|
HC SOP TPMT ENZYME
|
Facility
|
IP
|
$93.50
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914906
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$16.92 |
| Max. Negotiated Rate |
$70.12 |
| Rate for Payer: Adventist Health Commercial |
$18.70
|
| Rate for Payer: Cash Price |
$51.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.30
|
| Rate for Payer: Heritage Provider Network Senior |
$63.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.38
|
| Rate for Payer: Multiplan Commercial |
$70.12
|
|
|
HC SOQ 26477 ASPERG IGM 86606
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
900914876
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$129.75 |
| Rate for Payer: Adventist Health Commercial |
$34.60
|
| Rate for Payer: Cash Price |
$95.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$117.12
|
| Rate for Payer: Heritage Provider Network Senior |
$117.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.25
|
| Rate for Payer: Multiplan Commercial |
$129.75
|
|
|
HC SOQ 26477 ASPERG IGM 86606
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
900914876
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$137.43 |
| Rate for Payer: Adventist Health Commercial |
$34.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$92.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.43
|
| Rate for Payer: Blue Shield of California Commercial |
$121.13
|
| Rate for Payer: Blue Shield of California EPN |
$97.16
|
| Rate for Payer: Cash Price |
$95.15
|
| Rate for Payer: Cash Price |
$95.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$112.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.55
|
| Rate for Payer: Dignity Health Senior |
$15.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.09
|
| Rate for Payer: Heritage Provider Network Senior |
$107.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$82.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.96
|
| Rate for Payer: Multiplan Commercial |
$129.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.05
|
| Rate for Payer: TriValley Medical Group Senior |
$15.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
HC SOQ SARS-COV-2
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913686
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$329.38 |
| Rate for Payer: Adventist Health Commercial |
$13.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$54.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$329.38
|
| Rate for Payer: Blue Shield of California Commercial |
$42.09
|
| Rate for Payer: Blue Shield of California EPN |
$33.67
|
| Rate for Payer: Cash Price |
$37.95
|
| Rate for Payer: Cash Price |
$37.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Senior |
$51.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.71
|
| Rate for Payer: Heritage Provider Network Senior |
$42.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.65
|
| Rate for Payer: Multiplan Commercial |
$51.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.31
|
| Rate for Payer: TriValley Medical Group Senior |
$51.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HC SOQ SARS-COV-2
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913686
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$51.75 |
| Rate for Payer: Adventist Health Commercial |
$13.80
|
| Rate for Payer: Cash Price |
$37.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.71
|
| Rate for Payer: Heritage Provider Network Senior |
$46.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$51.75
|
|
|
HC SOSB MICRO ARTHROPOD EXAM
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 87220
|
| Hospital Charge Code |
900915252
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$38.97 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.97
|
| Rate for Payer: Blue Shield of California Commercial |
$34.33
|
| Rate for Payer: Blue Shield of California EPN |
$27.54
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Senior |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.19
|
| Rate for Payer: Heritage Provider Network Senior |
$6.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.38
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.27
|
| Rate for Payer: TriValley Medical Group Senior |
$4.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC SOSB MICRO ARTHROPOD EXAM
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 87220
|
| Hospital Charge Code |
900915252
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.77
|
| Rate for Payer: Heritage Provider Network Senior |
$6.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
|
|
HC SOSPH MTB PCR SPUTUM
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
900915436
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$310.02 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.02
|
| 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 |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$65.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.85
|
| Rate for Payer: Dignity Health Senior |
$41.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$41.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.90
|
| Rate for Payer: Heritage Provider Network Senior |
$61.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$54.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.52
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$41.68
|
| Rate for Payer: TriValley Medical Group Senior |
$41.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$45.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$45.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.85
|
| Rate for Payer: Vantage Medical Group Senior |
$41.68
|
|
|
HC SOSPH MTB PCR SPUTUM
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
900915436
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.70
|
| Rate for Payer: Heritage Provider Network Senior |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
|
|
HC SOSTL ABPA ALLERG SP IGE
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914779
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$144.32 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.32
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| 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 |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.47
|
| Rate for Payer: Heritage Provider Network Senior |
$15.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| 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 |
$18.75
|
| 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 SOSTL ABPA ALLERG SP IGE
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914779
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.93
|
| Rate for Payer: Heritage Provider Network Senior |
$16.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SOSTL ABPA ALLERG SP IGG
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900914780
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.93
|
| Rate for Payer: Heritage Provider Network Senior |
$16.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SOSTL ABPA ALLERG SP IGG
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900914780
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.70
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.60
|
| Rate for Payer: Dignity Health Senior |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.47
|
| Rate for Payer: Heritage Provider Network Senior |
$15.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.85
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.82
|
| Rate for Payer: TriValley Medical Group Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
HC SOSTL ABPA INTERP
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 95199
|
| Hospital Charge Code |
900914782
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.85
|
| Rate for Payer: Heritage Provider Network Senior |
$33.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
|
|
HC SOSTL ABPA INTERP
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 95199
|
| Hospital Charge Code |
900914782
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$46.68 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Blue Shield of California Commercial |
$30.50
|
| Rate for Payer: Blue Shield of California EPN |
$24.40
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Senior |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$31.12
