|
HC SOM ARYLSULFATASE A, URINE
|
Facility
IP
|
$125.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900910723
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.62
|
| Rate for Payer: Heritage Provider Network Senior |
$84.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
|
|
HC SOM ASPERGILLUS(GALACT)ANTIGEN
|
Facility
IP
|
$20.00
|
|
|
Service Code
|
CPT 87305
|
| Hospital Charge Code |
900912574
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC SOM ASPERGILLUS(GALACT)ANTIGEN
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
CPT 87305
|
| Hospital Charge Code |
900912574
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$76.07 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.07
|
| Rate for Payer: Blue Shield of California Commercial |
$72.56
|
| Rate for Payer: Blue Shield of California EPN |
$56.72
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Humana Medicare |
$11.98
|
| Rate for Payer: IEHP Medi-Cal |
$13.51
|
| Rate for Payer: IEHP Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.09
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC SOM ATIVAN
|
Facility
OP
|
$63.59
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$148.48 |
| Rate for Payer: Adventist Health Commercial |
$12.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$54.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$34.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$47.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.48
|
| Rate for Payer: Cash Price |
$28.62
|
| Rate for Payer: Cash Price |
$28.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.05
|
| Rate for Payer: Dignity Health Senior |
$54.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.36
|
| Rate for Payer: Heritage Provider Network Senior |
$39.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.90
|
| Rate for Payer: Multiplan Commercial |
$47.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.05
|
| Rate for Payer: Vantage Medical Group Senior |
$54.05
|
|
|
HC SOM ATIVAN
|
Facility
IP
|
$63.59
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$47.69 |
| Rate for Payer: Adventist Health Commercial |
$12.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.69
|
| Rate for Payer: Cash Price |
$28.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.05
|
| Rate for Payer: Heritage Provider Network Senior |
$43.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.90
|
| Rate for Payer: Multiplan Commercial |
$47.69
|
|
|
HC SOM BACLOFEN 83789
|
Facility
IP
|
$319.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900915259
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$239.25 |
| Rate for Payer: Adventist Health Commercial |
$63.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$219.15
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$215.96
|
| Rate for Payer: Heritage Provider Network Senior |
$215.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.75
|
| Rate for Payer: Multiplan Commercial |
$239.25
|
|
|
HC SOM BACLOFEN 83789
|
Facility
OP
|
$319.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900915259
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$239.25 |
| Rate for Payer: Adventist Health Commercial |
$63.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$219.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.51
|
| Rate for Payer: Blue Shield of California Commercial |
$141.04
|
| Rate for Payer: Blue Shield of California EPN |
$110.26
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$207.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.52
|
| Rate for Payer: Dignity Health Senior |
$24.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$197.46
|
| Rate for Payer: Heritage Provider Network Senior |
$197.46
|
| Rate for Payer: Humana Medicare |
$24.11
|
| Rate for Payer: IEHP Medi-Cal |
$25.49
|
| Rate for Payer: IEHP Medicare Advantage |
$24.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.38
|
| Rate for Payer: Multiplan Commercial |
$239.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.11
|
| Rate for Payer: TriValley Medical Group Senior |
$24.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Vantage Medical Group Senior |
$24.11
|
|
|
HC SOM BARBITURATE CONFIRM, U
|
Facility
OP
|
$61.25
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900912916
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$91.96 |
| Rate for Payer: Adventist Health Commercial |
$12.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$33.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$45.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.96
|
| Rate for Payer: Cash Price |
$27.56
|
| Rate for Payer: Cash Price |
$27.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.06
|
| Rate for Payer: Dignity Health Senior |
$52.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.91
|
| Rate for Payer: Heritage Provider Network Senior |
$37.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.31
|
| Rate for Payer: Multiplan Commercial |
$45.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.06
|
| Rate for Payer: Vantage Medical Group Senior |
$52.06
|
|
|
HC SOM BARBITURATE CONFIRM, U
|
Facility
IP
|
$61.25
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900912916
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$45.94 |
| Rate for Payer: Adventist Health Commercial |
$12.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.08
|
| Rate for Payer: Cash Price |
$27.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.47
|
| Rate for Payer: Heritage Provider Network Senior |
$41.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.31
|
| Rate for Payer: Multiplan Commercial |
$45.94
|
|
|
HC SOM BARTONELLA HENSELAE AB IGG
|
Facility
OP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900911386
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$85.09 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.09
|
| Rate for Payer: Blue Shield of California Commercial |
$79.49
|
| Rate for Payer: Blue Shield of California EPN |
$62.14
