|
HC SOM PARANEOPL EVAL P/Q AB
|
Facility
IP
|
$39.35
|
|
|
Service Code
|
CPT 86596
|
| Hospital Charge Code |
900914658
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$29.51 |
| Rate for Payer: Adventist Health Commercial |
$7.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.03
|
| Rate for Payer: Cash Price |
$17.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.64
|
| Rate for Payer: Heritage Provider Network Senior |
$26.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Multiplan Commercial |
$29.51
|
|
|
HC SOM PARASITIC EXAM CONC
|
Facility
IP
|
$28.71
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
900914691
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$21.53 |
| Rate for Payer: Adventist Health Commercial |
$5.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.72
|
| Rate for Payer: Cash Price |
$12.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.44
|
| Rate for Payer: Heritage Provider Network Senior |
$19.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.18
|
| Rate for Payer: Multiplan Commercial |
$21.53
|
|
|
HC SOM PARASITIC EXAM CONC
|
Facility
OP
|
$28.71
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
900914691
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$55.90 |
| Rate for Payer: Adventist Health Commercial |
$5.74
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.90
|
| Rate for Payer: Blue Shield of California Commercial |
$52.15
|
| Rate for Payer: Blue Shield of California EPN |
$40.77
|
| Rate for Payer: Cash Price |
$12.92
|
| Rate for Payer: Cash Price |
$12.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.35
|
| Rate for Payer: Dignity Health Senior |
$6.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.66
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.77
|
| Rate for Payer: Heritage Provider Network Senior |
$17.77
|
| Rate for Payer: Humana Medicare |
$6.68
|
| Rate for Payer: IEHP Medi-Cal |
$9.06
|
| Rate for Payer: IEHP Medicare Advantage |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.42
|
| Rate for Payer: Multiplan Commercial |
$21.53
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.68
|
| Rate for Payer: TriValley Medical Group Senior |
$6.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Vantage Medical Group Senior |
$6.68
|
|
|
HC SOM PARASITIC EXAM STAIN
|
Facility
IP
|
$77.27
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
900914692
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$57.95 |
| Rate for Payer: Adventist Health Commercial |
$15.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.08
|
| Rate for Payer: Cash Price |
$34.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.31
|
| Rate for Payer: Heritage Provider Network Senior |
$52.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.32
|
| Rate for Payer: Multiplan Commercial |
$57.95
|
|
|
HC SOM PARASITIC EXAM STAIN
|
Facility
OP
|
$77.27
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
900914692
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$147.13 |
| Rate for Payer: Adventist Health Commercial |
$15.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.13
|
| Rate for Payer: Blue Shield of California Commercial |
$140.36
|
| Rate for Payer: Blue Shield of California EPN |
$109.73
|
| Rate for Payer: Cash Price |
$34.77
|
| Rate for Payer: Cash Price |
$34.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.78
|
| Rate for Payer: Dignity Health Senior |
$17.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.23
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.83
|
| Rate for Payer: Heritage Provider Network Senior |
$47.83
|
| Rate for Payer: Humana Medicare |
$17.98
|
| Rate for Payer: IEHP Medi-Cal |
$24.93
|
| Rate for Payer: IEHP Medicare Advantage |
$17.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.65
|
| Rate for Payer: Multiplan Commercial |
$57.95
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.98
|
| Rate for Payer: TriValley Medical Group Senior |
$17.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.78
|
| Rate for Payer: Vantage Medical Group Senior |
$17.98
|
|
|
HC SOM PARIETAL CELL AB
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911267
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$195.82 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.82
|
| Rate for Payer: Blue Shield of California Commercial |
$72.56
|
| Rate for Payer: Blue Shield of California EPN |
$56.72
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.48
|
| Rate for Payer: Heritage Provider Network Senior |
$15.48
|
| Rate for Payer: Humana Medicare |
$11.53
|
| Rate for Payer: IEHP Medi-Cal |
$13.42
|
| Rate for Payer: IEHP Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM PARIETAL CELL AB
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911267
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.92
|
| Rate for Payer: Heritage Provider Network Senior |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SOM PARVOVIRUS B19 AB IGG
|
Facility
IP
|
$11.23
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
900912538
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.72
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.60
|
| Rate for Payer: Heritage Provider Network Senior |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
|
|
HC SOM PARVOVIRUS B19 AB IGG
|
Facility
OP
|
$11.23
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
900912538
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.00
|
