|
HC SOM CSF IGG INDEX ALB S
|
Facility
|
OP
|
$5.51
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
900914410
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$47.05 |
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.05
|
| Rate for Payer: Blue Shield of California Commercial |
$39.86
|
| Rate for Payer: Blue Shield of California EPN |
$31.97
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.41
|
| Rate for Payer: Heritage Provider Network Senior |
$3.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.63
|
| Rate for Payer: Multiplan Commercial |
$4.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.95
|
| Rate for Payer: TriValley Medical Group Senior |
$4.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4.95
|
|
|
HC SOM CSF IGG INDEX ALB S
|
Facility
|
IP
|
$5.51
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
900914410
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.55
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.73
|
| Rate for Payer: Heritage Provider Network Senior |
$3.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$4.13
|
|
|
HC SOM CSF IGG INDEX IGG, S
|
Facility
|
IP
|
$10.35
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900914409
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: Adventist Health Commercial |
$2.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.67
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.01
|
| Rate for Payer: Heritage Provider Network Senior |
$7.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$7.76
|
|
|
HC SOM CSF IGG INDEX IGG, S
|
Facility
|
OP
|
$10.35
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900914409
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$74.82 |
| Rate for Payer: Adventist Health Commercial |
$2.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.57
|
| Rate for Payer: Blue Shield of California Commercial |
$74.82
|
| Rate for Payer: Blue Shield of California EPN |
$60.01
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.11
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.41
|
| Rate for Payer: Heritage Provider Network Senior |
$6.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$7.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.30
|
| Rate for Payer: TriValley Medical Group Senior |
$9.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Senior |
$9.30
|
|
|
HC SOM C-TELOPEPTIDE
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
900912783
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$261.63 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.63
|
| Rate for Payer: Blue Shield of California Commercial |
$149.24
|
| Rate for Payer: Blue Shield of California EPN |
$119.70
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.03
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.68
|
| Rate for Payer: TriValley Medical Group Senior |
$18.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.55
|
| Rate for Payer: Vantage Medical Group Senior |
$18.68
|
|
|
HC SOM C-TELOPEPTIDE
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
900912783
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.59
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.19
|
| Rate for Payer: Heritage Provider Network Senior |
$12.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
|
|
HC SOM C. TRACHOMATIS, IGG
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
900912801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$122.54 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.33
|
| 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 |
$7.00
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.55
|
| 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 |
$4.13
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.33
|
| Rate for Payer: Heritage Provider Network Senior |
$4.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$5.25
|
| 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. TRACHOMATIS, IGG
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
900912801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.51
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.74
|
| Rate for Payer: Heritage Provider Network Senior |
$4.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$5.25
|
|
|
HC SOM C. TRACHOMATIS IGM
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912799
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$122.54 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.33
|
| 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 |
$7.00
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.55
|
| 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 |
$4.13
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.33
|
| Rate for Payer: Heritage Provider Network Senior |
$4.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.99
|
| Rate for Payer: Multiplan Commercial |
$5.25
|
| 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. TRACHOMATIS IGM
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912799
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.51
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.74
|
| Rate for Payer: Heritage Provider Network Senior |
$4.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$5.25
|
|
|
HC SOM CUCRU 82525
|
Facility
|
IP
|
$85.80
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900914747
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.53 |
| Max. Negotiated Rate |
$64.35 |
| Rate for Payer: Adventist Health Commercial |
$17.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.26
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.09
|
| Rate for Payer: Heritage Provider Network Senior |
$58.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.45
|
| Rate for Payer: Multiplan Commercial |
$64.35
|
|
|
HC SOM CUCRU 82525
|
Facility
|
OP
|
$85.80
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900914747
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.41 |
| Max. Negotiated Rate |
$118.13 |
| Rate for Payer: Adventist Health Commercial |
$17.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.13
|
| Rate for Payer: Blue Shield of California Commercial |
$99.88
|
| Rate for Payer: Blue Shield of California EPN |
$80.11
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.11
|
| Rate for Payer: Heritage Provider Network Senior |
$53.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$40.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.63
|
| Rate for Payer: Multiplan Commercial |
$64.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.41
|
| Rate for Payer: TriValley Medical Group Senior |
$12.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Vantage Medical Group Senior |
$12.41
|
|
|
HC SOM CULTURE 05
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900915288
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$1,355.40 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$108.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,355.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,187.25
|
| Rate for Payer: Blue Shield of California EPN |
$952.27
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$113.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$147.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$147.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.33
|
| Rate for Payer: Heritage Provider Network Senior |
$108.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$147.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$83.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$169.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$197.68
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$147.52
|
| Rate for Payer: TriValley Medical Group Senior |
$147.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$159.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$159.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Vantage Medical Group Senior |
$147.52
|
|
|
HC SOM CULTURE 05
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900915288
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$131.25 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$112.70
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.47
|
| Rate for Payer: Heritage Provider Network Senior |
$118.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.75
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
|
|
HC SOM CYSTATIN C WITH EGFR, S
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
900915362
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.88
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC SOM CYSTATIN C WITH EGFR, S
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
900915362
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$129.12 |
| Rate for Payer: EPIC Health Plan Medicare |
$18.52
|
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.12
|
