|
HC SOM CARNITINE PLASMA
|
Facility
|
OP
|
$29.01
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
900911103
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$159.42 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.42
|
| Rate for Payer: Blue Shield of California Commercial |
$135.76
|
| Rate for Payer: Blue Shield of California EPN |
$108.89
|
| Rate for Payer: Cash Price |
$29.01
|
| Rate for Payer: Cash Price |
$29.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.96
|
| Rate for Payer: Heritage Provider Network Senior |
$17.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$21.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.87
|
| Rate for Payer: TriValley Medical Group Senior |
$16.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Vantage Medical Group Senior |
$16.87
|
|
|
HC SOM CARNITINE URINE
|
Facility
|
OP
|
$60.59
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
900910730
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$159.42 |
| Rate for Payer: Adventist Health Commercial |
$12.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.42
|
| Rate for Payer: Blue Shield of California Commercial |
$135.76
|
| Rate for Payer: Blue Shield of California EPN |
$108.89
|
| Rate for Payer: Cash Price |
$60.59
|
| Rate for Payer: Cash Price |
$60.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.51
|
| Rate for Payer: Heritage Provider Network Senior |
$37.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$45.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.87
|
| Rate for Payer: TriValley Medical Group Senior |
$16.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Vantage Medical Group Senior |
$16.87
|
|
|
HC SOM CARNITINE URINE
|
Facility
|
IP
|
$60.59
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
900910730
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$45.44 |
| Rate for Payer: Adventist Health Commercial |
$12.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.02
|
| Rate for Payer: Cash Price |
$60.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.02
|
| Rate for Payer: Heritage Provider Network Senior |
$41.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.15
|
| Rate for Payer: Multiplan Commercial |
$45.44
|
|
|
HC SOM CAROTENE
|
Facility
|
OP
|
$122.75
|
|
|
Service Code
|
CPT 82380
|
| Hospital Charge Code |
900911303
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$92.06 |
| Rate for Payer: Adventist Health Commercial |
$24.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.64
|
| Rate for Payer: Blue Shield of California Commercial |
$74.25
|
| Rate for Payer: Blue Shield of California EPN |
$59.55
|
| Rate for Payer: Cash Price |
$122.75
|
| Rate for Payer: Cash Price |
$122.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$79.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$75.98
|
| Rate for Payer: Heritage Provider Network Senior |
$75.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$58.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.35
|
| Rate for Payer: Multiplan Commercial |
$92.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.22
|
| Rate for Payer: TriValley Medical Group Senior |
$9.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.14
|
| Rate for Payer: Vantage Medical Group Senior |
$9.22
|
|
|
HC SOM CAROTENE
|
Facility
|
IP
|
$122.75
|
|
|
Service Code
|
CPT 82380
|
| Hospital Charge Code |
900911303
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.22 |
| Max. Negotiated Rate |
$92.06 |
| Rate for Payer: Adventist Health Commercial |
$24.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.05
|
| Rate for Payer: Cash Price |
$122.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.10
|
| Rate for Payer: Heritage Provider Network Senior |
$83.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.69
|
| Rate for Payer: Multiplan Commercial |
$92.06
|
|
|
HC SOM CATECHOLAMINE FRACT FREE UR
|
Facility
|
IP
|
$33.87
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900914081
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.13 |
| Max. Negotiated Rate |
$25.40 |
| Rate for Payer: Adventist Health Commercial |
$6.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.81
|
| Rate for Payer: Cash Price |
$33.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.93
|
| Rate for Payer: Heritage Provider Network Senior |
$22.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.47
|
| Rate for Payer: Multiplan Commercial |
$25.40
|
|
|
HC SOM CATECHOLAMINE FRACT FREE UR
|
Facility
|
OP
|
$33.87
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900914081
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.13 |
| Max. Negotiated Rate |
$239.77 |
| Rate for Payer: Adventist Health Commercial |
$6.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.77
|
| Rate for Payer: Blue Shield of California Commercial |
$203.21
|
| Rate for Payer: Blue Shield of California EPN |
$162.99
|
| Rate for Payer: Cash Price |
$33.87
|
| Rate for Payer: Cash Price |
$33.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.98
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.97
|
| Rate for Payer: Heritage Provider Network Senior |
$20.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33.84
|
| Rate for Payer: Multiplan Commercial |
$25.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.25
|
| Rate for Payer: TriValley Medical Group Senior |
$25.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.77
|
| Rate for Payer: Vantage Medical Group Senior |
$25.25
|
|
|
HC SOM CATECHOLAMINES PL
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900910483
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.54
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.70
|
| Rate for Payer: Heritage Provider Network Senior |
$23.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
|
|
HC SOM CATECHOLAMINES PL
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900910483
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$239.77 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.77
|
| Rate for Payer: Blue Shield of California Commercial |
$203.21
|
| Rate for Payer: Blue Shield of California EPN |
$162.99
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.66
|
