|
HC SOM 199PC 86301
|
Facility
|
OP
|
$29.81
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
900914879
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$197.46 |
| Rate for Payer: Adventist Health Commercial |
$5.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.46
|
| Rate for Payer: Blue Shield of California Commercial |
$167.44
|
| Rate for Payer: Blue Shield of California EPN |
$134.30
|
| Rate for Payer: Cash Price |
$29.81
|
| Rate for Payer: Cash Price |
$29.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.45
|
| Rate for Payer: Heritage Provider Network Senior |
$18.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.89
|
| Rate for Payer: Multiplan Commercial |
$22.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.81
|
| Rate for Payer: TriValley Medical Group Senior |
$20.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC SOM 199PC 86301
|
Facility
|
IP
|
$29.81
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
900914879
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Adventist Health Commercial |
$5.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.20
|
| Rate for Payer: Cash Price |
$29.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.18
|
| Rate for Payer: Heritage Provider Network Senior |
$20.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.45
|
| Rate for Payer: Multiplan Commercial |
$22.36
|
|
|
HC SOM 22FP 88271 MULTIPLE
|
Facility
|
IP
|
$19.22
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914753
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$14.41 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.38
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.01
|
| Rate for Payer: Heritage Provider Network Senior |
$13.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$14.41
|
|
|
HC SOM 22FP 88271 MULTIPLE
|
Facility
|
OP
|
$19.22
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914753
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$1,610.83 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,610.83
|
| Rate for Payer: Blue Shield of California Commercial |
$172.40
|
| Rate for Payer: Blue Shield of California EPN |
$138.28
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.49
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.90
|
| Rate for Payer: Heritage Provider Network Senior |
$11.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$14.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.42
|
| Rate for Payer: TriValley Medical Group Senior |
$21.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC SOM 22FP 88271 SINGLE
|
Facility
|
OP
|
$19.46
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914752
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$1,610.83 |
| Rate for Payer: Adventist Health Commercial |
$3.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,610.83
|
| Rate for Payer: Blue Shield of California Commercial |
$172.40
|
| Rate for Payer: Blue Shield of California EPN |
$138.28
|
| Rate for Payer: Cash Price |
$19.46
|
| Rate for Payer: Cash Price |
$19.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.05
|
| Rate for Payer: Heritage Provider Network Senior |
$12.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$14.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.42
|
| Rate for Payer: TriValley Medical Group Senior |
$21.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC SOM 22FP 88271 SINGLE
|
Facility
|
IP
|
$19.46
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914752
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$14.60 |
| Rate for Payer: Adventist Health Commercial |
$3.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.53
|
| Rate for Payer: Cash Price |
$19.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.17
|
| Rate for Payer: Heritage Provider Network Senior |
$13.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: Multiplan Commercial |
$14.60
|
|
|
HC SOM 22FP 88275 MULTIPLE
|
Facility
|
IP
|
$19.22
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914754
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$14.41 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.38
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.01
|
| Rate for Payer: Heritage Provider Network Senior |
$13.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$14.41
|
|
|
HC SOM 22FP 88275 MULTIPLE
|
Facility
|
OP
|
$19.22
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914754
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$2,485.29 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,485.29
|
| Rate for Payer: Blue Shield of California Commercial |
$323.19
|
| Rate for Payer: Blue Shield of California EPN |
$259.23
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.49
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.90
|
| Rate for Payer: Heritage Provider Network Senior |
$11.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.59
|
| Rate for Payer: Multiplan Commercial |
$14.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.19
|
| Rate for Payer: TriValley Medical Group Senior |
$51.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC SOM 26 ADD FISH PROB 100-300
|
Facility
|
OP
|
$281.76
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914714
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$2,485.29 |
| Rate for Payer: Adventist Health Commercial |
$56.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$174.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,485.29
|
| Rate for Payer: Blue Shield of California Commercial |
$323.19
|
| Rate for Payer: Blue Shield of California EPN |
$259.23
|
| Rate for Payer: Cash Price |
$281.76
|
| Rate for Payer: Cash Price |
$281.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$183.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.41
|
| Rate for Payer: Heritage Provider Network Senior |
$174.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$134.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.59
|
