|
HC SOF ADENOVIRUS DNA QUANT PCR
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912932
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$63.17 |
| Max. Negotiated Rate |
$261.75 |
| Rate for Payer: Adventist Health Commercial |
$69.80
|
| Rate for Payer: Cash Price |
$191.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.27
|
| Rate for Payer: Heritage Provider Network Senior |
$236.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.25
|
| Rate for Payer: Multiplan Commercial |
$261.75
|
|
|
HC SOF INFLUENZA TYPE A AB
|
Facility
|
IP
|
$54.31
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900914694
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$40.73 |
| Rate for Payer: Adventist Health Commercial |
$10.86
|
| Rate for Payer: Cash Price |
$29.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.77
|
| Rate for Payer: Heritage Provider Network Senior |
$36.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.58
|
| Rate for Payer: Multiplan Commercial |
$40.73
|
|
|
HC SOF INFLUENZA TYPE A AB
|
Facility
|
OP
|
$54.31
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900914694
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$126.12 |
| Rate for Payer: Adventist Health Commercial |
$10.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.12
|
| Rate for Payer: Blue Shield of California Commercial |
$109.09
|
| Rate for Payer: Blue Shield of California EPN |
$87.50
|
| Rate for Payer: Cash Price |
$29.87
|
| Rate for Payer: Cash Price |
$29.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.90
|
| Rate for Payer: Dignity Health Senior |
$13.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.62
|
| Rate for Payer: Heritage Provider Network Senior |
$33.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.07
|
| Rate for Payer: Multiplan Commercial |
$40.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.55
|
| Rate for Payer: TriValley Medical Group Senior |
$13.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13.55
|
|
|
HC SOF INFLUENZA TYPE B AB
|
Facility
|
OP
|
$54.31
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900914695
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$126.12 |
| Rate for Payer: Adventist Health Commercial |
$10.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.12
|
| Rate for Payer: Blue Shield of California Commercial |
$109.09
|
| Rate for Payer: Blue Shield of California EPN |
$87.50
|
| Rate for Payer: Cash Price |
$29.87
|
| Rate for Payer: Cash Price |
$29.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.90
|
| Rate for Payer: Dignity Health Senior |
$13.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.62
|
| Rate for Payer: Heritage Provider Network Senior |
$33.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.07
|
| Rate for Payer: Multiplan Commercial |
$40.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.55
|
| Rate for Payer: TriValley Medical Group Senior |
$13.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13.55
|
|
|
HC SOF INFLUENZA TYPE B AB
|
Facility
|
IP
|
$54.31
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900914695
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$40.73 |
| Rate for Payer: Adventist Health Commercial |
$10.86
|
| Rate for Payer: Cash Price |
$29.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.77
|
| Rate for Payer: Heritage Provider Network Senior |
$36.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.58
|
| Rate for Payer: Multiplan Commercial |
$40.73
|
|
|
HC SOF NOROVIRUS RNA
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914720
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$310.02 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$159.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.02
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$163.90
|
| Rate for Payer: Cash Price |
$163.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$193.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$184.46
|
| Rate for Payer: Heritage Provider Network Senior |
$184.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$142.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOF NOROVIRUS RNA
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914720
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$53.94 |
| Max. Negotiated Rate |
$223.50 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Cash Price |
$163.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$201.75
|
| Rate for Payer: Heritage Provider Network Senior |
$201.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.50
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
|
|
HC SOFT PALATE
|
Facility
|
OP
|
$1,187.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$890.25 |
| Rate for Payer: Adventist Health Commercial |
$237.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$634.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$815.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Blue Shield of California Commercial |
$724.07
|
| Rate for Payer: Blue Shield of California EPN |
$579.26
|
| Rate for Payer: Cash Price |
$652.85
|
| Rate for Payer: Cash Price |
$652.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$771.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$771.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$734.75
|
| Rate for Payer: Heritage Provider Network Senior |
$734.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$566.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$890.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC SOFT PALATE
|
Facility
|
IP
|
$1,187.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$214.85 |
| Max. Negotiated Rate |
$890.25 |
| Rate for Payer: Adventist Health Commercial |
$237.40
|
| Rate for Payer: Cash Price |
$652.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$803.60
|
| Rate for Payer: Heritage Provider Network Senior |
$803.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.75
|
| Rate for Payer: Multiplan Commercial |
$890.25
|
|
|
HC SOGDX 230 GCH1 81479
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914803
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$167.43 |
| Max. Negotiated Rate |
$786.25 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$494.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$635.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$786.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$508.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.75
|
| Rate for Payer: Blue Shield of California Commercial |
$564.25
|
| Rate for Payer: Blue Shield of California EPN |
$451.40
|
| Rate for Payer: Cash Price |
$508.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$601.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$786.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$786.25
|
| Rate for Payer: Dignity Health Senior |
$786.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$601.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$572.58
|
| Rate for Payer: Heritage Provider Network Senior |
$572.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$441.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$647.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$647.50
|
| Rate for Payer: Multiplan Commercial |
$693.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$462.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$462.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$786.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$786.25
|