| Rate for Payer: Heritage Provider Network Senior |
$21.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33.84
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.25
|
| Rate for Payer: TriValley Medical Group Senior |
$25.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.77
|
| Rate for Payer: Vantage Medical Group Senior |
$25.25
|
|
|
HC SOM CD4 T-CELL ABSOLUTE CT
|
Facility
|
IP
|
$31.88
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
900914709
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.77 |
| Max. Negotiated Rate |
$23.91 |
| Rate for Payer: Adventist Health Commercial |
$6.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.53
|
| Rate for Payer: Cash Price |
$31.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.58
|
| Rate for Payer: Heritage Provider Network Senior |
$21.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.97
|
| Rate for Payer: Multiplan Commercial |
$23.91
|
|
|
HC SOM CD4 T-CELL ABSOLUTE CT
|
Facility
|
OP
|
$31.88
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
900914709
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.77 |
| Max. Negotiated Rate |
$378.14 |
| Rate for Payer: Adventist Health Commercial |
$6.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$374.65
|
| Rate for Payer: Blue Shield of California Commercial |
$378.14
|
| Rate for Payer: Blue Shield of California EPN |
$303.30
|
| Rate for Payer: Cash Price |
$31.88
|
| Rate for Payer: Cash Price |
$31.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.72
|
| Rate for Payer: EPIC Health Plan Medicare |
$46.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.73
|
| Rate for Payer: Heritage Provider Network Senior |
$19.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$46.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$15.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$62.95
|
| Rate for Payer: Multiplan Commercial |
$23.91
|
| Rate for Payer: TriValley Medical Group Commercial |
$46.98
|
| Rate for Payer: TriValley Medical Group Senior |
$46.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$50.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$50.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.68
|
| Rate for Payer: Vantage Medical Group Senior |
$46.98
|
|
|
HC SOM CD4 T-CELL TOTAL CT
|
Facility
|
IP
|
$29.87
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
900914708
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Adventist Health Commercial |
$5.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.24
|
| Rate for Payer: Cash Price |
$29.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.22
|
| Rate for Payer: Heritage Provider Network Senior |
$20.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.47
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
|
|
HC SOM CD4 T-CELL TOTAL CT
|
Facility
|
OP
|
$29.87
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
900914708
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$358.79 |
| Rate for Payer: Adventist Health Commercial |
$5.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$358.79
|
| Rate for Payer: Blue Shield of California Commercial |
$303.55
|
| Rate for Payer: Blue Shield of California EPN |
$243.47
|
| Rate for Payer: Cash Price |
$29.87
|
| Rate for Payer: Cash Price |
$29.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.49
|
| Rate for Payer: Heritage Provider Network Senior |
$18.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.73
|
| Rate for Payer: TriValley Medical Group Senior |
$37.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$40.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$40.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC SOM C DIFF PCR STOOL
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
900914042
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$408.72 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.72
|
| Rate for Payer: Blue Shield of California Commercial |
$289.56
|
| Rate for Payer: Blue Shield of California EPN |
$232.25
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$62.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.64
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.42
|
| Rate for Payer: Heritage Provider Network Senior |
$59.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$45.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.94
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.27
|
| Rate for Payer: TriValley Medical Group Senior |
$37.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$40.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$40.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.00
|
| Rate for Payer: Vantage Medical Group Senior |
$37.27
|
|
|
HC SOM C DIFF PCR STOOL
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
900914042
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.82
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.99
|
| Rate for Payer: Heritage Provider Network Senior |
$64.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
|
|
HC SOM CEA PANCREATIC CYST
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
900912997
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$179.81 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.81
|
| Rate for Payer: Blue Shield of California Commercial |
$152.70
|
| Rate for Payer: Blue Shield of California EPN |
$122.48
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.05
|
| Rate for Payer: Heritage Provider Network Senior |
$34.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$26.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.41
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.96
|
| Rate for Payer: TriValley Medical Group Senior |
$18.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.86
|
| Rate for Payer: Vantage Medical Group Senior |
$18.96
|
|
|
HC SOM CEA PANCREATIC CYST
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
900912997
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.42
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.23
|
| Rate for Payer: Heritage Provider Network Senior |
$37.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
|
|
HC SOM CEA PERITONEAL FLUID
|
Facility
|
OP
|
$60.12
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
