|
HC SOA 55284 CYSTICER AB IGG
|
Facility
|
OP
|
$59.10
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900914796
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$124.65 |
| Rate for Payer: Adventist Health Commercial |
$11.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.52
|
| 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 |
$124.65
|
| 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 |
$26.60
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.87
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.58
|
| Rate for Payer: Heritage Provider Network Senior |
$36.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.43
|
| Rate for Payer: Multiplan Commercial |
$44.33
|
| 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 SOA 837 CEL MODY8 MUT
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914773
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$135.75 |
| Max. Negotiated Rate |
$1,420.92 |
| Rate for Payer: Adventist Health Commercial |
$150.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$463.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,420.92
|
| Rate for Payer: Blue Shield of California Commercial |
$457.50
|
| Rate for Payer: Blue Shield of California EPN |
$366.00
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$487.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$185.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$487.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$185.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$464.25
|
| Rate for Payer: Heritage Provider Network Senior |
$464.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$185.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$357.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$135.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$212.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$248.17
|
| Rate for Payer: Multiplan Commercial |
$562.50
|
| 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 SOA 837 CEL MODY8 MUT
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914773
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$135.75 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Adventist Health Commercial |
$150.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$483.00
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$507.75
|
| Rate for Payer: Heritage Provider Network Senior |
$507.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$135.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.50
|
| Rate for Payer: Multiplan Commercial |
$562.50
|
|
|
HC SOA 885 MONOGEN EVL 81405
|
Facility
|
IP
|
$1,053.75
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914774
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$190.73 |
| Max. Negotiated Rate |
$790.31 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$678.62
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$713.39
|
| Rate for Payer: Heritage Provider Network Senior |
$713.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$190.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.44
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
|
|
HC SOA 885 MONOGEN EVL 81405
|
Facility
|
OP
|
$1,053.75
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914774
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$190.73 |
| Max. Negotiated Rate |
$2,237.65 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$651.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$331.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$301.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,237.65
|
| Rate for Payer: Blue Shield of California Commercial |
$642.79
|
| Rate for Payer: Blue Shield of California EPN |
$514.23
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$684.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$452.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$331.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$301.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$301.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$652.27
|
| Rate for Payer: Heritage Provider Network Senior |
$652.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$301.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$502.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$190.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$346.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$403.81
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$301.35
|
| Rate for Payer: TriValley Medical Group Senior |
$301.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$325.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$325.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$331.49
|
| Rate for Payer: Vantage Medical Group Senior |
$301.35
|
|
|
HC SOA 885 MONOGEN EVL 81406
|
Facility
|
OP
|
$1,053.75
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914775
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$190.73 |
| Max. Negotiated Rate |
$2,282.53 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$651.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$282.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,282.53
|
| Rate for Payer: Blue Shield of California Commercial |
$642.79
|
| Rate for Payer: Blue Shield of California EPN |
$514.23
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$684.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$424.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$282.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$282.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$652.27
|
| Rate for Payer: Heritage Provider Network Senior |
$652.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$282.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$502.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$190.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$325.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$379.06
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$282.88
|
| Rate for Payer: TriValley Medical Group Senior |
$282.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$305.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$305.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: Vantage Medical Group Senior |
$282.88
|
|
|
HC SOA 885 MONOGEN EVL 81406
|
Facility
|
IP
|
$1,053.75
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914775
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$190.73 |
| Max. Negotiated Rate |
$790.31 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$678.62
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$713.39
|
| Rate for Payer: Heritage Provider Network Senior |
$713.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$190.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.44
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
|
|
HC SOA 885 MONOGEN EVL 81479
|
Facility
|
IP
|
$1,053.75
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914776
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$190.73 |
| Max. Negotiated Rate |
$790.31 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$678.62
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$713.39
|
| Rate for Payer: Heritage Provider Network Senior |
$713.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$190.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.44
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
|
|
HC SOA 885 MONOGEN EVL 81479
|
Facility
|
OP
|
$1,053.75
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914776
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$190.73 |
| Max. Negotiated Rate |
$895.69 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$651.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$895.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$579.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$790.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$527.09
|
| Rate for Payer: Blue Shield of California Commercial |
$642.79
|
| Rate for Payer: Blue Shield of California EPN |
$514.23
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$684.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$895.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$895.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$895.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$652.27
|
| Rate for Payer: Heritage Provider Network Senior |
$652.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$502.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$190.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$737.62
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$526.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$895.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$895.69
|
| Rate for Payer: Vantage Medical Group Senior |
$895.69
|
|
|
HC SO ACROMIO/CLAVICULAR
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT L3670
|
| Hospital Charge Code |
901309109
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$160.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$100.10
|
| Rate for Payer: Blue Shield of California EPN |
$100.10
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$114.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.29
|
| Rate for Payer: Heritage Provider Network Senior |
$115.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$124.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$124.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$124.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.25
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$89.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$82.44
|
|
|
HC SO ACROMIO/CLAVICULAR
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT L3670
|
| Hospital Charge Code |
901309109
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.25 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$102.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$153.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$100.10
|
| Rate for Payer: Blue Shield of California EPN |
$100.10
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$114.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$211.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.29
|
| Rate for Payer: Heritage Provider Network Senior |
