|
HC SOM CRYOFIBRINOGEN CRYOGLOBULIN
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
900912819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.77
|
| Rate for Payer: Heritage Provider Network Senior |
$6.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
|
|
HC SOM CRYPTOSPORIDIUM AG, F
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
900912939
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: 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 Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
|
|
HC SOM CRYPTOSPORIDIUM AG, F
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
900912939
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$82.05 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.05
|
| 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 |
$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 |
$20.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.20
|
| Rate for Payer: Dignity Health Senior |
$13.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.82
|
| 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) Medi-Cal |
$13.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.41
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.82
|
| Rate for Payer: TriValley Medical Group Senior |
$13.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.20
|
| Rate for Payer: Vantage Medical Group Senior |
$13.82
|
|
|
HC SOM CSF IGG INDEX ALB CSF
|
Facility
|
OP
|
$8.66
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
900914411
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$47.20 |
| Rate for Payer: Adventist Health Commercial |
$1.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.20
|
| Rate for Payer: Blue Shield of California Commercial |
$41.64
|
| Rate for Payer: Blue Shield of California EPN |
$33.40
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.56
|
| Rate for Payer: Dignity Health Senior |
$7.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.36
|
| Rate for Payer: Heritage Provider Network Senior |
$5.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$6.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.78
|
| Rate for Payer: TriValley Medical Group Senior |
$7.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Vantage Medical Group Senior |
$7.78
|
|
|
HC SOM CSF IGG INDEX ALB CSF
|
Facility
|
IP
|
$8.66
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
900914411
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Adventist Health Commercial |
$1.73
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.86
|
| Rate for Payer: Heritage Provider Network Senior |
$5.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.17
|
| Rate for Payer: Multiplan Commercial |
$6.50
|
|
|
HC SOM CSF IGG INDEX ALB S
|
Facility
|
OP
|
$5.51
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
900914410
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$45.24 |
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.24
|
| Rate for Payer: Blue Shield of California Commercial |
$39.86
|
| Rate for Payer: Blue Shield of California EPN |
$31.97
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.45
|
| Rate for Payer: Dignity Health Senior |
$4.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.58
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.41
|
| Rate for Payer: Heritage Provider Network Senior |
$3.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$4.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.95
|
| Rate for Payer: TriValley Medical Group Senior |
$4.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4.95
|
|
|
HC SOM CSF IGG INDEX ALB S
|
Facility
|
IP
|
$5.51
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
900914410
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.73
|
| Rate for Payer: Heritage Provider Network Senior |
$3.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$4.13
|
|
|
HC SOM CSF IGG INDEX IGG, S
|
Facility
|
OP
|
$10.35
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900914409
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$74.82 |
| Rate for Payer: Adventist Health Commercial |
$2.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.11
|
| 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 |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.73
|
| 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 |
$6.73
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.41
|
| Rate for Payer: Heritage Provider Network Senior |
$6.41
|
| 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 |
$4.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| 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 |
$7.76
|
| 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 CSF IGG INDEX IGG, S
|
Facility
|
IP
|
$10.35
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900914409
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: Adventist Health Commercial |
$2.07
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.01
|
| Rate for Payer: Heritage Provider Network Senior |
$7.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$7.76
|
|
|
HC SOM C-TELOPEPTIDE
|
Facility
|
IP
|
$19.34
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
900912783
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$14.51 |
| Rate for Payer: Adventist Health Commercial |
$3.87
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.09
|
| Rate for Payer: Heritage Provider Network Senior |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.83
|
| Rate for Payer: Multiplan Commercial |
$14.51
|
|
|
HC SOM C-TELOPEPTIDE
|
Facility
|
OP
|
$19.34
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
900912783
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$251.57 |
| Rate for Payer: Adventist Health Commercial |
$3.87
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$251.57
|
| Rate for Payer: Blue Shield of California Commercial |
$149.24
|
| Rate for Payer: Blue Shield of California EPN |
$119.70
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.55
|
| Rate for Payer: Dignity Health Senior |
$18.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.57
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.97
|
| Rate for Payer: Heritage Provider Network Senior |
$11.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.54
|
| Rate for Payer: Multiplan Commercial |
$14.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.68
|
| Rate for Payer: TriValley Medical Group Senior |
$18.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.55
|
| Rate for Payer: Vantage Medical Group Senior |
$18.68
|
|
|
HC SOM C. TRACHOMATIS, IGG
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
900912801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.74
|
| Rate for Payer: Heritage Provider Network Senior |
$4.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$5.25
|
|
|
HC SOM C. TRACHOMATIS, IGG
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
900912801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$117.82 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.82
|
| Rate for Payer: Blue Shield of California Commercial |
$95.16
|
| Rate for Payer: Blue Shield of California EPN |
$76.32
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.00
|
| Rate for Payer: Dignity Health Senior |
$11.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.33
|
| Rate for Payer: Heritage Provider Network Senior |
$4.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.89
|
| Rate for Payer: Multiplan Commercial |
$5.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.82
|
| Rate for Payer: TriValley Medical Group Senior |
$11.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11.82
|
|
|
HC SOM C. TRACHOMATIS IGM
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912799
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$117.82 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.82
|
| Rate for Payer: Blue Shield of California Commercial |
$102.18
|
| Rate for Payer: Blue Shield of California EPN |
$81.96
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.95
|
| Rate for Payer: Dignity Health Senior |
$12.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.33
|
| Rate for Payer: Heritage Provider Network Senior |