| Rate for Payer: Blue Shield of California Commercial |
$109.44
|
| Rate for Payer: Blue Shield of California EPN |
$87.78
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.82
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.52
|
| Rate for Payer: TriValley Medical Group Senior |
$18.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.37
|
| Rate for Payer: Vantage Medical Group Senior |
$18.52
|
|
|
HC SOM CYSTICERCOSIS AB BLOOD
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911763
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$124.65 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.65
|
| Rate for Payer: Blue Shield of California Commercial |
$104.66
|
| Rate for Payer: Blue Shield of California EPN |
$83.95
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.57
|
| Rate for Payer: Heritage Provider Network Senior |
$18.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.43
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.01
|
| Rate for Payer: TriValley Medical Group Senior |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13.01
|
|
|
HC SOM CYSTICERCOSIS AB BLOOD
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911763
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.32
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.31
|
| Rate for Payer: Heritage Provider Network Senior |
$20.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
|
|
HC SOM CYSTICERCOSIS AB CSF
|
Facility
|
IP
|
$122.89
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911345
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.24 |
| Max. Negotiated Rate |
$92.17 |
| Rate for Payer: Adventist Health Commercial |
$24.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.14
|
| Rate for Payer: Cash Price |
$122.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.20
|
| Rate for Payer: Heritage Provider Network Senior |
$83.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Multiplan Commercial |
$92.17
|
|
|
HC SOM CYSTICERCOSIS AB CSF
|
Facility
|
OP
|
$122.89
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911345
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$124.65 |
| Rate for Payer: Adventist Health Commercial |
$24.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.65
|
| Rate for Payer: Blue Shield of California Commercial |
$104.66
|
| Rate for Payer: Blue Shield of California EPN |
$83.95
|
| Rate for Payer: Cash Price |
$122.89
|
| Rate for Payer: Cash Price |
$122.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$79.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.51
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.07
|
| Rate for Payer: Heritage Provider Network Senior |
$76.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$58.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.43
|
| Rate for Payer: Multiplan Commercial |
$92.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.01
|
| Rate for Payer: TriValley Medical Group Senior |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13.01
|
|
|
HC SOM CYSTIC FIBROSIS DNA
|
Facility
|
OP
|
$167.47
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
900911481
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.31 |
| Max. Negotiated Rate |
$4,025.04 |
| Rate for Payer: Adventist Health Commercial |
$33.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$834.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$612.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$556.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,025.04
|
| Rate for Payer: Blue Shield of California Commercial |
$102.16
|
| Rate for Payer: Blue Shield of California EPN |
$81.73
|
| Rate for Payer: Cash Price |
$167.47
|
| Rate for Payer: Cash Price |
$167.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$108.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$834.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$612.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$556.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$556.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.66
|
| Rate for Payer: Heritage Provider Network Senior |
$103.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$556.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$79.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$640.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$745.84
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$556.60
|
| Rate for Payer: TriValley Medical Group Senior |
$556.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$601.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$601.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$834.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$612.26
|
| Rate for Payer: Vantage Medical Group Senior |
$556.60
|
|
|
HC SOM CYSTIC FIBROSIS DNA
|
Facility
|
IP
|
$167.47
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
900911481
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.31 |
| Max. Negotiated Rate |
$125.60 |
| Rate for Payer: Adventist Health Commercial |
$33.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$107.85
|
| Rate for Payer: Cash Price |
$167.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.38
|
| Rate for Payer: Heritage Provider Network Senior |
$113.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.87
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
|
|
HC SOM CYSTIC FIBROSIS GENE MUTATION
|
Facility
|
IP
|
$130.90
|
|
|
Service Code
|
CPT 81222
|
| Hospital Charge Code |
900915427
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.69 |
| Max. Negotiated Rate |
$98.17 |
| Rate for Payer: Adventist Health Commercial |
$26.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$84.30
|
| Rate for Payer: Cash Price |
$130.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$88.62
|
| Rate for Payer: Heritage Provider Network Senior |
$88.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.73
|
| Rate for Payer: Multiplan Commercial |
$98.17
|
|
|
HC SOM CYSTIC FIBROSIS GENE MUTATION
|
Facility
|
OP
|
$130.90
|
|
|
Service Code
|
CPT 81222
|
| Hospital Charge Code |
900915427
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.69 |
| Max. Negotiated Rate |
$680.45 |
| Rate for Payer: Adventist Health Commercial |
$26.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$80.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$652.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$478.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$680.45
|
| Rate for Payer: Blue Shield of California Commercial |
$79.85
|
| Rate for Payer: Blue Shield of California EPN |
$63.88
|
| Rate for Payer: Cash Price |
$130.90
|
| Rate for Payer: Cash Price |
$130.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$85.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$652.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$478.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$435.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$435.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.03
|
| Rate for Payer: Heritage Provider Network Senior |
$81.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$435.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$62.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$500.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$582.99
|
| Rate for Payer: Multiplan Commercial |
$98.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$435.07
|
| Rate for Payer: TriValley Medical Group Senior |
$435.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$469.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$469.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$652.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$478.58
|
| Rate for Payer: Vantage Medical Group Senior |
$435.07
|
|
|
HC SOM DCP 83951
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 83951
|
| Hospital Charge Code |
900914920
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$609.43 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$609.43
|
| Rate for Payer: Blue Shield of California Commercial |
$541.67
|
| Rate for Payer: Blue Shield of California EPN |
$434.46
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$64.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.71
|
| Rate for Payer: Heritage Provider Network Senior |
$55.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$42.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$74.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$86.31
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$64.41
|
| Rate for Payer: TriValley Medical Group Senior |
$64.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$69.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$69.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.85
|
| Rate for Payer: Vantage Medical Group Senior |
$64.41
|
|