$115.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$124.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$124.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$124.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$174.30
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$89.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$82.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
|
HC SOCC FANCONI COMPLEM ASSAY
|
Facility
|
IP
|
$1,699.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914675
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$307.52 |
| Max. Negotiated Rate |
$1,274.25 |
| Rate for Payer: Adventist Health Commercial |
$339.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,094.16
|
| Rate for Payer: Cash Price |
$764.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,150.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,150.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$307.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.75
|
| Rate for Payer: Multiplan Commercial |
$1,274.25
|
|
|
HC SOCC FANCONI COMPLEM ASSAY
|
Facility
|
OP
|
$1,699.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914675
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$307.52 |
| Max. Negotiated Rate |
$1,444.15 |
| Rate for Payer: Adventist Health Commercial |
$339.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,049.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,444.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$934.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,274.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$849.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,036.39
|
| Rate for Payer: Blue Shield of California EPN |
$829.11
|
| Rate for Payer: Cash Price |
$764.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,104.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,444.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,444.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,444.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,104.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,051.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,051.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$810.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$307.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,189.30
|
| Rate for Payer: Multiplan Commercial |
$1,274.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$849.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$849.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,444.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,444.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,444.15
|
|
|
HC SOCDX ALLOSURE COLLECTION
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900915321
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$93.13 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.13
|
| Rate for Payer: Blue Shield of California Commercial |
$18.30
|
| Rate for Payer: Blue Shield of California EPN |
$14.64
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.57
|
| Rate for Payer: Heritage Provider Network Senior |
$18.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
|
|
HC SOCDX ALLOSURE COLLECTION
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900915321
|
|
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: Aetna of CA Non-Gatekeeper |
$19.32
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.31
|
| Rate for Payer: Heritage Provider Network Senior |
$20.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
|
|
HC SOCIDEM PDC 82657
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900915254
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$22.17 |
| Max. Negotiated Rate |
$170.74 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.74
|
| Rate for Payer: Blue Shield of California Commercial |
$145.32
|
| Rate for Payer: Blue Shield of California EPN |
$116.56
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$97.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.85
|
| Rate for Payer: Heritage Provider Network Senior |
$92.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$71.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.71
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.17
|
| Rate for Payer: TriValley Medical Group Senior |
$22.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22.17
|
|
|
HC SOCIDEM PDC 82657
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900915254
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.60
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.55
|
| Rate for Payer: Heritage Provider Network Senior |
$101.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
|
|
HC SOCIDEM PDC 82658
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 82658
|
| Hospital Charge Code |
900915255
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$170.74 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.74
|
| Rate for Payer: Blue Shield of California Commercial |
$145.32
|
| Rate for Payer: Blue Shield of California EPN |
$116.56
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$97.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$44.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.85
|
| Rate for Payer: Heritage Provider Network Senior |
$92.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$44.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$71.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$59.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$44.03
|
| Rate for Payer: TriValley Medical Group Senior |
$44.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$47.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$47.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.43
|
| Rate for Payer: Vantage Medical Group Senior |
$44.03
|
|
|
HC SOCIDEM PDC 82658
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 82658
|
| Hospital Charge Code |
900915255
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.60
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.55
|
| Rate for Payer: Heritage Provider Network Senior |
$101.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
|
|
HC SOCIDEM PDC 84157
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
900915256
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.60
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.55
|
| Rate for Payer: Heritage Provider Network Senior |
$101.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
|
|
HC SOCIDEM PDC 84157
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
900915256
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.90
|
| Rate for Payer: Blue Shield of California Commercial |
$29.49
|
| Rate for Payer: Blue Shield of California EPN |
$23.65
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$97.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.85
|
| Rate for Payer: Heritage Provider Network Senior |
$92.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$71.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.36
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.00
|
| Rate for Payer: TriValley Medical Group Senior |
$4.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4.00
|
|
|
HC SOCIDEM PDC 84999
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900915253
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.02
|
| Rate for Payer: Blue Shield of California Commercial |
$73.20
|
| Rate for Payer: Blue Shield of California EPN |
$58.56
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.28
|
| Rate for Payer: Heritage Provider Network Senior |
$74.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$57.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$60.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$60.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC SOCIDEM PDC 84999
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900915253
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.28
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.24
|
| Rate for Payer: Heritage Provider Network Senior |
$81.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
|
|
HC SOCINN 558 PRF1 GENE
|
Facility
|
OP
|
$2,371.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914743
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$429.15 |
| Max. Negotiated Rate |
$2,015.35 |
| Rate for Payer: Adventist Health Commercial |
$474.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,465.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,015.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,304.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,778.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,185.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,446.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,157.05
|
| Rate for Payer: Cash Price |
$1,066.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,541.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,015.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,015.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,015.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,467.65
|
| Rate for Payer: Heritage Provider Network Senior |
$1,467.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,130.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$429.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$592.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,659.70
|
| Rate for Payer: Multiplan Commercial |
$1,778.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,185.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,185.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,015.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,015.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,015.35
|
|
|
HC SOCINN 558 PRF1 GENE
|
Facility
|
IP
|
$2,371.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914743
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$429.15 |
| Max. Negotiated Rate |
$1,778.25 |
| Rate for Payer: Adventist Health Commercial |
$474.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,526.92
|
| Rate for Payer: Cash Price |
$1,066.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,605.17
|
| Rate for Payer: Heritage Provider Network Senior |
$1,605.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$429.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$592.75
|
| Rate for Payer: Multiplan Commercial |
$1,778.25
|
|