| Rate for Payer: Blue Shield of California Commercial |
$117.39
|
| Rate for Payer: Blue Shield of California EPN |
$91.77
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.53
|
| Rate for Payer: Dignity Health Senior |
$15.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.95
|
| Rate for Payer: Heritage Provider Network Senior |
$6.95
|
| Rate for Payer: Humana Medicare |
$15.03
|
| Rate for Payer: IEHP Medi-Cal |
$20.84
|
| Rate for Payer: IEHP Medicare Advantage |
$15.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.94
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.03
|
| Rate for Payer: TriValley Medical Group Senior |
$15.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.53
|
| Rate for Payer: Vantage Medical Group Senior |
$15.03
|
|
|
HC SOM PARVOVIRUS B19 AB IGM
|
Facility
IP
|
$11.23
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
900912694
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.72
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.60
|
| Rate for Payer: Heritage Provider Network Senior |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
|
|
HC SOM PARVOVIRUS B19 AB IGM
|
Facility
OP
|
$11.23
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
900912694
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.00
|
| Rate for Payer: Blue Shield of California Commercial |
$117.39
|
| Rate for Payer: Blue Shield of California EPN |
$91.77
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.53
|
| Rate for Payer: Dignity Health Senior |
$15.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.95
|
| Rate for Payer: Heritage Provider Network Senior |
$6.95
|
| Rate for Payer: Humana Medicare |
$15.03
|
| Rate for Payer: IEHP Medi-Cal |
$20.84
|
| Rate for Payer: IEHP Medicare Advantage |
$15.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.94
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.03
|
| Rate for Payer: TriValley Medical Group Senior |
$15.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.53
|
| Rate for Payer: Vantage Medical Group Senior |
$15.03
|
|
|
HC SOM PARVOVIRUS B19 PCR BF
|
Facility
IP
|
$41.48
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912782
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$31.11 |
| Rate for Payer: Adventist Health Commercial |
$8.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.50
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.08
|
| Rate for Payer: Heritage Provider Network Senior |
$28.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.37
|
| Rate for Payer: Multiplan Commercial |
$31.11
|
|
|
HC SOM PARVOVIRUS B19 PCR BF
|
Facility
OP
|
$41.48
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912782
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$284.23 |
| Rate for Payer: Adventist Health Commercial |
$8.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.23
|
| Rate for Payer: Blue Shield of California Commercial |
$274.13
|
| Rate for Payer: Blue Shield of California EPN |
$214.30
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.68
|
| Rate for Payer: Heritage Provider Network Senior |
$25.68
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: IEHP Medi-Cal |
$47.03
|
| Rate for Payer: IEHP Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$31.11
|
| 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 |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM PARVOVIRUS PCR
|
Facility
IP
|
$41.48
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911590
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$31.11 |
| Rate for Payer: Adventist Health Commercial |
$8.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.50
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.08
|
| Rate for Payer: Heritage Provider Network Senior |
$28.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.37
|
| Rate for Payer: Multiplan Commercial |
$31.11
|
|
|
HC SOM PARVOVIRUS PCR
|
Facility
OP
|
$41.48
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911590
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$284.23 |
| Rate for Payer: Adventist Health Commercial |
$8.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.23
|
| Rate for Payer: Blue Shield of California Commercial |
$274.13
|
| Rate for Payer: Blue Shield of California EPN |
$214.30
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.68
|
| Rate for Payer: Heritage Provider Network Senior |
$25.68
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: IEHP Medi-Cal |
$47.03
|
| Rate for Payer: IEHP Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$31.11
|
| 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 |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM PASSION FRUIT IGE
|
Facility
IP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914703
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.13
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.06
|
| Rate for Payer: Heritage Provider Network Senior |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
|
|
HC SOM PASSION FRUIT IGE
|
Facility
OP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914703
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$132.31 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
| Rate for Payer: Blue Shield of California Commercial |
$40.81
|
| Rate for Payer: Blue Shield of California EPN |
$31.90
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.86
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.62
|
| Rate for Payer: Heritage Provider Network Senior |
