|
HC SOM ASPERGILLUS AG BAL
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 87305
|
| Hospital Charge Code |
900915471
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.10
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.93
|
| Rate for Payer: Heritage Provider Network Senior |
$16.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SOM ASPERGILLUS AG BAL
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 87305
|
| Hospital Charge Code |
900915471
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$86.29 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.29
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.47
|
| Rate for Payer: Heritage Provider Network Senior |
$15.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC SOM ASPERGILLUS(GALACT)ANTIGEN
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 87305
|
| Hospital Charge Code |
900912574
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$86.29 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.29
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.47
|
| Rate for Payer: Heritage Provider Network Senior |
$15.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC SOM ASPERGILLUS(GALACT)ANTIGEN
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 87305
|
| Hospital Charge Code |
900912574
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.10
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.93
|
| Rate for Payer: Heritage Provider Network Senior |
$16.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SOM ATIVAN
|
Facility
|
IP
|
$73.59
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$55.19 |
| Rate for Payer: Adventist Health Commercial |
$14.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.39
|
| Rate for Payer: Cash Price |
$73.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.82
|
| Rate for Payer: Heritage Provider Network Senior |
$49.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$55.19
|
|
|
HC SOM ATIVAN
|
Facility
|
OP
|
$73.59
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$168.43 |
| Rate for Payer: Adventist Health Commercial |
$14.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.43
|
| Rate for Payer: Cash Price |
$73.59
|
| Rate for Payer: Cash Price |
$73.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.55
|
| Rate for Payer: Heritage Provider Network Senior |
$45.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$35.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51.51
|
| Rate for Payer: Multiplan Commercial |
$55.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.55
|
| Rate for Payer: Vantage Medical Group Senior |
$62.55
|
|
|
HC SOM BACLOFEN 83789
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900915259
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$239.25 |
| Rate for Payer: Adventist Health Commercial |
$63.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$197.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.11
|
| 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 |
$319.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$207.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.21
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$197.46
|
| Rate for Payer: Heritage Provider Network Senior |
$197.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$152.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.31
|
| Rate for Payer: Multiplan Commercial |
$239.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.11
|
| Rate for Payer: TriValley Medical Group Senior |
$24.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Vantage Medical Group Senior |
$24.11
|
|
|
HC SOM BACLOFEN 83789
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900915259
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$239.25 |
| Rate for Payer: Adventist Health Commercial |
$63.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$205.44
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$215.96
|
| Rate for Payer: Heritage Provider Network Senior |
$215.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.75
|
| Rate for Payer: Multiplan Commercial |
$239.25
|
|
|
HC SOM BARBITURATE CONFIRM, U
|
Facility
|
IP
|
$61.25
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900912916
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$45.94 |
| Rate for Payer: Adventist Health Commercial |
$12.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.45
|
| Rate for Payer: Cash Price |
$61.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.47
|
| Rate for Payer: Heritage Provider Network Senior |
$41.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.31
|
| Rate for Payer: Multiplan Commercial |
$45.94
|
|
|
HC SOM BARBITURATE CONFIRM, U
|
Facility
|
OP
|
$61.25
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900912916
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$104.32 |
| Rate for Payer: Adventist Health Commercial |
$12.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.32
|
| Rate for Payer: Cash Price |
$61.25
|
| Rate for Payer: Cash Price |
$61.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$52.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.91
|
| Rate for Payer: Heritage Provider Network Senior |
$37.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$29.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$42.88
|
| Rate for Payer: Multiplan Commercial |
$45.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$30.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$30.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.06
|
| Rate for Payer: Vantage Medical Group Senior |
$52.06
|
|
|
HC SOM BARTB 87798
|
Facility
|
IP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914848
|
|
Hospital Revenue Code
|
306
|
| 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 |
$32.37
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.03
|
| Rate for Payer: Heritage Provider Network Senior |
$34.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.57
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
|
|
HC SOM BARTB 87798
|
Facility
|
OP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914848
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.42
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.66
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| 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 |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM BARTONELLA HENSELAE AB IGG
|
Facility
|
IP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900911386
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$7.37 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.33
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.65
|
| Rate for Payer: Heritage Provider Network Senior |
$6.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
|
|
HC SOM BARTONELLA HENSELAE AB IGG
|
Facility
|
OP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900911386
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$96.52 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.52
|
| Rate for Payer: Blue Shield of California Commercial |
$81.91
|
| Rate for Payer: Blue Shield of California EPN |
$65.70
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.08
|
| Rate for Payer: Heritage Provider Network Senior |
$6.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.64
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.18
|
| Rate for Payer: TriValley Medical Group Senior |
$10.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
HC SOM BARTONELLA HENSELAE AB IGM
|
Facility
|
IP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900912690
