|
HC SOM CORTISOL FREE UR
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900914673
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.10
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.93
|
| Rate for Payer: Heritage Provider Network Senior |
$16.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SOM CORTISOL FREE URINE
|
Facility
|
IP
|
$31.01
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900911026
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$23.26 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.97
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.99
|
| Rate for Payer: Heritage Provider Network Senior |
$20.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$23.26
|
|
|
HC SOM CORTISOL FREE URINE
|
Facility
|
OP
|
$31.01
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900911026
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$161.02 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.02
|
| Rate for Payer: Blue Shield of California Commercial |
$134.50
|
| Rate for Payer: Blue Shield of California EPN |
$107.88
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.20
|
| Rate for Payer: Heritage Provider Network Senior |
$19.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.39
|
| Rate for Payer: Multiplan Commercial |
$23.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.71
|
| Rate for Payer: TriValley Medical Group Senior |
$16.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Vantage Medical Group Senior |
$16.71
|
|
|
HC SOM COUMADIN LEVEL
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 80375
|
| Hospital Charge Code |
900911161
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$164.09 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.09
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$70.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.47
|
| Rate for Payer: Heritage Provider Network Senior |
$67.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$51.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$76.30
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$54.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$54.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.65
|
| Rate for Payer: Vantage Medical Group Senior |
$92.65
|
|
|
HC SOM COUMADIN LEVEL
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 80375
|
| Hospital Charge Code |
900911161
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$81.75 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.20
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.79
|
| Rate for Payer: Heritage Provider Network Senior |
$73.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.25
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
|
|
HC SOM COXIELLA BURNETTI AB PANEL
|
Facility
|
IP
|
$10.02
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900911769
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$7.51 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.45
|
| Rate for Payer: Cash Price |
$10.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.78
|
| Rate for Payer: Heritage Provider Network Senior |
$6.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$7.51
|
|
|
HC SOM COXIELLA BURNETTI AB PANEL
|
Facility
|
OP
|
$10.02
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900911769
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$119.85 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.85
|
| Rate for Payer: Blue Shield of California Commercial |
$97.57
|
| Rate for Payer: Blue Shield of California EPN |
$78.26
|
| Rate for Payer: Cash Price |
$10.02
|
| Rate for Payer: Cash Price |
$10.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.91
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.20
|
| Rate for Payer: Heritage Provider Network Senior |
$6.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.24
|
| Rate for Payer: Multiplan Commercial |
$7.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.12
|
| Rate for Payer: TriValley Medical Group Senior |
$12.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.12
|
|
|
HC SOM C-PEPTIDE
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
900911116
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$161.02 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.02
|
| Rate for Payer: Blue Shield of California Commercial |
$147.57
|
| Rate for Payer: Blue Shield of California EPN |
$118.36
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.19
|
| Rate for Payer: Heritage Provider Network Senior |
$6.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.89
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.81
|
| Rate for Payer: TriValley Medical Group Senior |
$20.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC SOM C-PEPTIDE
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
900911116
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.44
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.77
|
| Rate for Payer: Heritage Provider Network Senior |
$6.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
|
|
HC SOM C PNEUMONIA IGG
|
Facility
|
OP
|
$16.64
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
900911125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$122.54 |
| Rate for Payer: Adventist Health Commercial |
$3.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.54
|
| Rate for Payer: Blue Shield of California Commercial |
$95.16
|
| Rate for Payer: Blue Shield of California EPN |
$76.32
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.30
|
| Rate for Payer: Heritage Provider Network Senior |
$10.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$12.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.82
|
| Rate for Payer: TriValley Medical Group Senior |
$11.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11.82
|
|
|
HC SOM C PNEUMONIA IGG
|
Facility
|
IP
|
$16.64
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
900911125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Adventist Health Commercial |
$3.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.72
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.27
|
| Rate for Payer: Heritage Provider Network Senior |
$11.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.16
|
| Rate for Payer: Multiplan Commercial |
$12.48
|
|
|
HC SOM C. PNEUMONIA IGM
|
Facility
|
OP
|
$17.85
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912797
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$122.54 |
| Rate for Payer: Adventist Health Commercial |
$3.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.54
|
| Rate for Payer: Blue Shield of California Commercial |
$102.18
|
| Rate for Payer: Blue Shield of California EPN |
$81.96
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.05
|
| Rate for Payer: Heritage Provider Network Senior |
$11.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.99
|
| Rate for Payer: Multiplan Commercial |
$13.39
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.68
|
| Rate for Payer: TriValley Medical Group Senior |
$12.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.95
|
| Rate for Payer: Vantage Medical Group Senior |
$12.68
|
|
|
HC SOM C. PNEUMONIA IGM
|
Facility
|
IP
|
$17.85
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912797
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$13.39 |
| Rate for Payer: Adventist Health Commercial |
$3.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.50
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.08
|
| Rate for Payer: Heritage Provider Network Senior |
$12.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$13.39
|
|
|
HC SOM C. PSITTACI IGG
|
Facility
|
OP
|
$16.64
