|
HC SOM EBV PCR QUANT
|
Facility
IP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$37.70 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.54
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.03
|
| Rate for Payer: Heritage Provider Network Senior |
$34.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.57
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
|
|
HC SOM EBV PCR QUANT
|
Facility
OP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$284.23 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.23
|
| Rate for Payer: Blue Shield of California Commercial |
$274.13
|
| Rate for Payer: Blue Shield of California EPN |
$214.30
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.12
|
| Rate for Payer: Heritage Provider Network Senior |
$31.12
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: IEHP Medi-Cal |
$47.03
|
| Rate for Payer: IEHP Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM ECHINOCOCCUS AB
|
Facility
IP
|
$30.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911392
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| 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 Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
|
|
HC SOM ECHINOCOCCUS AB
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911392
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$109.88 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.88
|
| Rate for Payer: Blue Shield of California Commercial |
$101.57
|
| Rate for Payer: Blue Shield of California EPN |
$79.40
|
| 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 |
$19.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: Dignity Health Senior |
$13.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.57
|
| Rate for Payer: Heritage Provider Network Senior |
$18.57
|
| Rate for Payer: Humana Medicare |
$13.01
|
| Rate for Payer: IEHP Medi-Cal |
$18.03
|
| Rate for Payer: IEHP Medicare Advantage |
$13.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.39
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.01
|
| Rate for Payer: TriValley Medical Group Senior |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13.01
|
|
|
HC SOM EHRLICHOSIS
|
Facility
IP
|
$35.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
900911388
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.04
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.70
|
| Rate for Payer: Heritage Provider Network Senior |
$23.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
|
|
HC SOM EHRLICHOSIS
|
Facility
OP
|
$35.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
900911388
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$85.09 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.04
|
| 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 |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.75
|
| 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 |
$22.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.66
|
| Rate for Payer: Heritage Provider Network Senior |
$21.66
|
| 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 |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| 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 |
$26.25
|
| 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 ELECTROPHORES,PROTEN,RANDM
|
Facility
IP
|
$24.88
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912891
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$18.66 |
| Rate for Payer: Adventist Health Commercial |
$4.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.09
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.84
|
| Rate for Payer: Heritage Provider Network Senior |
$16.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.22
|
| Rate for Payer: Multiplan Commercial |
$18.66
|
|
|
HC SOM ELECTROPHORES,PROTEN,RANDM
|
Facility
OP
|
$24.88
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912891
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$146.23 |
| Rate for Payer: Adventist Health Commercial |
$4.98
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.23
|
| Rate for Payer: Blue Shield of California Commercial |
$139.30
|
| Rate for Payer: Blue Shield of California EPN |
$108.90
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.61
|
| Rate for Payer: Dignity Health Senior |
$17.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.40
|
| Rate for Payer: Heritage Provider Network Senior |
$15.40
|
| Rate for Payer: Humana Medicare |
$17.83
|
| Rate for Payer: IEHP Medi-Cal |
$24.73
|
| Rate for Payer: IEHP Medicare Advantage |
$17.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$33.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.47
|
| Rate for Payer: Multiplan Commercial |
$18.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.83
|
| Rate for Payer: TriValley Medical Group Senior |
$17.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Vantage Medical Group Senior |
$17.83
|
|
|
HC SOM ENDOMYSIAL IGA AB
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
900911423
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$67.58 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.51
|
| Rate for Payer: Blue Shield of California Commercial |
$67.58
|
| Rate for Payer: Blue Shield of California EPN |
$52.83
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.30
|
| Rate for Payer: Dignity Health Senior |
$12.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.48
|
| Rate for Payer: Heritage Provider Network Senior |
$15.48
|
| Rate for Payer: Humana Medicare |
$12.09
|
| Rate for Payer: IEHP Medi-Cal |
$18.86
|
| Rate for Payer: IEHP Medicare Advantage |
$12.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.23
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.09
|
| Rate for Payer: TriValley Medical Group Senior |