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$7.37 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.33
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.65
|
| Rate for Payer: Heritage Provider Network Senior |
$6.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
|
|
HC SOM BARTONELLA HENSELAE AB IGM
|
Facility
|
OP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900912690
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$96.52 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.52
|
| Rate for Payer: Blue Shield of California Commercial |
$81.91
|
| Rate for Payer: Blue Shield of California EPN |
$65.70
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.08
|
| Rate for Payer: Heritage Provider Network Senior |
$6.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.64
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.18
|
| Rate for Payer: TriValley Medical Group Senior |
$10.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
HC SOM BARTONELLA QUINTANA AB IGG
|
Facility
|
OP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900912691
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$96.52 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.52
|
| Rate for Payer: Blue Shield of California Commercial |
$81.91
|
| Rate for Payer: Blue Shield of California EPN |
$65.70
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.08
|
| Rate for Payer: Heritage Provider Network Senior |
$6.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.64
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.18
|
| Rate for Payer: TriValley Medical Group Senior |
$10.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
HC SOM BARTONELLA QUINTANA AB IGG
|
Facility
|
IP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900912691
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$7.37 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.33
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.65
|
| Rate for Payer: Heritage Provider Network Senior |
$6.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
|
|
HC SOM BARTONELLA QUINTANA AB IGM
|
Facility
|
OP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900912692
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$96.52 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.52
|
| Rate for Payer: Blue Shield of California Commercial |
$81.91
|
| Rate for Payer: Blue Shield of California EPN |
$65.70
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.08
|
| Rate for Payer: Heritage Provider Network Senior |
$6.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.64
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.18
|
| Rate for Payer: TriValley Medical Group Senior |
$10.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
HC SOM BARTONELLA QUINTANA AB IGM
|
Facility
|
IP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900912692
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$7.37 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.33
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.65
|
| Rate for Payer: Heritage Provider Network Senior |
$6.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
|
|
HC SOM B-CELL LYMPH FISH INTERP
|
Facility
|
OP
|
$254.50
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914116
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$29.95 |
| Max. Negotiated Rate |
$216.32 |
| Rate for Payer: Adventist Health Commercial |
$50.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$157.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$139.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$190.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.38
|
| Rate for Payer: Blue Shield of California Commercial |
$37.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.95
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$165.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$216.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.54
|
| Rate for Payer: Heritage Provider Network Senior |
$157.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$121.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$178.15
|
| Rate for Payer: Multiplan Commercial |
$190.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.32
|
| Rate for Payer: Vantage Medical Group Senior |
$216.32
|
|
|
HC SOM B-CELL LYMPH FISH INTERP
|
Facility
|
IP
|
$254.50
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914116
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$46.06 |
| Max. Negotiated Rate |
$190.88 |
| Rate for Payer: Adventist Health Commercial |
$50.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$163.90
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.30
|
| Rate for Payer: Heritage Provider Network Senior |
$172.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.62
|
| Rate for Payer: Multiplan Commercial |
$190.88
|
|
|
HC SOM BCR/ABL1, P190, MRNA DETECTION, RT-PCR, QUANTITATIVE, MONITORING ASSAY
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
CPT 81207
|
| Hospital Charge Code |
900915426
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$383.47 |
| Rate for Payer: Adventist Health Commercial |
$97.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$299.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$217.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$383.47
|
| Rate for Payer: Blue Shield of California Commercial |
$295.85
|
| Rate for Payer: Blue Shield of California EPN |
$236.68
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$315.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$217.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$315.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$144.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$300.21
|
| Rate for Payer: Heritage Provider Network Senior |
$300.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$144.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$231.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$166.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$194.09
|
| Rate for Payer: Multiplan Commercial |
$363.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$144.84
|
| Rate for Payer: TriValley Medical Group Senior |
$144.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$156.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$156.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$217.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.32
|
| Rate for Payer: Vantage Medical Group Senior |
$144.84
|
|
|
HC SOM BCR/ABL1, P190, MRNA DETECTION, RT-PCR, QUANTITATIVE, MONITORING ASSAY
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
CPT 81207
|
| Hospital Charge Code |
900915426
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$363.75 |
| Rate for Payer: Adventist Health Commercial |
$97.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$312.34
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$328.35
|
| Rate for Payer: Heritage Provider Network Senior |
$328.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.25
|
| Rate for Payer: Multiplan Commercial |
$363.75
|
|
|
HC SOM BCR ABL MUTAT ASPE
|
Facility
|
IP
|
$435.08
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914536
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$326.31 |
| Rate for Payer: Adventist Health Commercial |
$87.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$280.19
|
| Rate for Payer: Cash Price |
$435.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$294.55
|
| Rate for Payer: Heritage Provider Network Senior |
$294.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.77
|
| Rate for Payer: Multiplan Commercial |
$326.31
|
|