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
900912800
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$122.54 |
| Rate for Payer: Adventist Health Commercial |
$3.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.54
|
| Rate for Payer: Blue Shield of California Commercial |
$95.16
|
| Rate for Payer: Blue Shield of California EPN |
$76.32
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.30
|
| Rate for Payer: Heritage Provider Network Senior |
$10.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$12.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.82
|
| Rate for Payer: TriValley Medical Group Senior |
$11.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11.82
|
|
|
HC SOM C. PSITTACI IGG
|
Facility
|
IP
|
$16.64
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
900912800
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Adventist Health Commercial |
$3.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.72
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.27
|
| Rate for Payer: Heritage Provider Network Senior |
$11.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.16
|
| Rate for Payer: Multiplan Commercial |
$12.48
|
|
|
HC SOM C. PSITTACI IGM
|
Facility
|
IP
|
$17.86
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912798
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$13.39 |
| Rate for Payer: Adventist Health Commercial |
$3.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.50
|
| Rate for Payer: Cash Price |
$17.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.09
|
| Rate for Payer: Heritage Provider Network Senior |
$12.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$13.39
|
|
|
HC SOM C. PSITTACI IGM
|
Facility
|
OP
|
$17.86
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912798
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$122.54 |
| Rate for Payer: Adventist Health Commercial |
$3.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.54
|
| Rate for Payer: Blue Shield of California Commercial |
$102.18
|
| Rate for Payer: Blue Shield of California EPN |
$81.96
|
| Rate for Payer: Cash Price |
$17.86
|
| Rate for Payer: Cash Price |
$17.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.54
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.06
|
| Rate for Payer: Heritage Provider Network Senior |
$11.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.99
|
| Rate for Payer: Multiplan Commercial |
$13.39
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.68
|
| Rate for Payer: TriValley Medical Group Senior |
$12.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.95
|
| Rate for Payer: Vantage Medical Group Senior |
$12.68
|
|
|
HC SOM CRYOFIBRINOGEN
|
Facility
|
IP
|
$16.69
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
900911373
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$12.52 |
| Rate for Payer: Adventist Health Commercial |
$3.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.75
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.30
|
| Rate for Payer: Heritage Provider Network Senior |
$11.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.17
|
| Rate for Payer: Multiplan Commercial |
$12.52
|
|
|
HC SOM CRYOFIBRINOGEN
|
Facility
|
OP
|
$16.69
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
900911373
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$81.44 |
| Rate for Payer: Adventist Health Commercial |
$3.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.44
|
| Rate for Payer: Blue Shield of California Commercial |
$69.00
|
| Rate for Payer: Blue Shield of California EPN |
$55.35
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.33
|
| Rate for Payer: Heritage Provider Network Senior |
$10.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.95
|
| Rate for Payer: Multiplan Commercial |
$12.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.14
|
| Rate for Payer: TriValley Medical Group Senior |
$14.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.55
|
| Rate for Payer: Vantage Medical Group Senior |
$14.14
|
|
|
HC SOM CRYOFIBRINOGEN CRYOGLOBULIN
|
Facility
|
OP
|
$7.63
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
900912819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$59.83 |
| Rate for Payer: Cigna of CA HMO/PPO |
$4.96
|
| Rate for Payer: Adventist Health Commercial |
$1.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.83
|
| Rate for Payer: Blue Shield of California Commercial |
$52.07
|
| Rate for Payer: Blue Shield of California EPN |
$41.76
|
| Rate for Payer: Cash Price |
$7.63
|
| Rate for Payer: Cash Price |
$7.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.72
|
| Rate for Payer: Heritage Provider Network Senior |
$4.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$5.72
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC SOM CRYOFIBRINOGEN CRYOGLOBULIN
|
Facility
|
IP
|
$7.63
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
900912819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Adventist Health Commercial |
$1.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.91
|
| Rate for Payer: Cash Price |
$7.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.17
|
| Rate for Payer: Heritage Provider Network Senior |
$5.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$5.72
|
|
|
HC SOM CRYPTOSPORIDIUM AG, F
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
900912939
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$85.34 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.34
|
| 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 |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.76
|
| Rate for Payer: Heritage Provider Network Senior |
$24.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.52
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.82
|
| Rate for Payer: TriValley Medical Group Senior |
$13.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.20
|
| Rate for Payer: Vantage Medical Group Senior |
$13.82
|
|
|
HC SOM CRYPTOSPORIDIUM AG, F
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
900912939
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.76
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.08
|
| Rate for Payer: Heritage Provider Network Senior |
$27.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
|
|
HC SOM CSF IGG INDEX ALB CSF
|
Facility
|
IP
|
$8.66
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
900914411
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Adventist Health Commercial |
$1.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.58
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.86
|
| Rate for Payer: Heritage Provider Network Senior |
$5.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.17
|
| Rate for Payer: Multiplan Commercial |
$6.50
|
|
|
HC SOM CSF IGG INDEX ALB CSF
|
Facility
|
OP
|
$8.66
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
900914411
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$49.09 |
| Rate for Payer: Adventist Health Commercial |
$1.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.09
|
| Rate for Payer: Blue Shield of California Commercial |
$41.64
|
| Rate for Payer: Blue Shield of California EPN |
$33.40
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.11
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.36
|
| Rate for Payer: Heritage Provider Network Senior |
$5.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.43
|
| Rate for Payer: Multiplan Commercial |
$6.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.78
|
| Rate for Payer: TriValley Medical Group Senior |
$7.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Vantage Medical Group Senior |
$7.78
|
|