900914706
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$179.81 |
| Rate for Payer: Adventist Health Commercial |
$12.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.81
|
| Rate for Payer: Blue Shield of California Commercial |
$152.70
|
| Rate for Payer: Blue Shield of California EPN |
$122.48
|
| Rate for Payer: Cash Price |
$60.12
|
| Rate for Payer: Cash Price |
$60.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.21
|
| Rate for Payer: Heritage Provider Network Senior |
$37.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.41
|
| Rate for Payer: Multiplan Commercial |
$45.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.96
|
| Rate for Payer: TriValley Medical Group Senior |
$18.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.86
|
| Rate for Payer: Vantage Medical Group Senior |
$18.96
|
|
|
HC SOM CEA PERITONEAL FLUID
|
Facility
|
IP
|
$60.12
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
900914706
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$45.09 |
| Rate for Payer: Adventist Health Commercial |
$12.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.72
|
| Rate for Payer: Cash Price |
$60.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.70
|
| Rate for Payer: Heritage Provider Network Senior |
$40.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.03
|
| Rate for Payer: Multiplan Commercial |
$45.09
|
|
|
HC SOM CEA PLEURAL FLUID
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
900915434
|
|
Hospital Revenue Code
|
300
|
| 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 CEA PLEURAL FLUID
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
900915434
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$179.81 |
| 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 |
$28.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.81
|
| Rate for Payer: Blue Shield of California Commercial |
$152.70
|
| Rate for Payer: Blue Shield of California EPN |
$122.48
|
| 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 |
$28.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.96
|
| 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 |
$18.96
|
| 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 |
$21.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.41
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.96
|
| Rate for Payer: TriValley Medical Group Senior |
$18.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.86
|
| Rate for Payer: Vantage Medical Group Senior |
$18.96
|
|
|
HC SOM CELIAC COMP HLA TYPING 1
|
Facility
|
OP
|
$69.85
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
900915327
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$718.04 |
| Rate for Payer: Adventist Health Commercial |
$13.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$718.04
|
| Rate for Payer: Blue Shield of California Commercial |
$42.61
|
| Rate for Payer: Blue Shield of California EPN |
$34.09
|
| Rate for Payer: Cash Price |
$69.85
|
| Rate for Payer: Cash Price |
$69.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$45.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$122.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.24
|
| Rate for Payer: Heritage Provider Network Senior |
$43.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$33.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$140.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$163.77
|
| Rate for Payer: Multiplan Commercial |
$52.39
|
| Rate for Payer: TriValley Medical Group Commercial |
$122.22
|
| Rate for Payer: TriValley Medical Group Senior |
$122.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$132.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$132.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Vantage Medical Group Senior |
$122.22
|
|
|
HC SOM CELIAC COMP HLA TYPING 1
|
Facility
|
IP
|
$69.85
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
900915327
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$52.39 |
| Rate for Payer: Adventist Health Commercial |
$13.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.98
|
| Rate for Payer: Cash Price |
$69.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.29
|
| Rate for Payer: Heritage Provider Network Senior |
$47.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.46
|
| Rate for Payer: Multiplan Commercial |
$52.39
|
|
|
HC SOM CELIAC COMP HLA TYPING 2
|
Facility
|
OP
|
$69.84
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
900915328
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$718.04 |
| Rate for Payer: Adventist Health Commercial |
$13.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$718.04
|
| Rate for Payer: Blue Shield of California Commercial |
$42.60
|
| Rate for Payer: Blue Shield of California EPN |
$34.08
|
| Rate for Payer: Cash Price |
$69.84
|
| Rate for Payer: Cash Price |
$69.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$45.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$122.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.23
|
| Rate for Payer: Heritage Provider Network Senior |
$43.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$33.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$140.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$163.77
|
| Rate for Payer: Multiplan Commercial |
$52.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$122.22
|
| Rate for Payer: TriValley Medical Group Senior |
$122.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$132.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$132.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Vantage Medical Group Senior |
$122.22
|
|
|
HC SOM CELIAC COMP HLA TYPING 2
|
Facility
|
IP
|
$69.84
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
900915328
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$52.38 |
| Rate for Payer: Adventist Health Commercial |
$13.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.98
|
| Rate for Payer: Cash Price |
$69.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.28
|
| Rate for Payer: Heritage Provider Network Senior |
$47.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.46
|
| Rate for Payer: Multiplan Commercial |
$52.38
|
|