| Rate for Payer: Multiplan Commercial |
$211.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.19
|
| Rate for Payer: TriValley Medical Group Senior |
$51.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC SOM 26 ADD FISH PROB 100-300
|
Facility
|
IP
|
$281.76
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914714
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$211.32 |
| Rate for Payer: Adventist Health Commercial |
$56.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$181.45
|
| Rate for Payer: Cash Price |
$281.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$190.75
|
| Rate for Payer: Heritage Provider Network Senior |
$190.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.44
|
| Rate for Payer: Multiplan Commercial |
$211.32
|
|
|
HC SOM 26 ADD FISH PROBES
|
Facility
|
IP
|
$463.14
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914713
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$83.83 |
| Max. Negotiated Rate |
$347.36 |
| Rate for Payer: Adventist Health Commercial |
$92.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$298.26
|
| Rate for Payer: Cash Price |
$463.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$313.55
|
| Rate for Payer: Heritage Provider Network Senior |
$313.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.78
|
| Rate for Payer: Multiplan Commercial |
$347.36
|
|
|
HC SOM 26 ADD FISH PROBES
|
Facility
|
OP
|
$463.14
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914713
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$1,610.83 |
| Rate for Payer: Adventist Health Commercial |
$92.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$286.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,610.83
|
| Rate for Payer: Blue Shield of California Commercial |
$172.40
|
| Rate for Payer: Blue Shield of California EPN |
$138.28
|
| Rate for Payer: Cash Price |
$463.14
|
| Rate for Payer: Cash Price |
$463.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$301.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$301.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$286.68
|
| Rate for Payer: Heritage Provider Network Senior |
$286.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$220.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$347.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.42
|
| Rate for Payer: TriValley Medical Group Senior |
$21.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC SOM 28 ADD FISH PROB 100-300
|
Facility
|
IP
|
$302.64
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914712
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$54.78 |
| Max. Negotiated Rate |
$226.98 |
| Rate for Payer: Adventist Health Commercial |
$60.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$194.90
|
| Rate for Payer: Cash Price |
$302.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$204.89
|
| Rate for Payer: Heritage Provider Network Senior |
$204.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.66
|
| Rate for Payer: Multiplan Commercial |
$226.98
|
|
|
HC SOM 28 ADD FISH PROB 100-300
|
Facility
|
OP
|
$302.64
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914712
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$2,485.29 |
| Rate for Payer: Adventist Health Commercial |
$60.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$187.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,485.29
|
| Rate for Payer: Blue Shield of California Commercial |
$323.19
|
| Rate for Payer: Blue Shield of California EPN |
$259.23
|
| Rate for Payer: Cash Price |
$302.64
|
| Rate for Payer: Cash Price |
$302.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$196.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.72
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$187.33
|
| Rate for Payer: Heritage Provider Network Senior |
$187.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$144.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.59
|
| Rate for Payer: Multiplan Commercial |
$226.98
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.19
|
| Rate for Payer: TriValley Medical Group Senior |
$51.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC SOM 28 ADD FISH PROBES
|
Facility
|
OP
|
$497.56
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914711
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$1,610.83 |
| Rate for Payer: Adventist Health Commercial |
$99.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$307.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,610.83
|
| Rate for Payer: Blue Shield of California Commercial |
$172.40
|
| Rate for Payer: Blue Shield of California EPN |
$138.28
|
| Rate for Payer: Cash Price |
$497.56
|
| Rate for Payer: Cash Price |
$497.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$323.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$307.99
|
| Rate for Payer: Heritage Provider Network Senior |
$307.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$237.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$90.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$373.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.42
|
| Rate for Payer: TriValley Medical Group Senior |
$21.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC SOM 28 ADD FISH PROBES
|
Facility
|
IP
|
$497.56
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914711
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$90.06 |
| Max. Negotiated Rate |
$373.17 |
| Rate for Payer: Adventist Health Commercial |
$99.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$320.43
|
| Rate for Payer: Cash Price |
$497.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$336.85
|
| Rate for Payer: Heritage Provider Network Senior |
$336.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$90.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.39
|
| Rate for Payer: Multiplan Commercial |
$373.17
|
|
|
HC SOM 5-FLUOROCYTOSINE
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911263
