|
HC SOM HEPARIN-PF4 AB
|
Facility
|
IP
|
$43.68
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900912527
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$32.76 |
| Rate for Payer: Adventist Health Commercial |
$8.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.13
|
| Rate for Payer: Cash Price |
$43.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.57
|
| Rate for Payer: Heritage Provider Network Senior |
$29.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.92
|
| Rate for Payer: Multiplan Commercial |
$32.76
|
|
|
HC SOM HEPARIN-PF4 AB
|
Facility
|
OP
|
$43.68
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900912527
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$147.98 |
| Rate for Payer: Adventist Health Commercial |
$8.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.98
|
| Rate for Payer: Blue Shield of California Commercial |
$147.80
|
| Rate for Payer: Blue Shield of California EPN |
$118.55
|
| Rate for Payer: Cash Price |
$43.68
|
| Rate for Payer: Cash Price |
$43.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.77
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.04
|
| Rate for Payer: Heritage Provider Network Senior |
$27.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.62
|
| Rate for Payer: Multiplan Commercial |
$32.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.37
|
| Rate for Payer: TriValley Medical Group Senior |
$18.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Vantage Medical Group Senior |
$18.37
|
|
|
HC SOM HEPATITIS B DNA (QUANT)
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
900911402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.79
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.04
|
| Rate for Payer: Heritage Provider Network Senior |
$46.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
|
|
HC SOM HEPATITIS B DNA (QUANT)
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
900911402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$344.74 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.65
|
| Rate for Payer: Blue Shield of California Commercial |
$344.74
|
| Rate for Payer: Blue Shield of California EPN |
$276.51
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.09
|
| Rate for Payer: Heritage Provider Network Senior |
$42.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$32.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.84
|
| Rate for Payer: TriValley Medical Group Senior |
$42.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC SOM HEPATITIS BE AB
|
Facility
|
OP
|
$16.43
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
900911195
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$106.24 |
| Rate for Payer: Adventist Health Commercial |
$3.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.24
|
| Rate for Payer: Blue Shield of California Commercial |
$93.08
|
| Rate for Payer: Blue Shield of California EPN |
$74.66
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.69
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.17
|
| Rate for Payer: Heritage Provider Network Senior |
$10.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.50
|
| Rate for Payer: Multiplan Commercial |
$12.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.57
|
| Rate for Payer: TriValley Medical Group Senior |
$11.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.73
|
| Rate for Payer: Vantage Medical Group Senior |
$11.57
|
|
|
HC SOM HEPATITIS BE AB
|
Facility
|
IP
|
$16.43
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
900911195
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$12.32 |
| Rate for Payer: Adventist Health Commercial |
$3.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.58
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.12
|
| Rate for Payer: Heritage Provider Network Senior |
$11.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.11
|
| Rate for Payer: Multiplan Commercial |
$12.32
|
|
|
HC SOM HEPATITIS D ANTIBODY
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 86692
|
| Hospital Charge Code |
900910354
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$152.97 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.97
|
| Rate for Payer: Blue Shield of California Commercial |
$138.12
|
| Rate for Payer: Blue Shield of California EPN |
$110.79
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.14
|
| Rate for Payer: Heritage Provider Network Senior |
$37.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.99
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.16
|
| Rate for Payer: TriValley Medical Group Senior |
$17.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.88
|
| Rate for Payer: Vantage Medical Group Senior |
$17.16
|
|
|
HC SOM HEPATITIS D ANTIBODY
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 86692
|
| Hospital Charge Code |
900910354
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.64
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.62
|
| Rate for Payer: Heritage Provider Network Senior |
$40.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
|
|
HC SOM HER2 BREAST IHC, AUTOMATED
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 88361
|
| Hospital Charge Code |
903800261
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$691.53 |
| 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 |
$691.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$629.12
|
| Rate for Payer: Blue Shield of California Commercial |
$450.48
|
| Rate for Payer: Blue Shield of California EPN |
$362.26
|
| 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 |
$691.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$461.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$461.02
|
| 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 |
$461.02
|
| 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 |
$530.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$617.77
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$461.02
|
| Rate for Payer: TriValley Medical Group Senior |
$461.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$321.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$321.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Vantage Medical Group Senior |
$461.02
|
|
|
HC SOM HER2 BREAST IHC, AUTOMATED
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 88361
|
| Hospital Charge Code |
903800261
|
|
Hospital Revenue Code
|
310
|
| 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 HHEMO 81256
|
Facility
|
OP
|
$70.98
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
900914875
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$511.38 |
| Rate for Payer: Adventist Health Commercial |
$14.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$98.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$511.38
|
| Rate for Payer: Blue Shield of California Commercial |
$43.30
|
| Rate for Payer: Blue Shield of California EPN |
$34.64
|
| Rate for Payer: Cash Price |
$70.98
|
| Rate for Payer: Cash Price |
$70.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$65.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$65.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.94
|
| Rate for Payer: Heritage Provider Network Senior |
$43.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$33.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$87.58
|
| Rate for Payer: Multiplan Commercial |
$53.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$65.36
|
| Rate for Payer: TriValley Medical Group Senior |
$65.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$70.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$70.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.90
|
| Rate for Payer: Vantage Medical Group Senior |
$65.36
|
|
|
HC SOM HHEMO 81256
|
Facility
|
IP
|
$70.98
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
900914875
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$53.23 |
| Rate for Payer: Adventist Health Commercial |
$14.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.71
|
| Rate for Payer: Cash Price |
$70.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.05
|
| Rate for Payer: Heritage Provider Network Senior |
$48.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.75
|
| Rate for Payer: Multiplan Commercial |
$53.23
|
|
|
HC SOM HISTAMINE PLASMA