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Senior |
$10.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.08
|
| Rate for Payer: Heritage Provider Network Senior |
$6.08
|
| Rate for Payer: Humana Medicare |
$10.18
|
| Rate for Payer: IEHP Medi-Cal |
$14.12
|
| Rate for Payer: IEHP Medicare Advantage |
$10.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.83
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.18
|
| Rate for Payer: TriValley Medical Group Senior |
$10.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
HC SOM BARTONELLA HENSELAE AB IGG
|
Facility
IP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900911386
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$7.37 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.75
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.65
|
| Rate for Payer: Heritage Provider Network Senior |
$6.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
|
|
HC SOM BARTONELLA HENSELAE AB IGM
|
Facility
OP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900912690
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$85.09 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.09
|
| Rate for Payer: Blue Shield of California Commercial |
$79.49
|
| Rate for Payer: Blue Shield of California EPN |
$62.14
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Senior |
$10.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.08
|
| Rate for Payer: Heritage Provider Network Senior |
$6.08
|
| Rate for Payer: Humana Medicare |
$10.18
|
| Rate for Payer: IEHP Medi-Cal |
$14.12
|
| Rate for Payer: IEHP Medicare Advantage |
$10.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.83
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.18
|
| Rate for Payer: TriValley Medical Group Senior |
$10.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
HC SOM BARTONELLA HENSELAE AB IGM
|
Facility
IP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900912690
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$7.37 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.75
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.65
|
| Rate for Payer: Heritage Provider Network Senior |
$6.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
|
|
HC SOM BARTONELLA QUINTANA AB IGG
|
Facility
IP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900912691
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$7.37 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.75
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.65
|
| Rate for Payer: Heritage Provider Network Senior |
$6.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
|
|
HC SOM BARTONELLA QUINTANA AB IGG
|
Facility
OP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900912691
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$85.09 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.09
|
| Rate for Payer: Blue Shield of California Commercial |
$79.49
|
| Rate for Payer: Blue Shield of California EPN |
$62.14
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Senior |
$10.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.08
|
| Rate for Payer: Heritage Provider Network Senior |
$6.08
|
| Rate for Payer: Humana Medicare |
$10.18
|
| Rate for Payer: IEHP Medi-Cal |
$14.12
|
| Rate for Payer: IEHP Medicare Advantage |
$10.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.83
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.18
|
| Rate for Payer: TriValley Medical Group Senior |
$10.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
HC SOM BARTONELLA QUINTANA AB IGM
|
Facility
IP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900912692
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$7.37 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.75
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.65
|
| Rate for Payer: Heritage Provider Network Senior |
$6.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
|
|
HC SOM BARTONELLA QUINTANA AB IGM
|
Facility
OP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900912692
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$85.09 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.09
|
| Rate for Payer: Blue Shield of California Commercial |
$79.49
|
| Rate for Payer: Blue Shield of California EPN |
$62.14
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Senior |
$10.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.08
|
| Rate for Payer: Heritage Provider Network Senior |
$6.08
|
| Rate for Payer: Humana Medicare |
$10.18
|
| Rate for Payer: IEHP Medi-Cal |
$14.12
|
| Rate for Payer: IEHP Medicare Advantage |
$10.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.83
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.18
|
| Rate for Payer: TriValley Medical Group Senior |
$10.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
HC SOM B-CELL LYMPH FISH INTERP
|
Facility
IP
|
$254.50
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914116
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$46.06 |
| Max. Negotiated Rate |
$190.88 |
| Rate for Payer: Adventist Health Commercial |
$50.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$174.84
|
| Rate for Payer: Cash Price |
$114.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.30
|
| Rate for Payer: Heritage Provider Network Senior |
$172.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.62
|
| Rate for Payer: Multiplan Commercial |
$190.88
|
|
|
HC SOM B-CELL LYMPH FISH INTERP
|
Facility
OP
|
$254.50
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914116
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$216.32 |
| Rate for Payer: Adventist Health Commercial |
$50.90
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$174.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$216.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$139.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$190.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.37
|
| Rate for Payer: Blue Shield of California Commercial |
$158.04
|
