|
HC SOM DILANTIN LV FREE PHENY TOT
|
Facility
|
IP
|
$13.83
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
900912809
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$10.37 |
| Rate for Payer: Adventist Health Commercial |
$2.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.91
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.36
|
| Rate for Payer: Heritage Provider Network Senior |
$9.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.46
|
| Rate for Payer: Multiplan Commercial |
$10.37
|
|
|
HC SOM DILANTIN LV FREE PHENY TOT
|
Facility
|
OP
|
$13.83
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
900912809
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$125.86 |
| Rate for Payer: Adventist Health Commercial |
$2.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.86
|
| Rate for Payer: Blue Shield of California Commercial |
$106.68
|
| Rate for Payer: Blue Shield of California EPN |
$85.56
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.56
|
| Rate for Payer: Heritage Provider Network Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.75
|
| Rate for Payer: Multiplan Commercial |
$10.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.25
|
| Rate for Payer: TriValley Medical Group Senior |
$13.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
|
HC SOM DIPHTHERIA ANTITOXOID (ELISA)
|
Facility
|
IP
|
$34.72
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900911755
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$26.04 |
| Rate for Payer: Adventist Health Commercial |
$6.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.36
|
| Rate for Payer: Cash Price |
$34.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.51
|
| Rate for Payer: Heritage Provider Network Senior |
$23.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$26.04
|
|
|
HC SOM DIPHTHERIA ANTITOXOID (ELISA)
|
Facility
|
OP
|
$34.72
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900911755
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$142.35 |
| Rate for Payer: EPIC Health Plan Medicare |
$14.99
|
| Rate for Payer: Adventist Health Commercial |
$6.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.35
|
| Rate for Payer: Blue Shield of California Commercial |
$120.67
|
| Rate for Payer: Blue Shield of California EPN |
$96.79
|
| Rate for Payer: Cash Price |
$34.72
|
| Rate for Payer: Cash Price |
$34.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.49
|
| Rate for Payer: Heritage Provider Network Senior |
$21.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$26.04
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.99
|
| Rate for Payer: TriValley Medical Group Senior |
$14.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC SOM DNA AND RNA EXTRACT AND HOLD
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
900915521
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.30
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.77
|
| Rate for Payer: Heritage Provider Network Senior |
$50.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
|
|
HC SOM DNA AND RNA EXTRACT AND HOLD
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
900915521
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$300.43 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$300.43
|
| Rate for Payer: Blue Shield of California Commercial |
$45.75
|
| Rate for Payer: Blue Shield of California EPN |
$36.60
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.42
|
| Rate for Payer: Heritage Provider Network Senior |
$46.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$35.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$157.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$183.58
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.00
|
| Rate for Payer: TriValley Medical Group Senior |
$137.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$147.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$147.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.00
|
|
|
HC SOM DNA EXTRACTION
|
Facility
|
IP
|
$203.61
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
900910721
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$152.71 |
| Rate for Payer: Adventist Health Commercial |
$40.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.12
|
| Rate for Payer: Cash Price |
$203.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$137.84
|
| Rate for Payer: Heritage Provider Network Senior |
$137.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.90
|
| Rate for Payer: Multiplan Commercial |
$152.71
|
|
|
HC SOM DNA EXTRACTION
|
Facility
|
OP
|
$203.61
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
900910721
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$300.43 |
| Rate for Payer: Adventist Health Commercial |
$40.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$125.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$300.43
|
| Rate for Payer: Blue Shield of California Commercial |
$124.20
|
| Rate for Payer: Blue Shield of California EPN |
$99.36
|
| Rate for Payer: Cash Price |
$203.61
|
| Rate for Payer: Cash Price |
$203.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$132.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.13
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$126.03
|
| Rate for Payer: Heritage Provider Network Senior |
$126.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$97.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$157.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$183.58
|
| Rate for Payer: Multiplan Commercial |
$152.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.00
|
| Rate for Payer: TriValley Medical Group Senior |
$137.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$147.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$147.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.00
|
|
|
HC SOM DRUG SCREEN PRESCRIPTION/OTC U
|
Facility
|
IP
|
$63.30
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912877
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.46 |
| Max. Negotiated Rate |
$47.48 |
| Rate for Payer: Adventist Health Commercial |
$12.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.77
|
| Rate for Payer: Cash Price |
$63.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.85
|
| Rate for Payer: Heritage Provider Network Senior |
$42.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.82
|
| Rate for Payer: Multiplan Commercial |
$47.48
|
|
|
HC SOM DRUG SCREEN PRESCRIPTION/OTC U
|
Facility
|
OP
|
$63.30
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912877
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.46 |
| Max. Negotiated Rate |
$585.08 |
| Rate for Payer: Adventist Health Commercial |
$12.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$585.08
|
| Rate for Payer: Blue Shield of California Commercial |
$459.71
|
| Rate for Payer: Blue Shield of California EPN |
$368.72
|
| Rate for Payer: Cash Price |
$63.30
|
| Rate for Payer: Cash Price |
$63.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$62.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.18
|
| Rate for Payer: Heritage Provider Network Senior |
$39.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$30.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$47.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.14
|
| Rate for Payer: TriValley Medical Group Senior |