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.40
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.76
|
| Rate for Payer: Heritage Provider Network Senior |
$27.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
|
|
HC SOM 5-FLUOROCYTOSINE
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911263
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$138.26 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.26
|
| Rate for Payer: Blue Shield of California Commercial |
$110.19
|
| Rate for Payer: Blue Shield of California EPN |
$88.38
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.38
|
| Rate for Payer: Heritage Provider Network Senior |
$25.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.64
|
| Rate for Payer: TriValley Medical Group Senior |
$18.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM 7-DEHYDROCHOLESTERL
|
Facility
|
IP
|
$84.56
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.31 |
| Max. Negotiated Rate |
$63.42 |
| Rate for Payer: Adventist Health Commercial |
$16.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.46
|
| Rate for Payer: Cash Price |
$84.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.25
|
| Rate for Payer: Heritage Provider Network Senior |
$57.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.14
|
| Rate for Payer: Multiplan Commercial |
$63.42
|
|
|
HC SOM 7-DEHYDROCHOLESTERL
|
Facility
|
OP
|
$84.56
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.31 |
| Max. Negotiated Rate |
$170.74 |
| Rate for Payer: Adventist Health Commercial |
$16.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| 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 |
$84.56
|
| Rate for Payer: Cash Price |
$84.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$54.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.89
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.34
|
| Rate for Payer: Heritage Provider Network Senior |
$52.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$40.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$63.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.09
|
| Rate for Payer: TriValley Medical Group Senior |
$24.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM 8INHE FACTOR VIII ACTIVITY ASSAY
|
Facility
|
OP
|
$26.81
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
900912802
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$170.03 |
| Rate for Payer: Adventist Health Commercial |
$5.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.03
|
| Rate for Payer: Blue Shield of California Commercial |
$144.12
|
| Rate for Payer: Blue Shield of California EPN |
$115.59
|
| Rate for Payer: Cash Price |
$26.81
|
| Rate for Payer: Cash Price |
$26.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.60
|
| Rate for Payer: Heritage Provider Network Senior |
$16.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.99
|
| Rate for Payer: Multiplan Commercial |
$20.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.90
|
| Rate for Payer: TriValley Medical Group Senior |
$17.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
|
|
HC SOM 8INHE FACTOR VIII ACTIVITY ASSAY
|
Facility
|
IP
|
$26.81
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
900912802
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$20.11 |
| Rate for Payer: Adventist Health Commercial |
$5.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.27
|
| Rate for Payer: Cash Price |
$26.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.15
|
| Rate for Payer: Heritage Provider Network Senior |
$18.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$20.11
|
|
|
HC SOM 8INHE FACTOR VIII INHIB TECH INTERP
|
Facility
|
IP
|
$23.19
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900911120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$17.39 |
| Rate for Payer: Adventist Health Commercial |
$4.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.93
|
| Rate for Payer: Cash Price |
$23.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.70
|
| Rate for Payer: Heritage Provider Network Senior |
$15.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.80
|
| Rate for Payer: Multiplan Commercial |
$17.39
|
|
|
HC SOM 8INHE FACTOR VIII INHIB TECH INTERP
|
Facility
|
OP
|
$23.19
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900911120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Adventist Health Commercial |
$4.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.96
|
| Rate for Payer: Blue Shield of California Commercial |
$41.59
|
| Rate for Payer: Blue Shield of California EPN |
$33.36
|
| Rate for Payer: Cash Price |
$23.19
|
| Rate for Payer: Cash Price |
$23.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.35
|
| Rate for Payer: Heritage Provider Network Senior |
$14.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.74
|
| Rate for Payer: Multiplan Commercial |
$17.39
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.48
|
| Rate for Payer: TriValley Medical Group Senior |
$15.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Vantage Medical Group Senior |
$15.48
|
|
|
HC SOM 9INHE FACTOR IX ACTIVITY ASSAY
|
Facility
|
OP
|
$35.72
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
900915513
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$180.77 |
| Rate for Payer: Adventist Health Commercial |
$7.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.77
|
| Rate for Payer: Blue Shield of California Commercial |
$153.22
|
| Rate for Payer: Blue Shield of California EPN |
$122.89
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.11
|
| Rate for Payer: Heritage Provider Network Senior |
$22.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.51
|
| Rate for Payer: Multiplan Commercial |
$26.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.04
|
| Rate for Payer: TriValley Medical Group Senior |
$19.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.94
|
| Rate for Payer: Vantage Medical Group Senior |
$19.04
|
|
