|
HC SOM COAG FACTOR VIII ASSAY
|
Facility
|
OP
|
$75.32
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
900913969
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$170.03 |
| Rate for Payer: Adventist Health Commercial |
$15.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.03
|
| Rate for Payer: Blue Shield of California Commercial |
$144.12
|
| Rate for Payer: Blue Shield of California EPN |
$115.59
|
| Rate for Payer: Cash Price |
$75.32
|
| Rate for Payer: Cash Price |
$75.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.44
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.62
|
| Rate for Payer: Heritage Provider Network Senior |
$46.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$35.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.99
|
| Rate for Payer: Multiplan Commercial |
$56.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.90
|
| Rate for Payer: TriValley Medical Group Senior |
$17.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
|
|
HC SOM COAG FVIII INHIB SCREEN
|
Facility
|
OP
|
$222.45
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900913971
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$166.84 |
| Rate for Payer: Adventist Health Commercial |
$44.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.22
|
| Rate for Payer: Blue Shield of California Commercial |
$103.62
|
| Rate for Payer: Blue Shield of California EPN |
$83.11
|
| Rate for Payer: Cash Price |
$222.45
|
| Rate for Payer: Cash Price |
$222.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$144.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$137.70
|
| Rate for Payer: Heritage Provider Network Senior |
$137.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$106.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$166.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.87
|
| Rate for Payer: TriValley Medical Group Senior |
$12.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC SOM COAG FVIII INHIB SCREEN
|
Facility
|
IP
|
$222.45
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900913971
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$166.84 |
| Rate for Payer: Adventist Health Commercial |
$44.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$143.26
|
| Rate for Payer: Cash Price |
$222.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$150.60
|
| Rate for Payer: Heritage Provider Network Senior |
$150.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.61
|
| Rate for Payer: Multiplan Commercial |
$166.84
|
|
|
HC SOM COCCI AB IGG CSF BY CF
|
Facility
|
OP
|
$17.75
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900911338
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$110.46 |
| Rate for Payer: Adventist Health Commercial |
$3.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.46
|
| Rate for Payer: Blue Shield of California Commercial |
$92.33
|
| Rate for Payer: Blue Shield of California EPN |
$74.06
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.99
|
| Rate for Payer: Heritage Provider Network Senior |
$10.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.47
|
| Rate for Payer: TriValley Medical Group Senior |
$11.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COCCI AB IGG CSF BY CF
|
Facility
|
IP
|
$17.75
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900911338
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$13.31 |
| Rate for Payer: Adventist Health Commercial |
$3.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.43
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.02
|
| Rate for Payer: Heritage Provider Network Senior |
$12.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.44
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
|
|
HC SOM COCCI AB IGG CSF BY ID
|
Facility
|
OP
|
$17.75
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$110.46 |
| Rate for Payer: Adventist Health Commercial |
$3.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.46
|
| Rate for Payer: Blue Shield of California Commercial |
$92.33
|
| Rate for Payer: Blue Shield of California EPN |
$74.06
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.99
|
| Rate for Payer: Heritage Provider Network Senior |
$10.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.47
|
| Rate for Payer: TriValley Medical Group Senior |
$11.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COCCI AB IGG CSF BY ID
|
Facility
|
IP
|
$17.75
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$13.31 |
| Rate for Payer: Adventist Health Commercial |
$3.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.43
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.02
|
| Rate for Payer: Heritage Provider Network Senior |
$12.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.44
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
|
|
HC SOM COCCI AB IGM CSF BY ID
|
Facility
|
OP
|
$17.75
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912665
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$110.46 |
| Rate for Payer: Adventist Health Commercial |
$3.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.46
|
| Rate for Payer: Blue Shield of California Commercial |
$92.33
|
| Rate for Payer: Blue Shield of California EPN |
$74.06
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.99
|
| Rate for Payer: Heritage Provider Network Senior |
$10.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.47
|
| Rate for Payer: TriValley Medical Group Senior |
$11.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COCCI AB IGM CSF BY ID
|
Facility
|
IP
|
$17.75
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912665
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$13.31 |
| Rate for Payer: Adventist Health Commercial |
$3.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.43
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.02
|
| Rate for Payer: Heritage Provider Network Senior |
$12.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.44
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
|
|
HC SOM COCCIDIOIDES AB IGG BY CF
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912669
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.73
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.12
|
| Rate for Payer: Heritage Provider Network Senior |
$8.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
|
|
HC SOM COCCIDIOIDES AB IGG BY CF
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912669
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$110.46 |
| Rate for Payer: EPIC Health Plan Medicare |
$11.47
|
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.46
|
| Rate for Payer: Blue Shield of California Commercial |
$92.33
|
| Rate for Payer: Blue Shield of California EPN |
$74.06
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.43
|
| Rate for Payer: Heritage Provider Network Senior |
$7.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.47
|
| Rate for Payer: TriValley Medical Group Senior |
$11.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COCCIDIOIDES AB IGG BY ID
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900911752
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$110.46 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.46
|
| Rate for Payer: Blue Shield of California Commercial |
$92.33
|
| Rate for Payer: Blue Shield of California EPN |
$74.06
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.43
|
| Rate for Payer: Heritage Provider Network Senior |
$7.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.47