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 83088
|
| Hospital Charge Code |
900914665
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.28
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.24
|
| Rate for Payer: Heritage Provider Network Senior |
$81.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
|
|
HC SOM HISTAMINE PLASMA
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 83088
|
| Hospital Charge Code |
900914665
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$280.36 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$280.36
|
| Rate for Payer: Blue Shield of California Commercial |
$237.66
|
| Rate for Payer: Blue Shield of California EPN |
$190.62
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$29.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.28
|
| Rate for Payer: Heritage Provider Network Senior |
$74.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$57.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39.57
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.53
|
| Rate for Payer: TriValley Medical Group Senior |
$29.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.48
|
| Rate for Payer: Vantage Medical Group Senior |
$29.53
|
|
|
HC SOM HISTOPLAS BLASTOMYC PCR1
|
Facility
|
OP
|
$148.12
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914670
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$26.81 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$29.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$91.54
|
| 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 |
$148.12
|
| Rate for Payer: Cash Price |
$148.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$96.28
|
| 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 |
$96.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.69
|
| Rate for Payer: Heritage Provider Network Senior |
$91.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$70.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$111.09
|
| 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 HISTOPLAS BLASTOMYC PCR1
|
Facility
|
IP
|
$148.12
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914670
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$26.81 |
| Max. Negotiated Rate |
$111.09 |
| Rate for Payer: Adventist Health Commercial |
$29.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$95.39
|
| Rate for Payer: Cash Price |
$148.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.28
|
| Rate for Payer: Heritage Provider Network Senior |
$100.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.03
|
| Rate for Payer: Multiplan Commercial |
$111.09
|
|
|
HC SOM HISTOPLAS BLASTOMYC PCR2
|
Facility
|
IP
|
$148.13
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914671
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$26.81 |
| Max. Negotiated Rate |
$111.10 |
| Rate for Payer: Adventist Health Commercial |
$29.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$95.40
|
| Rate for Payer: Cash Price |
$148.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.28
|
| Rate for Payer: Heritage Provider Network Senior |
$100.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.03
|
| Rate for Payer: Multiplan Commercial |
$111.10
|
|
|
HC SOM HISTOPLAS BLASTOMYC PCR2
|
Facility
|
OP
|
$148.13
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914671
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$26.81 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$29.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$91.54
|
| 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 |
$148.13
|
| Rate for Payer: Cash Price |
$148.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$96.28
|
| 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 |
$96.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.69
|
| Rate for Payer: Heritage Provider Network Senior |
$91.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$70.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$111.10
|
| 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 HISTOPLASMA AB IMMUNODIFFUSION
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
900912643
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$119.85 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.85
|
| Rate for Payer: Blue Shield of California Commercial |
$100.57
|
| Rate for Payer: Blue Shield of California EPN |
$80.67
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.57
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.24
|
| Rate for Payer: Heritage Provider Network Senior |
$14.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.48
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.79
|
| Rate for Payer: TriValley Medical Group Senior |
$13.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.17
|
| Rate for Payer: Vantage Medical Group Senior |
$13.79
|
|
|
HC SOM HISTOPLASMA AB IMMUNODIFFUSION
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
900912643
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.81
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.57
|
| Rate for Payer: Heritage Provider Network Senior |
$15.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.75
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
|
|
HC SOM HISTOPLASMA/BLASTOMYCES PCR
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915469
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.77 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$109.48
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.09
|
| Rate for Payer: Heritage Provider Network Senior |
$115.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.50
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
|
|
HC SOM HISTOPLASMA/BLASTOMYCES PCR
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915469
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.77 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$105.06
|
| 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 |
$170.00
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$110.50
|
| 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 |
$110.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.23
|
| Rate for Payer: Heritage Provider Network Senior |
$105.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$81.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| 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 HIV-1 ANTIBODY
|
Facility
|
OP
|
$29.76
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
900915308
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$84.31 |
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.31
|
| Rate for Payer: Blue Shield of California Commercial |
$71.48
|
| Rate for Payer: Blue Shield of California EPN |
$57.33
|
| Rate for Payer: Cash Price |
$29.76
|
| Rate for Payer: Cash Price |
$29.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.56
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.42
|
| Rate for Payer: Heritage Provider Network Senior |
$18.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$22.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.89
|
| Rate for Payer: TriValley Medical Group Senior |
$8.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.78
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
HC SOM HIV-1 ANTIBODY
|
Facility
|
IP
|
$29.76
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
900915308
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$22.32 |
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.17
|
| Rate for Payer: Cash Price |
$29.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.15
|
| Rate for Payer: Heritage Provider Network Senior |
$20.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: Multiplan Commercial |
$22.32
|
|
|
HC SOM HIV-1 GENOTYPIC RESISTANCE
|
Facility
|
IP
|
$441.82
|
|
|
Service Code
|
CPT 0219U
|
| Hospital Charge Code |
900915502
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$79.97 |
| Max. Negotiated Rate |
$331.37 |
| Rate for Payer: Adventist Health Commercial |
$88.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$284.53
|
| Rate for Payer: Cash Price |
$441.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$299.11
|
| Rate for Payer: Heritage Provider Network Senior |
$299.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.45
|
| Rate for Payer: Multiplan Commercial |
$331.37
|
|
