|
HC SOM PRADER WILLI SYNDROME ANALYSIS
|
Facility
|
IP
|
$358.60
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
900910668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.91 |
| Max. Negotiated Rate |
$268.95 |
| Rate for Payer: Adventist Health Commercial |
$71.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$230.94
|
| Rate for Payer: Cash Price |
$358.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$242.77
|
| Rate for Payer: Heritage Provider Network Senior |
$242.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.65
|
| Rate for Payer: Multiplan Commercial |
$268.95
|
|
|
HC SOM PREGNENOLONE, SERUM
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 84140
|
| Hospital Charge Code |
900915512
|
|
Hospital Revenue Code
|
300
|
| 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 |
$19.32
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.31
|
| Rate for Payer: Heritage Provider Network Senior |
$20.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
|
|
HC SOM PREGNENOLONE, SERUM
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 84140
|
| Hospital Charge Code |
900915512
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$192.09 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.09
|
| Rate for Payer: Blue Shield of California Commercial |
$166.41
|
| Rate for Payer: Blue Shield of California EPN |
$133.47
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.57
|
| Rate for Payer: Heritage Provider Network Senior |
$18.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.70
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.67
|
| Rate for Payer: TriValley Medical Group Senior |
$20.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.74
|
| Rate for Payer: Vantage Medical Group Senior |
$20.67
|
|
|
HC SOM PRIMIDONE LEVEL
|
Facility
|
OP
|
$18.74
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
900911489
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$157.63 |
| Rate for Payer: Adventist Health Commercial |
$3.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.63
|
| Rate for Payer: Blue Shield of California Commercial |
$133.52
|
| Rate for Payer: Blue Shield of California EPN |
$107.09
|
| Rate for Payer: Cash Price |
$18.74
|
| Rate for Payer: Cash Price |
$18.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.60
|
| Rate for Payer: Heritage Provider Network Senior |
$11.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.23
|
| Rate for Payer: Multiplan Commercial |
$14.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.59
|
| Rate for Payer: TriValley Medical Group Senior |
$16.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.25
|
| Rate for Payer: Vantage Medical Group Senior |
$16.59
|
|
|
HC SOM PRIMIDONE LEVEL
|
Facility
|
IP
|
$18.74
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
900911489
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Adventist Health Commercial |
$3.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.07
|
| Rate for Payer: Cash Price |
$18.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.69
|
| Rate for Payer: Heritage Provider Network Senior |
$12.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$14.05
|
|
|
HC SOM PROBE SET COUNT
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900915278
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$1,610.83 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,610.83
|
| Rate for Payer: Blue Shield of California Commercial |
$172.40
|
| Rate for Payer: Blue Shield of California EPN |
$138.28
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.76
|
| Rate for Payer: Heritage Provider Network Senior |
$24.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.42
|
| Rate for Payer: TriValley Medical Group Senior |
$21.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC SOM PROBE SET COUNT
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900915278
|
|
Hospital Revenue Code
|
310
|
| 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 |
$25.76
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.08
|
| Rate for Payer: Heritage Provider Network Senior |
$27.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
|
|
HC SOM PROINSULIN
|
Facility
|
OP
|
$51.45
|
|
|
Service Code
|
CPT 84206
|
| Hospital Charge Code |
900911398
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$163.64 |
| Rate for Payer: Adventist Health Commercial |
$10.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.64
|
| Rate for Payer: Blue Shield of California Commercial |
$143.37
|
| Rate for Payer: Blue Shield of California EPN |
$114.99
|
| Rate for Payer: Cash Price |
$51.45
|
| Rate for Payer: Cash Price |
$51.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.36
|
| Rate for Payer: EPIC Health Plan Medicare |
$26.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.85
|
| Rate for Payer: Heritage Provider Network Senior |
$31.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$24.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.76
|
| Rate for Payer: Multiplan Commercial |
$38.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$26.69
|
| Rate for Payer: TriValley Medical Group Senior |
$26.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.36
|
| Rate for Payer: Vantage Medical Group Senior |
$26.69
|
|
|