|
| 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) Medi-Cal |
$8.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.21
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$31.12
|
| Rate for Payer: TriValley Medical Group Senior |
$31.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC SOSTL ABPA PRECIP AB
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
900914781
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.17
|
| Rate for Payer: Heritage Provider Network Senior |
$142.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
|
|
HC SOSTL ABPA PRECIP AB
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
900914781
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$112.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.40
|
| Rate for Payer: Blue Shield of California Commercial |
$96.48
|
| Rate for Payer: Blue Shield of California EPN |
$77.39
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$136.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.99
|
| Rate for Payer: Heritage Provider Network Senior |
$129.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$100.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.09
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC SOSTL ABPA TOTAL IGE
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
900914778
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$41.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.77
|
| Rate for Payer: Heritage Provider Network Senior |
$50.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
|
|
HC SOSTL ABPA TOTAL IGE
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
900914778
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$150.34 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$40.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$51.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.34
|
| Rate for Payer: Blue Shield of California Commercial |
$132.54
|
| Rate for Payer: Blue Shield of California EPN |
$106.31
|
| Rate for Payer: Cash Price |
$41.25
|
| Rate for Payer: Cash Price |
$41.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.11
|
| Rate for Payer: Dignity Health Senior |
$16.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.46
|
| 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) Medi-Cal |
$23.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.74
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.46
|
| Rate for Payer: TriValley Medical Group Senior |
$16.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.11
|
| Rate for Payer: Vantage Medical Group Senior |
$16.46
|
|
|
HC SOUCI METHOTREXATE
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 80229
|
| Hospital Charge Code |
900915251
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$30.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.23
|
| Rate for Payer: Heritage Provider Network Senior |
$37.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
|
|
HC SOUCI METHOTREXATE
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 80229
|
| Hospital Charge Code |
900915251
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$46.75 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.25
|
| Rate for Payer: Blue Shield of California Commercial |
$33.55
|
| Rate for Payer: Blue Shield of California EPN |
$26.84
|
| Rate for Payer: Cash Price |
$30.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.75
|
| Rate for Payer: Dignity Health Senior |
$46.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.05
|
| Rate for Payer: Heritage Provider Network Senior |
$34.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38.50
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.75
|
| Rate for Payer: Vantage Medical Group Senior |
$46.75
|
|
|
HC SOUMN OCA1 81479
|
Facility
|
IP
|
$1,359.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914802
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$245.98 |
| Max. Negotiated Rate |
$1,019.25 |
| Rate for Payer: Adventist Health Commercial |
$271.80
|
| Rate for Payer: Cash Price |
$747.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$920.04
|
| Rate for Payer: Heritage Provider Network Senior |
$920.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.75
|
| Rate for Payer: Multiplan Commercial |
$1,019.25
|
|
|
HC SOUMN OCA1 81479
|
Facility
|
OP
|
$1,359.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914802
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$245.98 |
| Max. Negotiated Rate |
$1,155.15 |
| Rate for Payer: Adventist Health Commercial |
$271.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$726.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$933.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,155.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$747.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,019.25
|
| Rate for Payer: Blue Shield of California Commercial |
$828.99
|
| Rate for Payer: Blue Shield of California EPN |
$663.19
|
| Rate for Payer: Cash Price |
$747.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$883.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,155.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,155.15
|
| Rate for Payer: Dignity Health Senior |
$1,155.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$883.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$841.22
|
| Rate for Payer: Heritage Provider Network Senior |
$841.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$648.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$951.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$951.30
|
| Rate for Payer: Multiplan Commercial |
$1,019.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$679.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$679.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,155.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,155.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,155.15
|
|
|
HC SOUOC NSD1 DEL/DUP
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT 81407
|
| Hospital Charge Code |
900914719
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$95.03 |
| Max. Negotiated Rate |
$17,692.19 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$280.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$360.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,269.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$930.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$846.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,692.19
|
| Rate for Payer: Blue Shield of California Commercial |
$320.25
|
| Rate for Payer: Blue Shield of California EPN |
$256.20
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$341.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,269.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$930.90
|
| Rate for Payer: Dignity Health Senior |
$846.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$846.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$324.98
|
| Rate for Payer: Heritage Provider Network Senior |
$324.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,370.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$846.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$250.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$973.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,066.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,066.30
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$846.27
|
| Rate for Payer: TriValley Medical Group Senior |
$846.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$913.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$913.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,269.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$930.90
|
| Rate for Payer: Vantage Medical Group Senior |
$846.27
|
|
|
HC SOUOC NSD1 DEL/DUP
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT 81407
|
| Hospital Charge Code |
900914719
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$95.03 |
| Max. Negotiated Rate |
$393.75 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$355.43
|
| Rate for Payer: Heritage Provider Network Senior |
$355.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.25
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
|
