|
HC SOM IMMUNOGLOBULINS IGG SUBCLASS 3
|
Facility
|
OP
|
$7.24
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
900911273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$316.29 |
| Rate for Payer: Adventist Health Commercial |
$1.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$316.29
|
| Rate for Payer: Blue Shield of California Commercial |
$64.51
|
| Rate for Payer: Blue Shield of California EPN |
$51.74
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.27
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.48
|
| Rate for Payer: Heritage Provider Network Senior |
$4.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.75
|
| Rate for Payer: Multiplan Commercial |
$5.43
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.02
|
| Rate for Payer: TriValley Medical Group Senior |
$8.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.82
|
| Rate for Payer: Vantage Medical Group Senior |
$8.02
|
|
|
HC SOM IMMUNOGLOBULINS IGG SUBCLASS 3
|
Facility
|
IP
|
$7.24
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
900911273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$5.43 |
| Rate for Payer: Adventist Health Commercial |
$1.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.66
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.90
|
| Rate for Payer: Heritage Provider Network Senior |
$4.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.81
|
| Rate for Payer: Multiplan Commercial |
$5.43
|
|
|
HC SOM IMMUNOGLOBULINS IGG SUBCLASS 4
|
Facility
|
OP
|
$7.25
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
900910440
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$316.29 |
| Rate for Payer: Adventist Health Commercial |
$1.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$316.29
|
| Rate for Payer: Blue Shield of California Commercial |
$64.51
|
| Rate for Payer: Blue Shield of California EPN |
$51.74
|
| Rate for Payer: Cash Price |
$7.25
|
| Rate for Payer: Cash Price |
$7.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.49
|
| Rate for Payer: Heritage Provider Network Senior |
$4.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.75
|
| Rate for Payer: Multiplan Commercial |
$5.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.02
|
| Rate for Payer: TriValley Medical Group Senior |
$8.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.82
|
| Rate for Payer: Vantage Medical Group Senior |
$8.02
|
|
|
HC SOM IMMUNOGLOBULINS IGG SUBCLASS 4
|
Facility
|
IP
|
$7.25
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
900910440
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$5.44 |
| Rate for Payer: Adventist Health Commercial |
$1.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.67
|
| Rate for Payer: Cash Price |
$7.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.91
|
| Rate for Payer: Heritage Provider Network Senior |
$4.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.81
|
| Rate for Payer: Multiplan Commercial |
$5.44
|
|
|
HC SOM INFLIXIMAB AB
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900915313
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64.40
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.70
|
| Rate for Payer: Heritage Provider Network Senior |
$67.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
|
|
HC SOM INFLIXIMAB AB
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900915313
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$134.17 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.17
|
| Rate for Payer: Blue Shield of California Commercial |
$113.70
|
| Rate for Payer: Blue Shield of California EPN |
$91.20
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$65.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.12
|
| 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) Medicare Advantage |
$14.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$47.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.92
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.12
|
| Rate for Payer: TriValley Medical Group Senior |
$14.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Vantage Medical Group Senior |
$14.12
|
|
|
HC SOM INFLIXIMAB, QUANT
|
Facility
|
IP
|
$155.31
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
900915310
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.11 |
| Max. Negotiated Rate |
$116.48 |
| Rate for Payer: Adventist Health Commercial |
$31.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$100.02
|
| Rate for Payer: Cash Price |
$155.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.14
|
| Rate for Payer: Heritage Provider Network Senior |
$105.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.83
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
|
|
HC SOM INFLIXIMAB, QUANT
|
Facility
|
OP
|
$155.31
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
900915310
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.11 |
| Max. Negotiated Rate |
$222.16 |
| Rate for Payer: Adventist Health Commercial |
$31.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$95.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.76
|
| Rate for Payer: Blue Shield of California Commercial |
$222.16
|
| Rate for Payer: Blue Shield of California EPN |
$178.19
|
| Rate for Payer: Cash Price |
$155.31
|
| Rate for Payer: Cash Price |
$155.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$100.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$38.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.14
|
| Rate for Payer: Heritage Provider Network Senior |
$96.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$74.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51.68
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$38.57
|
| Rate for Payer: TriValley Medical Group Senior |
$38.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$41.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$41.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Vantage Medical Group Senior |
$38.57
|
|
|
HC SOM INFLUENZA A AB TITER (CF)
|
Facility
|
OP
|
$14.75
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900911771
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$131.17 |
| Rate for Payer: Adventist Health Commercial |
$2.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.17
|
| Rate for Payer: Blue Shield of California Commercial |
$109.09
|
| Rate for Payer: Blue Shield of California EPN |
$87.50
|
| Rate for Payer: Cash Price |
$14.75
|
| Rate for Payer: Cash Price |
$14.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.13
|
| Rate for Payer: Heritage Provider Network Senior |
$9.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.16
|
| Rate for Payer: Multiplan Commercial |
$11.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.55
|
| Rate for Payer: TriValley Medical Group Senior |
$13.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13.55
|
|
|
HC SOM INFLUENZA A AB TITER (CF)
|
Facility
|
IP
|
$14.75
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900911771
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$11.06 |
| Rate for Payer: Adventist Health Commercial |
$2.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.50
|
| Rate for Payer: Cash Price |
$14.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.99
|
| Rate for Payer: Heritage Provider Network Senior |
$9.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.69
|
| Rate for Payer: Multiplan Commercial |
$11.06
|
|
|
HC SOM INFLUENZA B AB TITER (CF)
|
Facility
|
OP
|
$7.50
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900911772
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$131.17 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.63
|
| Rate for Payer: Adventist Health Commercial |
$1.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.17
|
| Rate for Payer: Blue Shield of California Commercial |
$109.09
|
| Rate for Payer: Blue Shield of California EPN |
$87.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.64
|
| Rate for Payer: Heritage Provider Network Senior |
$4.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.16
|
| Rate for Payer: Multiplan Commercial |