HC SOM PROINSULIN
|
Facility
|
IP
|
$51.45
|
|
|
Service Code
|
CPT 84206
|
| Hospital Charge Code |
900911398
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$38.59 |
| Rate for Payer: Adventist Health Commercial |
$10.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.13
|
| Rate for Payer: Cash Price |
$51.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.83
|
| Rate for Payer: Heritage Provider Network Senior |
$34.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.86
|
| Rate for Payer: Multiplan Commercial |
$38.59
|
|
|
HC SOM PROSTATE HEALTH INDEX
|
Facility
|
OP
|
$13.68
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900915518
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$174.63 |
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.63
|
| Rate for Payer: Blue Shield of California Commercial |
$148.03
|
| Rate for Payer: Blue Shield of California EPN |
$118.73
|
| Rate for Payer: Cash Price |
$13.68
|
| Rate for Payer: Cash Price |
$13.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.89
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.47
|
| Rate for Payer: Heritage Provider Network Senior |
$8.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.64
|
| Rate for Payer: Multiplan Commercial |
$10.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.39
|
| Rate for Payer: TriValley Medical Group Senior |
$18.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
|
|
HC SOM PROSTATE HEALTH INDEX
|
Facility
|
IP
|
$13.68
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900915518
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$10.26 |
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.81
|
| Rate for Payer: Cash Price |
$13.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.26
|
| Rate for Payer: Heritage Provider Network Senior |
$9.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.42
|
| Rate for Payer: Multiplan Commercial |
$10.26
|
|
|
HC SOM PROTEINASE 3 AB
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.10
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.93
|
| Rate for Payer: Heritage Provider Network Senior |
$16.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SOM PROTEINASE 3 AB
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$222.13 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.13
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.47
|
| Rate for Payer: Heritage Provider Network Senior |
$15.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM PROTEIN C AG
|
Facility
|
OP
|
$223.58
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
900913801
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$167.69 |
| Rate for Payer: Adventist Health Commercial |
$44.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$138.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.48
|
| Rate for Payer: Blue Shield of California Commercial |
$96.77
|
| Rate for Payer: Blue Shield of California EPN |
$77.62
|
| Rate for Payer: Cash Price |
$223.58
|
| Rate for Payer: Cash Price |
$223.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$145.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.91
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.40
|
| Rate for Payer: Heritage Provider Network Senior |
$138.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$106.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.09
|
| Rate for Payer: Multiplan Commercial |
$167.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.01
|
| Rate for Payer: TriValley Medical Group Senior |
$12.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.21
|
| Rate for Payer: Vantage Medical Group Senior |
$12.01
|
|
|
HC SOM PROTEIN C AG
|
Facility
|
IP
|
$223.58
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
900913801
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$40.47 |
| Max. Negotiated Rate |
$167.69 |
| Rate for Payer: Adventist Health Commercial |
$44.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$143.99
|
| Rate for Payer: Cash Price |
$223.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$151.36
|
| Rate for Payer: Heritage Provider Network Senior |
$151.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.90
|
| Rate for Payer: Multiplan Commercial |
$167.69
|
|
|
HC SOM PROTEIN ELECT URINE
|
Facility
|
IP
|
$24.88
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912721
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$18.66 |
| Rate for Payer: Adventist Health Commercial |
$4.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.02
|
| Rate for Payer: Cash Price |
$24.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.84
|
| Rate for Payer: Heritage Provider Network Senior |
$16.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.22
|
| Rate for Payer: Multiplan Commercial |
$18.66
|
|
|
HC SOM PROTEIN ELECT URINE
|
Facility
|
OP
|
$24.88
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912721
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$165.88 |
| Rate for Payer: Adventist Health Commercial |
$4.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.88
|
| Rate for Payer: Blue Shield of California Commercial |
$143.54
|
| Rate for Payer: Blue Shield of California EPN |
$115.13
|
| Rate for Payer: Cash Price |
$24.88
|
| Rate for Payer: Cash Price |