$4.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.98
|
| Rate for Payer: Multiplan Commercial |
$5.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.68
|
| Rate for Payer: TriValley Medical Group Senior |
$12.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.95
|
| Rate for Payer: Vantage Medical Group Senior |
$12.68
|
|
|
HC SOM C. TRACHOMATIS IGM
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912799
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.74
|
| Rate for Payer: Heritage Provider Network Senior |
$4.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$5.25
|
|
|
HC SOM CUCRU 82525
|
Facility
|
IP
|
$85.80
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900914747
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.53 |
| Max. Negotiated Rate |
$64.35 |
| Rate for Payer: Adventist Health Commercial |
$17.16
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.09
|
| Rate for Payer: Heritage Provider Network Senior |
$58.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.45
|
| Rate for Payer: Multiplan Commercial |
$64.35
|
|
|
HC SOM CUCRU 82525
|
Facility
|
OP
|
$85.80
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900914747
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.41 |
| Max. Negotiated Rate |
$113.58 |
| Rate for Payer: Adventist Health Commercial |
$17.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.58
|
| Rate for Payer: Blue Shield of California Commercial |
$99.88
|
| Rate for Payer: Blue Shield of California EPN |
$80.11
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.65
|
| Rate for Payer: Dignity Health Senior |
$12.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.77
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.11
|
| Rate for Payer: Heritage Provider Network Senior |
$53.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$40.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.64
|
| Rate for Payer: Multiplan Commercial |
$64.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.41
|
| Rate for Payer: TriValley Medical Group Senior |
$12.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Vantage Medical Group Senior |
$12.41
|
|
|
HC SOM CULTURE 05
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900915288
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$131.25 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.47
|
| Rate for Payer: Heritage Provider Network Senior |
$118.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.75
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
|
|
HC SOM CULTURE 05
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900915288
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$1,303.26 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$93.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,303.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,187.25
|
| Rate for Payer: Blue Shield of California EPN |
$952.27
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$113.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.27
|
| Rate for Payer: Dignity Health Senior |
$147.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$147.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.33
|
| Rate for Payer: Heritage Provider Network Senior |
$108.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$212.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$147.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$83.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.88
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$147.52
|
| Rate for Payer: TriValley Medical Group Senior |
$147.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$159.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$159.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Vantage Medical Group Senior |
$147.52
|
|
|
HC SOM CYSTATIN C WITH EGFR, S
|
Facility
|
OP
|
$37.23
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
900915362
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$124.16 |
| Rate for Payer: Adventist Health Commercial |
$7.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.16
|
| Rate for Payer: Blue Shield of California Commercial |
$109.44
|
| Rate for Payer: Blue Shield of California EPN |
$87.78
|
| Rate for Payer: Cash Price |
$37.23
|
| Rate for Payer: Cash Price |
$37.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.37
|
| Rate for Payer: Dignity Health Senior |
$18.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.05
|
| Rate for Payer: Heritage Provider Network Senior |
$23.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.34
|
| Rate for Payer: Multiplan Commercial |
$27.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.52
|
| Rate for Payer: TriValley Medical Group Senior |
$18.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.37
|
| Rate for Payer: Vantage Medical Group Senior |
$18.52
|
|
|
HC SOM CYSTATIN C WITH EGFR, S
|
Facility
|
IP
|
$37.23
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
900915362
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$27.92 |
| Rate for Payer: Adventist Health Commercial |
$7.45
|
| Rate for Payer: Cash Price |
$37.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.20
|
| Rate for Payer: Heritage Provider Network Senior |
$25.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.31
|
| Rate for Payer: Multiplan Commercial |
$27.92
|
|
|
HC SOM CYSTICERCOSIS AB BLOOD
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911763
|
|
Hospital Revenue Code
|
302
|
| 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 CYSTICERCOSIS AB BLOOD
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911763
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$119.85 |
| 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 |
$19.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.85
|
| Rate for Payer: Blue Shield of California Commercial |
$104.66
|
| Rate for Payer: Blue Shield of California EPN |
$83.95
|
| 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 |
$19.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: Dignity Health Senior |
$13.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.01
|
| 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 |
$18.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.01
|
| 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 |
$14.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.39
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.01
|
| Rate for Payer: TriValley Medical Group Senior |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13.01
|
|
|
HC SOM CYSTICERCOSIS AB CSF
|
Facility
|
IP
|
$122.89
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911345
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.24 |
| Max. Negotiated Rate |
$92.17 |
| Rate for Payer: Adventist Health Commercial |
$24.58
|
| Rate for Payer: Cash Price |
$122.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.20
|
| Rate for Payer: Heritage Provider Network Senior |
$83.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Multiplan Commercial |
$92.17
|
|
|
HC SOM CYSTICERCOSIS AB CSF
|
Facility
|
OP
|
$122.89
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911345
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$119.85 |
| Rate for Payer: Adventist Health Commercial |
$24.58
|
| Rate for Payer: Aetna of CA Gatekeeper |
$65.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$84.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.85
|
| Rate for Payer: Blue Shield of California Commercial |
$104.66
|
| Rate for Payer: Blue Shield of California EPN |
$83.95
|
| Rate for Payer: Cash Price |
$122.89
|
| Rate for Payer: Cash Price |
$122.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$79.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: Dignity Health Senior |
$13.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.07
|
| Rate for Payer: Heritage Provider Network Senior |
$76.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$58.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.39
|
| Rate for Payer: Multiplan Commercial |
$92.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.01
|
| Rate for Payer: TriValley Medical Group Senior |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13.01
|
|