$4.62
|
| Rate for Payer: Humana Medicare |
$5.22
|
| Rate for Payer: IEHP Medi-Cal |
$7.24
|
| Rate for Payer: IEHP Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SOM PCA3 U
|
Facility
IP
|
$500.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900913905
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$90.50 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$343.50
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$338.50
|
| Rate for Payer: Heritage Provider Network Senior |
$338.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.00
|
| Rate for Payer: Multiplan Commercial |
$375.00
|
|
|
HC SOM PCA3 U
|
Facility
OP
|
$500.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900913905
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$90.50 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$109.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$343.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$425.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$375.00
|
| Rate for Payer: Blue Shield of California Commercial |
$310.50
|
| Rate for Payer: Blue Shield of California EPN |
$293.50
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$325.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$425.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.00
|
| Rate for Payer: Dignity Health Senior |
$425.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$309.50
|
| Rate for Payer: Heritage Provider Network Senior |
$309.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$241.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.00
|
| Rate for Payer: Multiplan Commercial |
$375.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.00
|
| Rate for Payer: Vantage Medical Group Senior |
$425.00
|
|
|
HC SOM PCDEC ANNA1
|
Facility
IP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915442
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$40.14 |
| Rate for Payer: Adventist Health Commercial |
$10.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.77
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.23
|
| Rate for Payer: Heritage Provider Network Senior |
$36.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| Rate for Payer: Multiplan Commercial |
$40.14
|
|
|
HC SOM PCDEC ANNA1
|
Facility
OP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915442
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$100.92 |
| Rate for Payer: Adventist Health Commercial |
$10.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.92
|
| Rate for Payer: Blue Shield of California Commercial |
$94.14
|
| Rate for Payer: Blue Shield of California EPN |
$73.59
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.13
|
| Rate for Payer: Heritage Provider Network Senior |
$33.13
|
| Rate for Payer: Humana Medicare |
$12.05
|
| Rate for Payer: IEHP Medi-Cal |
$13.46
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$40.14
|
| 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 |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDEC CASPR2-IGG
|
Facility
OP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915449
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$100.92 |
| Rate for Payer: Adventist Health Commercial |
$10.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.92
|
| Rate for Payer: Blue Shield of California Commercial |
$94.14
|
| Rate for Payer: Blue Shield of California EPN |
$73.59
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.13
|
| Rate for Payer: Heritage Provider Network Senior |
$33.13
|
| Rate for Payer: Humana Medicare |
$12.05
|
| Rate for Payer: IEHP Medi-Cal |
$13.46
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$40.14
|
| 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 |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDEC CASPR2-IGG
|
Facility
IP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915449
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$40.14 |
| Rate for Payer: Adventist Health Commercial |
$10.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.77
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.23
|
| Rate for Payer: Heritage Provider Network Senior |
$36.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| Rate for Payer: Multiplan Commercial |
$40.14
|
|
|
HC SOM PCDEC DPPX AB IFA
|
Facility
OP
|
$53.53
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$100.92 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.92
|
| Rate for Payer: Blue Shield of California Commercial |
$94.14
|
| Rate for Payer: Blue Shield of California EPN |
$73.59
|
| Rate for Payer: Cash Price |
$24.09
|
| Rate for Payer: Cash Price |
$24.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.14
|
| Rate for Payer: Heritage Provider Network Senior |
$33.14
|
| Rate for Payer: Humana Medicare |
$12.05
|
| Rate for Payer: IEHP Medi-Cal |
$13.46
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$40.15
|
| 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 |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDEC DPPX AB IFA
|
Facility
IP
|
$53.53
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$40.15 |
| Rate for Payer: Adventist Health Commercial |
$10.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.78
|
| Rate for Payer: Cash Price |
$24.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.24
|
| Rate for Payer: Heritage Provider Network Senior |
$36.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| Rate for Payer: Multiplan Commercial |
$40.15
|
|