| Rate for Payer: Vantage Medical Group Senior |
$786.25
|
|
|
HC SOGDX 230 GCH1 81479
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914803
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$167.43 |
| Max. Negotiated Rate |
$693.75 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Cash Price |
$508.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$626.23
|
| Rate for Payer: Heritage Provider Network Senior |
$626.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.25
|
| Rate for Payer: Multiplan Commercial |
$693.75
|
|
|
HC SOGDX 317 SIX1 81479
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914808
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$122.17 |
| Max. Negotiated Rate |
$573.75 |
| Rate for Payer: Adventist Health Commercial |
$135.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$360.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$463.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$573.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$371.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$506.25
|
| Rate for Payer: Blue Shield of California Commercial |
$411.75
|
| Rate for Payer: Blue Shield of California EPN |
$329.40
|
| Rate for Payer: Cash Price |
$371.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$438.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$573.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$573.75
|
| Rate for Payer: Dignity Health Senior |
$573.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$417.82
|
| Rate for Payer: Heritage Provider Network Senior |
$417.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$321.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$472.50
|
| Rate for Payer: Multiplan Commercial |
$506.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$337.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$337.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$573.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$573.75
|
| Rate for Payer: Vantage Medical Group Senior |
$573.75
|
|
|
HC SOGDX 317 SIX1 81479
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914808
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$122.17 |
| Max. Negotiated Rate |
$506.25 |
| Rate for Payer: Adventist Health Commercial |
$135.00
|
| Rate for Payer: Cash Price |
$371.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$456.98
|
| Rate for Payer: Heritage Provider Network Senior |
$456.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.75
|
| Rate for Payer: Multiplan Commercial |
$506.25
|
|
|
HC SOGDX 559 TP53 GENE 81405
|
Facility
|
IP
|
$1,395.00
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914849
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$252.50 |
| Max. Negotiated Rate |
$1,046.25 |
| Rate for Payer: Adventist Health Commercial |
$279.00
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$944.41
|
| Rate for Payer: Heritage Provider Network Senior |
$944.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$348.75
|
| Rate for Payer: Multiplan Commercial |
$1,046.25
|
|
|
HC SOGDX 559 TP53 GENE 81405
|
Facility
|
OP
|
$1,395.00
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914849
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$252.50 |
| Max. Negotiated Rate |
$2,151.57 |
| Rate for Payer: Adventist Health Commercial |
$279.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$745.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$958.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$331.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$301.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,151.57
|
| Rate for Payer: Blue Shield of California Commercial |
$850.95
|
| Rate for Payer: Blue Shield of California EPN |
$680.76
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$906.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$452.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$331.49
|
| Rate for Payer: Dignity Health Senior |
$301.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$906.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$301.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$863.50
|
| Rate for Payer: Heritage Provider Network Senior |
$863.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$488.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$301.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$665.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$348.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$379.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$379.70
|
| Rate for Payer: Multiplan Commercial |
$1,046.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$301.35
|
| Rate for Payer: TriValley Medical Group Senior |
$301.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$325.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$325.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$331.49
|
| Rate for Payer: Vantage Medical Group Senior |
$301.35
|
|
|
HC SOHAR HERED PARAGANG PHEO A
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914679
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$217.20 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Adventist Health Commercial |
$240.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$641.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$824.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,020.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$660.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$900.00
|
| Rate for Payer: Blue Shield of California Commercial |
$732.00
|
| Rate for Payer: Blue Shield of California EPN |
$585.60
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$780.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,020.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,020.00
|
| Rate for Payer: Dignity Health Senior |
$1,020.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$780.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$742.80
|
| Rate for Payer: Heritage Provider Network Senior |
$742.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$572.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$217.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$840.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$840.00
|
| Rate for Payer: Multiplan Commercial |
$900.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$600.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,020.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,020.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,020.00
|
|
|
HC SOHAR HERED PARAGANG PHEO A
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914679
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$217.20 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Adventist Health Commercial |
$240.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$812.40
|
| Rate for Payer: Heritage Provider Network Senior |
$812.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$217.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.00
|
| Rate for Payer: Multiplan Commercial |
$900.00
|
|
|
HC SOHAR HERED PARAGANG PHEO B
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914680
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$90.50 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$267.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$343.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$425.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.00
|
| Rate for Payer: Blue Shield of California Commercial |