$24.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.40
|
| Rate for Payer: Heritage Provider Network Senior |
$15.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.89
|
| Rate for Payer: Multiplan Commercial |
$18.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.83
|
| Rate for Payer: TriValley Medical Group Senior |
$17.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Vantage Medical Group Senior |
$17.83
|
|
|
HC SOM PROTEIN S AG
|
Facility
|
IP
|
$25.45
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900913807
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.61 |
| Max. Negotiated Rate |
$19.09 |
| Rate for Payer: Adventist Health Commercial |
$5.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.39
|
| Rate for Payer: Cash Price |
$25.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.23
|
| Rate for Payer: Heritage Provider Network Senior |
$17.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.36
|
| Rate for Payer: Multiplan Commercial |
$19.09
|
|
|
HC SOM PROTEIN S AG
|
Facility
|
OP
|
$25.45
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900913807
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.61 |
| Max. Negotiated Rate |
$145.55 |
| Rate for Payer: Adventist Health Commercial |
$5.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.55
|
| Rate for Payer: Blue Shield of California Commercial |
$123.32
|
| Rate for Payer: Blue Shield of California EPN |
$98.91
|
| Rate for Payer: Cash Price |
$25.45
|
| Rate for Payer: Cash Price |
$25.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.02
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.75
|
| Rate for Payer: Heritage Provider Network Senior |
$15.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.53
|
| Rate for Payer: Multiplan Commercial |
$19.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.32
|
| Rate for Payer: TriValley Medical Group Senior |
$15.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Vantage Medical Group Senior |
$15.32
|
|
|
HC SOM PROTEIN S PLASMA
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900911277
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.10
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.93
|
| Rate for Payer: Heritage Provider Network Senior |
$16.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SOM PROTEIN S PLASMA
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900911277
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$145.55 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.55
|
| Rate for Payer: Blue Shield of California Commercial |
$123.32
|
| Rate for Payer: Blue Shield of California EPN |
$98.91
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.47
|
| Rate for Payer: Heritage Provider Network Senior |
$15.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.53
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.32
|
| Rate for Payer: TriValley Medical Group Senior |
$15.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Vantage Medical Group Senior |
$15.32
|
|
|
HC SOM PROTEIN, TOTAL, RANDOM, U
|
Facility
|
IP
|
$4.13
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912892
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Adventist Health Commercial |
$0.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.66
|
| Rate for Payer: Cash Price |
$4.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.80
|
| Rate for Payer: Heritage Provider Network Senior |
$2.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$3.10
|
|
|
HC SOM PROTEIN, TOTAL, RANDOM, U
|
Facility
|
OP
|
$4.13
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912892
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$34.90 |
| Rate for Payer: Adventist Health Commercial |
$0.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.90
|
| Rate for Payer: Blue Shield of California Commercial |
$29.49
|
| Rate for Payer: Blue Shield of California EPN |
$23.65
|
| Rate for Payer: Cash Price |
$4.13
|
| Rate for Payer: Cash Price |
$4.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.44
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.56
|
| Rate for Payer: Heritage Provider Network Senior |
$2.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$3.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.67
|
| Rate for Payer: TriValley Medical Group Senior |
$3.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
HC SOM PROTEIN TOTAL URINE
|
Facility
|
IP
|
$5.12
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.30
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.47
|
| Rate for Payer: Heritage Provider Network Senior |
$3.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
|
|
HC SOM PROTEIN TOTAL URINE
|
Facility
|
OP
|
$5.12
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$34.90 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.90
|
| Rate for Payer: Blue Shield of California Commercial |
$29.49
|
| Rate for Payer: Blue Shield of California EPN |
$23.65
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.02
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.17
|
| Rate for Payer: Heritage Provider Network Senior |
$3.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.67
|
| Rate for Payer: TriValley Medical Group Senior |
$3.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