$12.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: Vantage Medical Group Senior |
$12.09
|
|
|
HC SOM ENDOMYSIAL IGA AB
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
900911423
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.92
|
| Rate for Payer: Heritage Provider Network Senior |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SOM ENTEROVIRUS PCR, BLOOD
|
Facility
OP
|
$39.23
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
900910691
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$287.39 |
| Rate for Payer: Adventist Health Commercial |
$7.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$287.39
|
| Rate for Payer: Blue Shield of California Commercial |
$274.13
|
| Rate for Payer: Blue Shield of California EPN |
$214.30
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.28
|
| Rate for Payer: Heritage Provider Network Senior |
$24.28
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: IEHP Medi-Cal |
$48.66
|
| Rate for Payer: IEHP Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$29.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM ENTEROVIRUS PCR, BLOOD
|
Facility
IP
|
$39.23
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
900910691
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$29.42 |
| Rate for Payer: Adventist Health Commercial |
$7.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.95
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.56
|
| Rate for Payer: Heritage Provider Network Senior |
$26.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.81
|
| Rate for Payer: Multiplan Commercial |
$29.42
|
|
|
HC SOM ENTEROVIRUS PCR CSF
|
Facility
OP
|
$39.23
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
900910771
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$287.39 |
| Rate for Payer: Adventist Health Commercial |
$7.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$287.39
|
| Rate for Payer: Blue Shield of California Commercial |
$274.13
|
| Rate for Payer: Blue Shield of California EPN |
$214.30
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.28
|
| Rate for Payer: Heritage Provider Network Senior |
$24.28
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: IEHP Medi-Cal |
$48.66
|
| Rate for Payer: IEHP Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$29.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM ENTEROVIRUS PCR CSF
|
Facility
IP
|
$39.23
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
900910771
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$29.42 |
| Rate for Payer: Adventist Health Commercial |
$7.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.95
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.56
|
| Rate for Payer: Heritage Provider Network Senior |
$26.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.81
|
| Rate for Payer: Multiplan Commercial |
$29.42
|
|
|
HC SOM ERYTHROPOIETIN
|
Facility
IP
|
$15.68
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
900911227
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$11.76 |
| Rate for Payer: Adventist Health Commercial |
$3.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.77
|
| Rate for Payer: Cash Price |
$7.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.62
|
| Rate for Payer: Heritage Provider Network Senior |
$10.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.92
|
| Rate for Payer: Multiplan Commercial |
$11.76
|
|
|
HC SOM ERYTHROPOIETIN
|
Facility
OP
|
$15.68
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
900911227
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$156.20 |
| Rate for Payer: Adventist Health Commercial |
$3.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$54.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.20
|
| Rate for Payer: Blue Shield of California Commercial |
$146.79
|
| Rate for Payer: Blue Shield of California EPN |
$114.76
|
| Rate for Payer: Cash Price |
$7.06
|
| Rate for Payer: Cash Price |
$7.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.67
|
| Rate for Payer: Dignity Health Senior |
$18.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.71
|
| Rate for Payer: Heritage Provider Network Senior |
$9.71
|
| Rate for Payer: Humana Medicare |
$18.79
|
| Rate for Payer: IEHP Medi-Cal |
$26.07
|
| Rate for Payer: IEHP Medicare Advantage |
$18.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.68
|
| Rate for Payer: Multiplan Commercial |
$11.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.79
|
| Rate for Payer: TriValley Medical Group Senior |
$18.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.67
|
| Rate for Payer: Vantage Medical Group Senior |
$18.79
|
|
|
HC SOM ESTRADIOL
|
Facility
IP
|
$23.80
|
|
|
Service Code
|
CPT 82671
|
| Hospital Charge Code |
900911014
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$17.85 |
| Rate for Payer: Adventist Health Commercial |
$4.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.35
|
| Rate for Payer: Cash Price |
$10.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.11
|
| Rate for Payer: Heritage Provider Network Senior |
$16.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.95
|
| Rate for Payer: Multiplan Commercial |
$17.85
|
|
|
HC SOM ESTRADIOL
|
Facility
OP
|
$23.80
|
|
|
Service Code
|
CPT 82671
|
| Hospital Charge Code |
900911014
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$270.32 |
| Rate for Payer: Adventist Health Commercial |
$4.76
|
| Rate for Payer: Aetna of CA Gatekeeper |
$93.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$48.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$35.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$32.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$270.32
|
