|
HC SOM CATECHOLAMINE FRACT FREE UR
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900914081
|
|
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: 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 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 CATECHOLAMINES PL
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900910483
|
|
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: 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 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 CATECHOLAMINES PL
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900910483
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$230.55 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$230.55
|
| Rate for Payer: Blue Shield of California Commercial |
$203.21
|
| Rate for Payer: Blue Shield of California EPN |
$162.99
|
| 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 |
$37.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.77
|
| Rate for Payer: Dignity Health Senior |
$25.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.25
|
| 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) Medi-Cal |
$36.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.82
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.25
|
| Rate for Payer: TriValley Medical Group Senior |
$25.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.77
|
| Rate for Payer: Vantage Medical Group Senior |
$25.25
|
|
|
HC SOM CD4 T-CELL ABSOLUTE CT
|
Facility
|
IP
|
$31.88
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
900914709
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.77 |
| Max. Negotiated Rate |
$23.91 |
| Rate for Payer: Adventist Health Commercial |
$6.38
|
| Rate for Payer: Cash Price |
$31.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.58
|
| Rate for Payer: Heritage Provider Network Senior |
$21.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.97
|
| Rate for Payer: Multiplan Commercial |
$23.91
|
|
|
HC SOM CD4 T-CELL ABSOLUTE CT
|
Facility
|
OP
|
$31.88
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
900914709
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.77 |
| Max. Negotiated Rate |
$378.14 |
| Rate for Payer: Adventist Health Commercial |
$6.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$360.23
|
| Rate for Payer: Blue Shield of California Commercial |
$378.14
|
| Rate for Payer: Blue Shield of California EPN |
$303.30
|
| Rate for Payer: Cash Price |
$31.88
|
| Rate for Payer: Cash Price |
$31.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.68
|
| Rate for Payer: Dignity Health Senior |
$46.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.72
|
| Rate for Payer: EPIC Health Plan Medicare |
$46.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.73
|
| Rate for Payer: Heritage Provider Network Senior |
$19.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$46.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.19
|
| Rate for Payer: Multiplan Commercial |
$23.91
|
| Rate for Payer: TriValley Medical Group Commercial |
$46.98
|
| Rate for Payer: TriValley Medical Group Senior |
$46.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$50.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$50.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.68
|
| Rate for Payer: Vantage Medical Group Senior |
$46.98
|
|
|
HC SOM CD4 T-CELL TOTAL CT
|
Facility
|
IP
|
$29.87
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
900914708
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Adventist Health Commercial |
$5.97
|
| Rate for Payer: Cash Price |
$29.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.22
|
| Rate for Payer: Heritage Provider Network Senior |
$20.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.47
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
|
|
HC SOM CD4 T-CELL TOTAL CT
|
Facility
|
OP
|
$29.87
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
900914708
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$344.99 |
| Rate for Payer: Adventist Health Commercial |
$5.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$344.99
|
| Rate for Payer: Blue Shield of California Commercial |
$303.55
|
| Rate for Payer: Blue Shield of California EPN |
$243.47
|
| Rate for Payer: Cash Price |
$29.87
|
| Rate for Payer: Cash Price |
$29.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Senior |
$37.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.49
|
| Rate for Payer: Heritage Provider Network Senior |
$18.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$54.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.54
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.73
|
| Rate for Payer: TriValley Medical Group Senior |
$37.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$40.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$40.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC SOM C DIFF PCR STOOL
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
900914042
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.62
|
| Rate for Payer: Heritage Provider Network Senior |
$40.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
|
|
HC SOM C DIFF PCR STOOL
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
900914042
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$392.99 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$32.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$392.99
|
| Rate for Payer: Blue Shield of California Commercial |
$289.56
|
| Rate for Payer: Blue Shield of California EPN |
$232.25
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.00
|
| Rate for Payer: Dignity Health Senior |
$37.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.14
|
| Rate for Payer: Heritage Provider Network Senior |
$37.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$46.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.96
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.27
|
| Rate for Payer: TriValley Medical Group Senior |
$37.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$40.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$40.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.00
|
| Rate for Payer: Vantage Medical Group Senior |
$37.27
|
|
|
HC SOM CEA PANCREATIC CYST
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
900912997
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.46
|
| Rate for Payer: Heritage Provider Network Senior |
$30.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
|
|
HC SOM CEA PANCREATIC CYST
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
900912997
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$172.90
|
| Rate for Payer: Blue Shield of California Commercial |
$152.70
|
| Rate for Payer: Blue Shield of California EPN |
$122.48
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.86
|
| Rate for Payer: Dignity Health Senior |
$18.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.86
|
| Rate for Payer: Heritage Provider Network Senior |
$27.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.89
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.96
|
| Rate for Payer: TriValley Medical Group Senior |
$18.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.86
|
| Rate for Payer: Vantage Medical Group Senior |
$18.96
|
|
|
HC SOM CEA PERITONEAL FLUID
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
900914706
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$172.90
|
| Rate for Payer: Blue Shield of California Commercial |
$152.70
|
| Rate for Payer: Blue Shield of California EPN |
$122.48
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.86
|
| Rate for Payer: Dignity Health Senior |
$18.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.86
|
| Rate for Payer: Heritage Provider Network Senior |
$27.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.89
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.96
|
| Rate for Payer: TriValley Medical Group Senior |
$18.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.86
|
| Rate for Payer: Vantage Medical Group Senior |
$18.96
|
|
|
HC SOM CEA PERITONEAL FLUID
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
900914706
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.46