$62.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$67.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC SOM DRUG SCRN MECONIUM AMPHETAMINE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911008
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$585.08 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$585.08
|
| Rate for Payer: Blue Shield of California Commercial |
$459.71
|
| Rate for Payer: Blue Shield of California EPN |
$368.72
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$62.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.14
|
| Rate for Payer: TriValley Medical Group Senior |
$62.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$67.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC SOM DRUG SCRN MECONIUM AMPHETAMINE
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911008
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.20
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.85
|
| Rate for Payer: Heritage Provider Network Senior |
$33.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
|
|
HC SOM DULOX 80299
|
Facility
|
IP
|
$45.63
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900914748
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$34.22 |
| Rate for Payer: Adventist Health Commercial |
$9.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.39
|
| Rate for Payer: Cash Price |
$45.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.89
|
| Rate for Payer: Heritage Provider Network Senior |
$30.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.41
|
| Rate for Payer: Multiplan Commercial |
$34.22
|
|
|
HC SOM DULOX 80299
|
Facility
|
OP
|
$45.63
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900914748
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$138.26 |
| Rate for Payer: Adventist Health Commercial |
$9.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.26
|
| Rate for Payer: Blue Shield of California Commercial |
$110.19
|
| Rate for Payer: Blue Shield of California EPN |
$88.38
|
| Rate for Payer: Cash Price |
$45.63
|
| Rate for Payer: Cash Price |
$45.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.92
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.24
|
| Rate for Payer: Heritage Provider Network Senior |
$28.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$34.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.64
|
| Rate for Payer: TriValley Medical Group Senior |
$18.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM EBV PCR QUANT
|
Facility
|
OP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.07
|
| 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 |
$50.27
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.68
|
| 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 |
$29.66
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.12
|
| Rate for Payer: Heritage Provider Network Senior |
$31.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
| 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 EBV PCR QUANT
|
Facility
|
IP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$37.70 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.37
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.03
|
| Rate for Payer: Heritage Provider Network Senior |
$34.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.57
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
|
|
HC SOM ECHINOCOCCUS AB
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911392
|
|
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 ECHINOCOCCUS AB
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911392
|
|
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 EHRLICHOSIS
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
900911388
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.05
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.43
|
| Rate for Payer: Heritage Provider Network Senior |
$28.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
|
|
HC SOM EHRLICHOSIS
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
900911388
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$96.52 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.52
|
| Rate for Payer: Blue Shield of California Commercial |
$81.91
|
| Rate for Payer: Blue Shield of California EPN |
$65.70
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.00
|
| Rate for Payer: Heritage Provider Network Senior |
$26.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.64
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.18
|
| Rate for Payer: TriValley Medical Group Senior |
$10.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
HC SOM ELECTROPHORES,PROTEN,RANDM
|
Facility
|
IP
|
$20.05
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912891
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$15.04 |
| Rate for Payer: Adventist Health Commercial |
$4.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.91
|
| Rate for Payer: Cash Price |
$20.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.57
|
| Rate for Payer: Heritage Provider Network Senior |
$13.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.01
|
| Rate for Payer: Multiplan Commercial |
$15.04
|
|
|
HC SOM ELECTROPHORES,PROTEN,RANDM
|
Facility
|
OP
|
$20.05
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912891
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$165.88 |
| Rate for Payer: Adventist Health Commercial |
$4.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.88
|
| Rate for Payer: Blue Shield of California Commercial |
$143.54
|
| Rate for Payer: Blue Shield of California EPN |
$115.13
|
| Rate for Payer: Cash Price |
$20.05
|
| Rate for Payer: Cash Price |
$20.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.83
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.41
|
| Rate for Payer: Heritage Provider Network Senior |
$12.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.89
|
| Rate for Payer: Multiplan Commercial |
$15.04
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.83
|
| Rate for Payer: TriValley Medical Group Senior |
$17.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Vantage Medical Group Senior |
$17.83
|
|
|
HC SOM ENC AGNA-1, CSF
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915408
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$25.55 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.93
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.06
|
| Rate for Payer: Heritage Provider Network Senior |
$23.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
|
|
HC SOM ENC AGNA-1, CSF
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915408
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.48
|
| Rate for Payer: Blue Shield of California Commercial |
$97.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.80
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.08
|
| Rate for Payer: Heritage Provider Network Senior |
$21.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENC AMPA-R AB CBA, CSF
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915410
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.48
|
| Rate for Payer: Blue Shield of California Commercial |
$97.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.80
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.08
|
| Rate for Payer: Heritage Provider Network Senior |
$21.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