$5.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.55
|
| Rate for Payer: TriValley Medical Group Senior |
$13.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13.55
|
|
|
HC SOM INFLUENZA B AB TITER (CF)
|
Facility
|
IP
|
$7.50
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900911772
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Adventist Health Commercial |
$1.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.83
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.08
|
| Rate for Payer: Heritage Provider Network Senior |
$5.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.88
|
| Rate for Payer: Multiplan Commercial |
$5.62
|
|
|
HC SOM INHIBIN B
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900913934
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$122.92 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.92
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.27
|
| Rate for Payer: TriValley Medical Group Senior |
$17.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM INHIBIN B
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900913934
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.20
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.85
|
| Rate for Payer: Heritage Provider Network Senior |
$33.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
|
|
HC SOM INSULIN ANTIBODIES QUANTITATIV
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
900911061
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.86
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.01
|
| Rate for Payer: Heritage Provider Network Senior |
$44.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.25
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
|
|
HC SOM INSULIN ANTIBODIES QUANTITATIV
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
900911061
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$172.59 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$172.59
|
| Rate for Payer: Blue Shield of California Commercial |
$172.34
|
| Rate for Payer: Blue Shield of California EPN |
$138.23
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.23
|
| Rate for Payer: Heritage Provider Network Senior |
$40.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$31.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.69
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.41
|
| Rate for Payer: TriValley Medical Group Senior |
$21.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.55
|
| Rate for Payer: Vantage Medical Group Senior |
$21.41
|
|
|
HC SOM INSULIN-LIKE GROWTH FACTOR I
|
Facility
|
OP
|
$62.50
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
900911132
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$161.47 |
| Rate for Payer: EPIC Health Plan Medicare |
$21.26
|
| Rate for Payer: Adventist Health Commercial |
$12.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.47
|
| Rate for Payer: Blue Shield of California Commercial |
$147.97
|
| Rate for Payer: Blue Shield of California EPN |
$118.69
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.69
|
| Rate for Payer: Heritage Provider Network Senior |
$38.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$29.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.49
|
| Rate for Payer: Multiplan Commercial |
$46.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.26
|
| Rate for Payer: TriValley Medical Group Senior |
$21.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.39
|
| Rate for Payer: Vantage Medical Group Senior |
$21.26
|
|
|
HC SOM INSULIN-LIKE GROWTH FACTOR I
|
Facility
|
IP
|
$62.50
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
900911132
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$46.88 |
| Rate for Payer: Adventist Health Commercial |
$12.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.25
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.31
|
| Rate for Payer: Heritage Provider Network Senior |
$42.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.62
|
| Rate for Payer: Multiplan Commercial |
$46.88
|
|
|
HC SOM INTERPHASES 100-300
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900915276
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$2,485.29 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,485.29
|
| Rate for Payer: Blue Shield of California Commercial |
$323.19
|
| Rate for Payer: Blue Shield of California EPN |
$259.23
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.57
|
| Rate for Payer: Heritage Provider Network Senior |
$18.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.59
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.19
|
| Rate for Payer: TriValley Medical Group Senior |
$51.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC SOM INTERPHASES 100-300
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900915276
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.32
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.31
|
| Rate for Payer: Heritage Provider Network Senior |
$20.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
|
|
HC SOM INTERPHASES 25-99
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 88274
|
| Hospital Charge Code |
900915275
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.32
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.31
|
| Rate for Payer: Heritage Provider Network Senior |
$20.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
|
|
HC SOM INTERPHASES 25-99
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 88274
|
| Hospital Charge Code |
900915275
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$1,988.23 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,988.23
|
| Rate for Payer: Blue Shield of California Commercial |
$280.11
|
| Rate for Payer: Blue Shield of California EPN |
$224.67
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.57
|
| Rate for Payer: Heritage Provider Network Senior |
$18.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$56.79
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.38
|
| Rate for Payer: TriValley Medical Group Senior |
$42.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$45.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$45.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.62
|
| Rate for Payer: Vantage Medical Group Senior |
$42.38
|
|
|
HC SOM INTERPHASES LT 25
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 88274
|
| Hospital Charge Code |
900915277
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$1,988.23 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,988.23
|
| Rate for Payer: Blue Shield of California Commercial |
$280.11
|
| Rate for Payer: Blue Shield of California EPN |
$224.67
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.57
|
| Rate for Payer: Heritage Provider Network Senior |
$18.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$56.79
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.38
|
| Rate for Payer: TriValley Medical Group Senior |
$42.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$45.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$45.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.62
|
| Rate for Payer: Vantage Medical Group Senior |
$42.38
|
|
|
HC SOM INTERPHASES LT 25
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 88274
|
| Hospital Charge Code |
900915277
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.32
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.31
|
| Rate for Payer: Heritage Provider Network Senior |
$20.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
|
|
HC SOM INTRINSIC FACTOR BLOCKING AB
|
Facility
|
IP
|
$23.15
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
900911094
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$17.36 |
| Rate for Payer: Adventist Health Commercial |
$4.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.91
|
| Rate for Payer: Cash Price |
$23.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.67
|
| Rate for Payer: Heritage Provider Network Senior |
$15.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.79
|
| Rate for Payer: Multiplan Commercial |
$17.36
|
|
