer: Humana Medicare |
$8.44
|
| Rate for Payer: IEHP Medi-Cal |
$11.70
|
| Rate for Payer: IEHP Medicare Advantage |
$8.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.63
|
| Rate for Payer: Multiplan Commercial |
$9.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.44
|
| Rate for Payer: TriValley Medical Group Senior |
$8.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.28
|
| Rate for Payer: Vantage Medical Group Senior |
$8.44
|
|
|
HC SOM PORPHYRINS QN RND U
|
Facility
IP
|
$12.09
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
900914686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$9.07 |
| Rate for Payer: Adventist Health Commercial |
$2.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.31
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.18
|
| Rate for Payer: Heritage Provider Network Senior |
$8.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$9.07
|
|
|
HC SOM PORPHYRINS TOTAL PLAS
|
Facility
OP
|
$55.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900914689
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$58.55 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.55
|
| Rate for Payer: Blue Shield of California Commercial |
$54.61
|
| Rate for Payer: Blue Shield of California EPN |
$42.69
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.91
|
| Rate for Payer: Dignity Health Senior |
$8.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.04
|
| Rate for Payer: Heritage Provider Network Senior |
$34.04
|
| Rate for Payer: Humana Medicare |
$8.10
|
| Rate for Payer: IEHP Medi-Cal |
$10.11
|
| Rate for Payer: IEHP Medicare Advantage |
$8.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.21
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.10
|
| Rate for Payer: TriValley Medical Group Senior |
$8.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Vantage Medical Group Senior |
$8.10
|
|
|
HC SOM PORPHYRINS TOTAL PLAS
|
Facility
IP
|
$55.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900914689
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.24
|
| Rate for Payer: Heritage Provider Network Senior |
$37.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
|
|
HC SOM PORPHYRINS URINE FRACTIONATED
|
Facility
OP
|
$28.59
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
900911511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$123.13 |
| Rate for Payer: Adventist Health Commercial |
$5.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.13
|
| Rate for Payer: Blue Shield of California Commercial |
$114.87
|
| Rate for Payer: Blue Shield of California EPN |
$89.80
|
| Rate for Payer: Cash Price |
$12.87
|
| Rate for Payer: Cash Price |
$12.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.18
|
| Rate for Payer: Dignity Health Senior |
$14.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.58
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.70
|
| Rate for Payer: Heritage Provider Network Senior |
$17.70
|
| Rate for Payer: Humana Medicare |
$14.71
|
| Rate for Payer: IEHP Medi-Cal |
$20.40
|
| Rate for Payer: IEHP Medicare Advantage |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.53
|
| Rate for Payer: Multiplan Commercial |
$21.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.71
|
| Rate for Payer: TriValley Medical Group Senior |
$14.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.18
|
| Rate for Payer: Vantage Medical Group Senior |
$14.71
|
|
|
HC SOM PORPHYRINS URINE FRACTIONATED
|
Facility
IP
|
$28.59
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
900911511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$21.44 |
| Rate for Payer: Adventist Health Commercial |
$5.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.64
|
| Rate for Payer: Cash Price |
$12.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.36
|
| Rate for Payer: Heritage Provider Network Senior |
$19.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$21.44
|
|
