|
HC SOM BILE ACIDS TOTAL
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 82239
|
| Hospital Charge Code |
900911123
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.03
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.96
|
| Rate for Payer: Heritage Provider Network Senior |
$18.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
|
|
HC SOM BILE ACIDS TOTAL
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 82239
|
| Hospital Charge Code |
900911123
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$164.22 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.22
|
| Rate for Payer: Blue Shield of California Commercial |
$137.89
|
| Rate for Payer: Blue Shield of California EPN |
$110.60
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.33
|
| Rate for Payer: Heritage Provider Network Senior |
$17.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.94
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.12
|
| Rate for Payer: TriValley Medical Group Senior |
$17.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.83
|
| Rate for Payer: Vantage Medical Group Senior |
$17.12
|
|
|
HC SOM BK VIRUS DNA QUANT PCR
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912559
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$344.74 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.65
|
| Rate for Payer: Blue Shield of California Commercial |
$344.74
|
| Rate for Payer: Blue Shield of California EPN |
$276.51
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.14
|
| Rate for Payer: Heritage Provider Network Senior |
$37.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.84
|
| Rate for Payer: TriValley Medical Group Senior |
$42.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC SOM BK VIRUS DNA QUANT PCR
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912559
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.64
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.62
|
| Rate for Payer: Heritage Provider Network Senior |
$40.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
|
|
HC SOM BLASTOMYCES AB EIA
|
Facility
|
IP
|
$43.94
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
900915370
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$32.95 |
| Rate for Payer: Adventist Health Commercial |
$8.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.30
|
| Rate for Payer: Cash Price |
$43.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.75
|
| Rate for Payer: Heritage Provider Network Senior |
$29.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.98
|
| Rate for Payer: Multiplan Commercial |
$32.95
|
|
|
HC SOM BLASTOMYCES AB EIA
|
Facility
|
OP
|
$43.94
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
900915370
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$8.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$103.85
|
| Rate for Payer: Blue Shield of California EPN |
$83.30
|
| Rate for Payer: Cash Price |
$43.94
|
| Rate for Payer: Cash Price |
$43.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.92
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.20
|
| Rate for Payer: Heritage Provider Network Senior |
$27.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.29
|
| Rate for Payer: Multiplan Commercial |
$32.95
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.90
|
| Rate for Payer: TriValley Medical Group Senior |
$12.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Vantage Medical Group Senior |
$12.90
|
|
|
HC SOM BLASTOMYCES AB IMMUNODIFFUSION
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
900912686
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| 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 |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$103.85
|
| Rate for Payer: Blue Shield of California EPN |
$83.30
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.90
|
| 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 |
$12.90
|
| 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 |
$14.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.29
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.90
|
| Rate for Payer: TriValley Medical Group Senior |
$12.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Vantage Medical Group Senior |
$12.90
|
|
|
HC SOM BLASTOMYCES AB IMMUNODIFFUSION
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
900912686
|
|
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 BLOOM CULTURE 01
|
Facility
|
OP
|
$937.09
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900915282
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$116.49 |
| Max. Negotiated Rate |
$939.08 |
| Rate for Payer: Adventist Health Commercial |
$187.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$579.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$939.08
|
| Rate for Payer: Blue Shield of California Commercial |
$937.56
|
| Rate for Payer: Blue Shield of California EPN |
$752.00
|
| Rate for Payer: Cash Price |
$937.09
|
| Rate for Payer: Cash Price |
$937.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$609.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$609.11
|
| Rate for Payer: EPIC Health Plan Medicare |
$116.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$580.06
|
| Rate for Payer: Heritage Provider Network Senior |
$580.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$116.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$446.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$169.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$133.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$156.10
|
| Rate for Payer: Multiplan Commercial |
$702.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$116.49
|
| Rate for Payer: TriValley Medical Group Senior |
$116.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$125.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$125.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Vantage Medical Group Senior |
$116.49
|
|
|
HC SOM BLOOM CULTURE 01
|
Facility
|
IP
|
$937.09
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900915282
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$169.61 |
| Max. Negotiated Rate |
$702.82 |
| Rate for Payer: Adventist Health Commercial |
$187.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$603.49
|
| Rate for Payer: Cash Price |
$937.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$634.41
|
| Rate for Payer: Heritage Provider Network Senior |
$634.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$169.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.27
|
| Rate for Payer: Multiplan Commercial |
$702.82
|
|
|
HC SOM BNP 83880
|
Facility
|
IP
|
$170.78
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
900914724
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.91 |
| Max. Negotiated Rate |
$128.09 |
| Rate for Payer: Adventist Health Commercial |
$34.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$109.98
|
| Rate for Payer: Cash Price |
$170.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.62
|
| Rate for Payer: Heritage Provider Network Senior |
$115.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.70
|
| Rate for Payer: Multiplan Commercial |
$128.09
|
|
|
HC SOM BNP 83880
|
Facility
|
OP
|
$170.78
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
900914724
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.91 |
| Max. Negotiated Rate |
$322.36 |
| Rate for Payer: Adventist Health Commercial |
$34.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$105.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.36
|
| Rate for Payer: Blue Shield of California Commercial |
$273.20
|
| Rate for Payer: Blue Shield of California EPN |
$219.13
|
| Rate for Payer: Cash Price |
$170.78
|
| Rate for Payer: Cash Price |
$170.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$111.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$39.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.71
|
| Rate for Payer: Heritage Provider Network Senior |
$105.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$39.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$81.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$52.61
|
| Rate for Payer: Multiplan Commercial |
$128.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$39.26
|
| Rate for Payer: TriValley Medical Group Senior |