| Rate for Payer: Blue Shield of California Commercial |
$252.28
|
| Rate for Payer: Blue Shield of California EPN |
$197.22
|
| Rate for Payer: Cash Price |
$10.71
|
| Rate for Payer: Cash Price |
$10.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.53
|
| Rate for Payer: Dignity Health Senior |
$32.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$32.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.73
|
| Rate for Payer: Heritage Provider Network Senior |
$14.73
|
| Rate for Payer: Humana Medicare |
$32.30
|
| Rate for Payer: IEHP Medi-Cal |
$44.79
|
| Rate for Payer: IEHP Medicare Advantage |
$32.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$61.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40.70
|
| Rate for Payer: Multiplan Commercial |
$17.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$32.30
|
| Rate for Payer: TriValley Medical Group Senior |
$32.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$34.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$34.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.53
|
| Rate for Payer: Vantage Medical Group Senior |
$32.30
|
|
|
HC SOM ESTRIOL
|
Facility
IP
|
$130.00
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
900911036
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$97.50 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$89.31
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$88.01
|
| Rate for Payer: Heritage Provider Network Senior |
$88.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.50
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
|
|
HC SOM ESTRIOL
|
Facility
OP
|
$130.00
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
900911036
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$203.26 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$70.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$89.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.26
|
| Rate for Payer: Blue Shield of California Commercial |
$188.89
|
| Rate for Payer: Blue Shield of California EPN |
$147.66
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.60
|
| Rate for Payer: Dignity Health Senior |
$24.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$80.47
|
| Rate for Payer: Heritage Provider Network Senior |
$80.47
|
| Rate for Payer: Humana Medicare |
$24.18
|
| Rate for Payer: IEHP Medi-Cal |
$33.52
|
| Rate for Payer: IEHP Medicare Advantage |
$24.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.47
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.18
|
| Rate for Payer: TriValley Medical Group Senior |
$24.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.60
|
| Rate for Payer: Vantage Medical Group Senior |
$24.18
|
|
|
HC SOM ESTRONE
|
Facility
IP
|
$20.00
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
900911482
|
|
Hospital Revenue Code
|
301
|
| 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 ESTRONE
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
900911482
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$208.89 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$72.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$37.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$208.89
|
| Rate for Payer: Blue Shield of California Commercial |
$194.98
|
| Rate for Payer: Blue Shield of California EPN |
$152.43
|
| 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 |
$37.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.44
|
| Rate for Payer: Dignity Health Senior |
$24.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Humana Medicare |
$24.95
|
| Rate for Payer: IEHP Medi-Cal |
$34.60
|
| Rate for Payer: IEHP Medicare Advantage |
$24.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.44
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.95
|
| Rate for Payer: TriValley Medical Group Senior |
$24.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.44
|
| Rate for Payer: Vantage Medical Group Senior |
$24.95
|
|
|
HC SOM ETHANOL, U
|
Facility
OP
|
$49.90
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900912919
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$86.78 |
| Rate for Payer: Adventist Health Commercial |
$9.98
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$42.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$37.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.78
|
| Rate for Payer: Cash Price |
$22.46
|
| Rate for Payer: Cash Price |
$22.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.42
|
| Rate for Payer: Dignity Health Senior |
$42.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.89
|
| Rate for Payer: Heritage Provider Network Senior |
$30.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.48
|
| Rate for Payer: Multiplan Commercial |
$37.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.42
|
| Rate for Payer: Vantage Medical Group Senior |
$42.42
|
|
|
HC SOM ETHANOL, U
|
Facility
IP
|
$49.90
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900912919
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$37.42 |
| Rate for Payer: Adventist Health Commercial |
$9.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.28
|
| Rate for Payer: Cash Price |
$22.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.78
|
| Rate for Payer: Heritage Provider Network Senior |
$33.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.48
|
| Rate for Payer: Multiplan Commercial |
$37.42
|
|
|
HC SOM ETHCHLORVINYL (PLACIDYL)
|
Facility
IP
|
$45.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910427
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.92
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.46
|
| Rate for Payer: Heritage Provider Network Senior |
$30.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
|