| Rate for Payer: Blue Shield of California EPN |
$149.39
|
| Rate for Payer: Cash Price |
$114.53
|
| Rate for Payer: Cash Price |
$114.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$165.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.32
|
| Rate for Payer: Dignity Health Senior |
$216.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.54
|
| Rate for Payer: Heritage Provider Network Senior |
$157.54
|
| Rate for Payer: IEHP Medi-Cal |
$21.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$122.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.62
|
| Rate for Payer: Multiplan Commercial |
$190.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.32
|
| Rate for Payer: Vantage Medical Group Senior |
$216.32
|
|
|
HC SOM BCR ABL MUTAT ASPE
|
Facility
OP
|
$435.08
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914536
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$1,252.63 |
| Rate for Payer: Adventist Health Commercial |
$87.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$145.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$298.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$185.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,252.63
|
| Rate for Payer: Blue Shield of California Commercial |
$270.18
|
| Rate for Payer: Blue Shield of California EPN |
$255.39
|
| Rate for Payer: Cash Price |
$195.79
|
| Rate for Payer: Cash Price |
$195.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$282.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.72
|
| Rate for Payer: Dignity Health Senior |
$185.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$185.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$269.31
|
| Rate for Payer: Heritage Provider Network Senior |
$269.31
|
| Rate for Payer: Humana Medicare |
$185.20
|
| Rate for Payer: IEHP Medi-Cal |
$288.91
|
| Rate for Payer: IEHP Medicare Advantage |
$185.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$351.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$218.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$233.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$233.35
|
| Rate for Payer: Multiplan Commercial |
$326.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$185.20
|
| Rate for Payer: TriValley Medical Group Senior |
$185.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$200.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$200.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Vantage Medical Group Senior |
$185.20
|
|
|
HC SOM BCR ABL MUTAT ASPE
|
Facility
IP
|
$435.08
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914536
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$326.31 |
| Rate for Payer: Adventist Health Commercial |
$87.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$298.90
|
| Rate for Payer: Cash Price |
$195.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$294.55
|
| Rate for Payer: Heritage Provider Network Senior |
$294.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.77
|
| Rate for Payer: Multiplan Commercial |
$326.31
|
|
|
HC SOM BCR/ABL P210 QN MON
|
Facility
IP
|
$200.00
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
900914648
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.40
|
| Rate for Payer: Heritage Provider Network Senior |
$135.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
|
|
HC SOM BCR/ABL P210 QN MON
|
Facility
OP
|
$200.00
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
900914648
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$338.05 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$142.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$245.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$180.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$163.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$338.05
|
| Rate for Payer: Blue Shield of California Commercial |
$124.20
|
| Rate for Payer: Blue Shield of California EPN |
$117.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.36
|
| Rate for Payer: Dignity Health Senior |
$163.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.80
|
| Rate for Payer: Heritage Provider Network Senior |
$123.80
|
| Rate for Payer: Humana Medicare |
$163.96
|
| Rate for Payer: IEHP Medi-Cal |
$135.25
|
| Rate for Payer: IEHP Medicare Advantage |
$163.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$311.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$193.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.59
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$163.96
|
| Rate for Payer: TriValley Medical Group Senior |
$163.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$177.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$177.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.36
|
| Rate for Payer: Vantage Medical Group Senior |
$163.96
|
|
|
HC SOM BENZODIAZEPINE CONFIRM, U
|
Facility
OP
|
$36.96
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900912915
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$148.48 |
| Rate for Payer: Adventist Health Commercial |
$7.39
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.48
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.42
|
| Rate for Payer: Dignity Health Senior |
$31.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.88
|
| Rate for Payer: Heritage Provider Network Senior |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$27.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.42
|
| Rate for Payer: Vantage Medical Group Senior |
$31.42
|
|
|
HC SOM BENZODIAZEPINE CONFIRM, U
|
Facility
IP
|
$36.96
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900912915
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.69 |
| Max. Negotiated Rate |
$27.72 |
| Rate for Payer: Adventist Health Commercial |
$7.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.39
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.02
|
| Rate for Payer: Heritage Provider Network Senior |
$25.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$27.72
|
|