|
| Rate for Payer: Heritage Provider Network Senior |
$30.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
|
|
HC SOM CEA PLEURAL FLUID
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
900915434
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$172.90
|
| Rate for Payer: Blue Shield of California Commercial |
$152.70
|
| Rate for Payer: Blue Shield of California EPN |
$122.48
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.86
|
| Rate for Payer: Dignity Health Senior |
$18.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.86
|
| Rate for Payer: Heritage Provider Network Senior |
$27.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.89
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.96
|
| Rate for Payer: TriValley Medical Group Senior |
$18.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.86
|
| Rate for Payer: Vantage Medical Group Senior |
$18.96
|
|
|
HC SOM CEA PLEURAL FLUID
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
900915434
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.46
|
| Rate for Payer: Heritage Provider Network Senior |
$30.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
|
|
HC SOM CELIAC COMP HLA TYPING 1
|
Facility
|
IP
|
$85.17
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
900915327
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.42 |
| Max. Negotiated Rate |
$63.88 |
| Rate for Payer: Adventist Health Commercial |
$17.03
|
| Rate for Payer: Cash Price |
$85.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.66
|
| Rate for Payer: Heritage Provider Network Senior |
$57.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.29
|
| Rate for Payer: Multiplan Commercial |
$63.88
|
|
|
HC SOM CELIAC COMP HLA TYPING 1
|
Facility
|
OP
|
$85.17
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
900915327
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.42 |
| Max. Negotiated Rate |
$690.41 |
| Rate for Payer: Adventist Health Commercial |
$17.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$690.41
|
| Rate for Payer: Blue Shield of California Commercial |
$51.95
|
| Rate for Payer: Blue Shield of California EPN |
$41.56
|
| Rate for Payer: Cash Price |
$85.17
|
| Rate for Payer: Cash Price |
$85.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.44
|
| Rate for Payer: Dignity Health Senior |
$122.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.36
|
| Rate for Payer: EPIC Health Plan Medicare |
$122.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.72
|
| Rate for Payer: Heritage Provider Network Senior |
$52.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$176.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$40.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$154.00
|
| Rate for Payer: Multiplan Commercial |
$63.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$122.22
|
| Rate for Payer: TriValley Medical Group Senior |
$122.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$132.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$132.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Vantage Medical Group Senior |
$122.22
|
|
|
HC SOM CELIAC COMP HLA TYPING 2
|
Facility
|
IP
|
$85.18
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
900915328
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.42 |
| Max. Negotiated Rate |
$63.88 |
| Rate for Payer: Adventist Health Commercial |
$17.04
|
| Rate for Payer: Cash Price |
$85.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.67
|
| Rate for Payer: Heritage Provider Network Senior |
$57.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.30
|
| Rate for Payer: Multiplan Commercial |
$63.88
|
|
|
HC SOM CELIAC COMP HLA TYPING 2
|
Facility
|
OP
|
$85.18
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
900915328
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.42 |
| Max. Negotiated Rate |
$690.41 |
| Rate for Payer: Adventist Health Commercial |
$17.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$690.41
|
| Rate for Payer: Blue Shield of California Commercial |
$51.96
|
| Rate for Payer: Blue Shield of California EPN |
$41.57
|
| Rate for Payer: Cash Price |
$85.18
|
| Rate for Payer: Cash Price |
$85.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.44
|
| Rate for Payer: Dignity Health Senior |
$122.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.37
|
| Rate for Payer: EPIC Health Plan Medicare |
$122.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.73
|
| Rate for Payer: Heritage Provider Network Senior |
$52.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$176.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$40.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$154.00
|
| Rate for Payer: Multiplan Commercial |
$63.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$122.22
|
| Rate for Payer: TriValley Medical Group Senior |
$122.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$132.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$132.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Vantage Medical Group Senior |
$122.22
|
|
|
HC SOM CELIAC COMP IGA
|
Facility
|
OP
|
$6.48
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900914382
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$74.82 |
| Rate for Payer: Adventist Health Commercial |
$1.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.74
|
| Rate for Payer: Blue Shield of California Commercial |
$74.82
|
| Rate for Payer: Blue Shield of California EPN |
$60.01
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Senior |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.21
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.01
|
| Rate for Payer: Heritage Provider Network Senior |
$4.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.72
|
| Rate for Payer: Multiplan Commercial |
$4.86
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.30
|
| Rate for Payer: TriValley Medical Group Senior |
$9.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Senior |
$9.30
|
|
|
HC SOM CELIAC COMP IGA
|
Facility
|
IP
|
$6.48
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900914382
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$4.86 |
| Rate for Payer: Adventist Health Commercial |
$1.30
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.39
|
| Rate for Payer: Heritage Provider Network Senior |
$4.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
| Rate for Payer: Multiplan Commercial |
$4.86
|
|
|
HC SOM CERULOPLASMIN
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
900915329
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.12
|
| Rate for Payer: Heritage Provider Network Senior |
$8.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
|
|
HC SOM CERULOPLASMIN
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
900915329
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$98.03 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.03
|
| Rate for Payer: Blue Shield of California Commercial |
$86.46
|
| Rate for Payer: Blue Shield of California EPN |
$69.35
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.81
|
| Rate for Payer: Dignity Health Senior |
$10.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.43
|
| Rate for Payer: Heritage Provider Network Senior |
$7.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.53
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.74
|
| Rate for Payer: TriValley Medical Group Senior |
$10.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
|
|
HC SOM CHESTNUT IGE
|
Facility
|
OP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914685
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$144.32 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.32
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.86
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.62
|
| Rate for Payer: Heritage Provider Network Senior |
$4.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SOM CHESTNUT IGE
|
Facility
|
IP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914685
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.06
|
| Rate for Payer: Heritage Provider Network Senior |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
|