$305.00
|
| Rate for Payer: Blue Shield of California EPN |
$244.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$325.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$425.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.00
|
| Rate for Payer: Dignity Health Senior |
$425.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$309.50
|
| Rate for Payer: Heritage Provider Network Senior |
$309.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$238.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$350.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$350.00
|
| Rate for Payer: Multiplan Commercial |
$375.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$250.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$250.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$425.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.00
|
| Rate for Payer: Vantage Medical Group Senior |
$425.00
|
|
|
HC SOHAR HERED PARAGANG PHEO B
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914680
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$90.50 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$338.50
|
| Rate for Payer: Heritage Provider Network Senior |
$338.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.00
|
| Rate for Payer: Multiplan Commercial |
$375.00
|
|
|
HC SOHAR HERED PARAGANG PHEO C
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914681
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$153.85 |
| Max. Negotiated Rate |
$637.50 |
| Rate for Payer: Adventist Health Commercial |
$170.00
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$575.45
|
| Rate for Payer: Heritage Provider Network Senior |
$575.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.50
|
| Rate for Payer: Multiplan Commercial |
$637.50
|
|
|
HC SOHAR HERED PARAGANG PHEO C
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914681
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$153.85 |
| Max. Negotiated Rate |
$722.50 |
| Rate for Payer: Adventist Health Commercial |
$170.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$454.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$583.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$722.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$637.50
|
| Rate for Payer: Blue Shield of California Commercial |
$518.50
|
| Rate for Payer: Blue Shield of California EPN |
$414.80
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$552.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$722.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$722.50
|
| Rate for Payer: Dignity Health Senior |
$722.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$552.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$526.15
|
| Rate for Payer: Heritage Provider Network Senior |
$526.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$405.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$595.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$595.00
|
| Rate for Payer: Multiplan Commercial |
$637.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$425.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$425.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$722.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$722.50
|
| Rate for Payer: Vantage Medical Group Senior |
$722.50
|
|
|
HC SOK KARIUS TEST
|
Facility
|
OP
|
$1,360.00
|
|
|
Service Code
|
CPT 0152U
|
| Hospital Charge Code |
900915508
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$81.62 |
| Max. Negotiated Rate |
$3,189.30 |
| Rate for Payer: Adventist Health Commercial |
$272.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$726.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$934.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,189.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,338.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,126.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.62
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$884.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,189.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,338.82
|
| Rate for Payer: Dignity Health Senior |
$2,126.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$884.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,126.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$841.84
|
| Rate for Payer: Heritage Provider Network Senior |
$841.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,126.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$648.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,445.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,679.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,679.01
|
| Rate for Payer: Multiplan Commercial |
$1,020.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,126.20
|
| Rate for Payer: TriValley Medical Group Senior |
$2,126.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,296.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,296.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,189.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,338.82
|
| Rate for Payer: Vantage Medical Group Senior |
$2,126.20
|
|
|
HC SOK KARIUS TEST
|
Facility
|
IP
|
$1,360.00
|
|
|
Service Code
|
CPT 0152U
|
| Hospital Charge Code |
900915508
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$246.16 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Adventist Health Commercial |
$272.00
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$920.72
|
| Rate for Payer: Heritage Provider Network Senior |
$920.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.00
|
| Rate for Payer: Multiplan Commercial |
$1,020.00
|
|
|
HC SOLUBLE FIBRIN
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 85366
|
| Hospital Charge Code |
900910118
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$90.75 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$66.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.92
|
| Rate for Payer: Heritage Provider Network Senior |
$81.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.25
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
|
|
HC SOLUBLE FIBRIN
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 85366
|
| Hospital Charge Code |
900910118
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.88 |
| Max. Negotiated Rate |
$120.69 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$120.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.55
|
| Rate for Payer: Blue Shield of California Commercial |
$69.29
|
| Rate for Payer: Blue Shield of California EPN |
$55.58
|
| Rate for Payer: Cash Price |
$66.55
|
| Rate for Payer: Cash Price |
$66.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.51
|
| Rate for Payer: Dignity Health Senior |
$80.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$80.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.90
|
| Rate for Payer: Heritage Provider Network Senior |
$74.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$80.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$57.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.38
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$80.46
|
| Rate for Payer: TriValley Medical Group Senior |
$80.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$86.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$86.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$120.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.51
|
| Rate for Payer: Vantage Medical Group Senior |
$80.46
|
|