|
| Rate for Payer: TriValley Medical Group Senior |
$11.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COCCIDIOIDES AB IGG BY ID
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900911752
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.73
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.12
|
| Rate for Payer: Heritage Provider Network Senior |
$8.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
|
|
HC SOM COCCIDIOIDES AB IGM BY ID
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912668
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$110.46 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.46
|
| Rate for Payer: Blue Shield of California Commercial |
$92.33
|
| Rate for Payer: Blue Shield of California EPN |
$74.06
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.43
|
| Rate for Payer: Heritage Provider Network Senior |
$7.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.47
|
| Rate for Payer: TriValley Medical Group Senior |
$11.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COCCIDIOIDES AB IGM BY ID
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912668
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.73
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.12
|
| Rate for Payer: Heritage Provider Network Senior |
$8.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
|
|
HC SOM COCCIDOIDES PCR
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$31.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$95.79
|
| 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 |
$155.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$100.75
|
| 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 |
$100.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$95.94
|
| Rate for Payer: Heritage Provider Network Senior |
$95.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$73.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$116.25
|
| 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 COCCIDOIDES PCR
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$116.25 |
| Rate for Payer: Adventist Health Commercial |
$31.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$99.82
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$104.94
|
| Rate for Payer: Heritage Provider Network Senior |
$104.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.75
|
| Rate for Payer: Multiplan Commercial |
$116.25
|
|
|
HC SOM COLONIES 1-6
|
Facility
|
OP
|
$93.75
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
900915300
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$16.97 |
| Max. Negotiated Rate |
$1,579.07 |
| Rate for Payer: Adventist Health Commercial |
$18.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$57.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$191.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,579.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1,338.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,073.60
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$173.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.03
|
| Rate for Payer: Heritage Provider Network Senior |
$58.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$173.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$199.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$232.70
|
| Rate for Payer: Multiplan Commercial |
$70.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$173.66
|
| Rate for Payer: TriValley Medical Group Senior |
$173.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$187.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$187.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$260.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.03
|
| Rate for Payer: Vantage Medical Group Senior |
$173.66
|
|
|
HC SOM COLONIES 1-6
|
Facility
|
IP
|
$93.75
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
900915300
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$16.97 |
| Max. Negotiated Rate |
$70.31 |
| Rate for Payer: Adventist Health Commercial |
$18.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.38
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.47
|
| Rate for Payer: Heritage Provider Network Senior |
$63.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.44
|
| Rate for Payer: Multiplan Commercial |
$70.31
|
|
|
HC SOM COMPLEMENT C1Q
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900911109
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.66
|
| Rate for Payer: Heritage Provider Network Senior |
$21.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
|
|
HC SOM COMPLEMENT C1Q
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900911109
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$113.97 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.97
|
| Rate for Payer: Blue Shield of California Commercial |
$96.65
|
| Rate for Payer: Blue Shield of California EPN |
$77.52
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.81
|
| Rate for Payer: Heritage Provider Network Senior |
$19.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$15.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
|
|
HC SOM COMPLEMENT C1Q BINDING
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900911097
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.38
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.22
|
| Rate for Payer: Heritage Provider Network Senior |
$58.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
|
|
HC SOM COMPLEMENT C1Q BINDING
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900911097
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$231.40 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.40
|
| Rate for Payer: Blue Shield of California Commercial |
$196.13
|
| Rate for Payer: Blue Shield of California EPN |
$157.31
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.23
|
| Rate for Payer: Heritage Provider Network Senior |
$53.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$41.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.66
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.37
|
| Rate for Payer: TriValley Medical Group Senior |
$24.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: Vantage Medical Group Senior |
$24.37
|
|
|
HC SOM COMPLEMENT C-2
|
Facility
|
OP
|
$49.63
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
900911110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$113.97 |
| Rate for Payer: Adventist Health Commercial |
$9.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.97
|
| Rate for Payer: Blue Shield of California Commercial |
$96.65
|
| Rate for Payer: Blue Shield of California EPN |
$77.52
|
| Rate for Payer: Cash Price |
$49.63
|
| Rate for Payer: Cash Price |
$49.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.72
|
| Rate for Payer: Heritage Provider Network Senior |
$30.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$37.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
|
|
HC SOM COMPLEMENT C-2
|
Facility
|
IP
|
$49.63
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
900911110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$37.22 |
| Rate for Payer: Adventist Health Commercial |
$9.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.96
|
| Rate for Payer: Cash Price |
$49.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.60
|
| Rate for Payer: Heritage Provider Network Senior |
$33.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.41
|
| Rate for Payer: Multiplan Commercial |
$37.22
|
|