$39.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$42.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$42.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.19
|
| Rate for Payer: Vantage Medical Group Senior |
$39.26
|
|
|
HC SOM BONE ALKALINE PHOSPHATASE
|
Facility
|
IP
|
$26.50
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
900915326
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$19.88 |
| Rate for Payer: Adventist Health Commercial |
$5.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.07
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.94
|
| Rate for Payer: Heritage Provider Network Senior |
$17.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.62
|
| Rate for Payer: Multiplan Commercial |
$19.88
|
|
|
HC SOM BONE ALKALINE PHOSPHATASE
|
Facility
|
OP
|
$26.50
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
900915326
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$140.44 |
| Rate for Payer: Adventist Health Commercial |
$5.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.44
|
| Rate for Payer: Blue Shield of California Commercial |
$119.00
|
| Rate for Payer: Blue Shield of California EPN |
$95.45
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.40
|
| Rate for Payer: Heritage Provider Network Senior |
$16.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.81
|
| Rate for Payer: Multiplan Commercial |
$19.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.78
|
| Rate for Payer: TriValley Medical Group Senior |
$14.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14.78
|
|
|
HC SOM BORDETELLA PCR
|
Facility
|
OP
|
$38.80
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914165
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$7.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.98
|
| 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 |
$38.80
|
| Rate for Payer: Cash Price |
$38.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.22
|
| 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 |
$22.89
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.02
|
| Rate for Payer: Heritage Provider Network Senior |
$24.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$29.10
|
| 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 BORDETELLA PCR
|
Facility
|
IP
|
$38.80
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914165
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$29.10 |
| Rate for Payer: Adventist Health Commercial |
$7.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.99
|
| Rate for Payer: Cash Price |
$38.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.27
|
| Rate for Payer: Heritage Provider Network Senior |
$26.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.70
|
| Rate for Payer: Multiplan Commercial |
$29.10
|
|
|
HC SOM BORIC ACID
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
900911050
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.67
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.58
|
| Rate for Payer: Heritage Provider Network Senior |
$59.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
|
|
HC SOM BORIC ACID
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
900911050
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$176.94 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.94
|
| Rate for Payer: Blue Shield of California Commercial |
$176.72
|
| Rate for Payer: Blue Shield of California EPN |
$141.74
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.92
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.47
|
| Rate for Payer: Heritage Provider Network Senior |
$54.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$41.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.43
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.96
|
| Rate for Payer: TriValley Medical Group Senior |
$21.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.16
|
| Rate for Payer: Vantage Medical Group Senior |
$21.96
|
|
|
HC SOM BORON
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
900914503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$176.94 |
| Rate for Payer: Adventist Health Commercial |
$14.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.94
|
| Rate for Payer: Blue Shield of California Commercial |
$176.72
|
| Rate for Payer: Blue Shield of California EPN |
$141.74
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.07
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.19
|
| Rate for Payer: Heritage Provider Network Senior |
$45.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$34.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.43
|
| Rate for Payer: Multiplan Commercial |
$54.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.96
|
| Rate for Payer: TriValley Medical Group Senior |
$21.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.16
|
| Rate for Payer: Vantage Medical Group Senior |
$21.96
|
|
|
HC SOM BORON
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
900914503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$54.75 |
| Rate for Payer: Adventist Health Commercial |
$14.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.01
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.42
|
| Rate for Payer: Heritage Provider Network Senior |
$49.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.25
|
| Rate for Payer: Multiplan Commercial |
$54.75
|
|
|
HC SOM BORRELIA BURGDORFERI PCR DETECT
|
Facility
|
IP
|
$26.67
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915376
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Adventist Health Commercial |
$5.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Cash Price |
$26.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.06
|
| Rate for Payer: Heritage Provider Network Senior |
$18.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.67
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
|
|
HC SOM BORRELIA BURGDORFERI PCR DETECT
|
Facility
|
OP
|
$26.67
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915376
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$5.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.48
|
| 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 |
$26.67
|
| Rate for Payer: Cash Price |
$26.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.34
|
| 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 |
$17.34
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.51
|
| Rate for Payer: Heritage Provider Network Senior |
$16.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| 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 BORRELIA BURGDORFERI PCR PROBE
|
Facility
|
OP
|
$26.66
|
|
|
Service Code
|
CPT 87476
|
| Hospital Charge Code |
900912513
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$5.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.48
|
| 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 |
$26.66
|
| Rate for Payer: Cash Price |
$26.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.33
|
| 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 |
$15.73
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.50
|
| Rate for Payer: Heritage Provider Network Senior |
$16.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| 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 BORRELIA BURGDORFERI PCR PROBE
|
Facility
|
IP
|
$26.66
|
|
|
Service Code
|
CPT 87476
|
| Hospital Charge Code |
900912513
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Adventist Health Commercial |
$5.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.17
|
| Rate for Payer: Cash Price |
$26.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.05
|
| Rate for Payer: Heritage Provider Network Senior |
$18.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.67
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
|
|
HC SOM BPAB IMMUNOASSAY NONANTIBODY
|
Facility
|
OP
|
$62.50
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900915527
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$222.13 |
| Rate for Payer: Adventist Health Commercial |
$12.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.13
|
| 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 |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.69
|
| Rate for Payer: Heritage Provider Network Senior |
$38.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$29.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$46.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
