|
HC SOM INTRINSIC FACTOR BLOCKING AB
|
Facility
|
OP
|
$23.15
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
900911094
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$143.12 |
| Rate for Payer: Adventist Health Commercial |
$4.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.12
|
| Rate for Payer: Blue Shield of California Commercial |
$121.31
|
| Rate for Payer: Blue Shield of California EPN |
$97.30
|
| Rate for Payer: Cash Price |
$23.15
|
| Rate for Payer: Cash Price |
$23.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.66
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.33
|
| Rate for Payer: Heritage Provider Network Senior |
$14.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.21
|
| Rate for Payer: Multiplan Commercial |
$17.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.08
|
| Rate for Payer: TriValley Medical Group Senior |
$15.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Vantage Medical Group Senior |
$15.08
|
|
|
HC SOM IRON LIVER TISSUE
|
Facility
|
IP
|
$9.28
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
900914805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$6.96 |
| Rate for Payer: Adventist Health Commercial |
$1.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.98
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.28
|
| Rate for Payer: Heritage Provider Network Senior |
$6.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.32
|
| Rate for Payer: Multiplan Commercial |
$6.96
|
|
|
HC SOM IRON LIVER TISSUE
|
Facility
|
OP
|
$9.28
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
900914805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$61.49 |
| Rate for Payer: Adventist Health Commercial |
$1.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.49
|
| Rate for Payer: Blue Shield of California Commercial |
$52.13
|
| Rate for Payer: Blue Shield of California EPN |
$41.81
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.74
|
| Rate for Payer: Heritage Provider Network Senior |
$5.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$6.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC SOM ITRACONAZOLE LEVEL
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 80189
|
| Hospital Charge Code |
900911379
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$156.15 |
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.22
|
| Rate for Payer: Blue Shield of California Commercial |
$156.15
|
| Rate for Payer: Blue Shield of California EPN |
$125.25
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.11
|
| Rate for Payer: EPIC Health Plan Medicare |
$27.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.76
|
| Rate for Payer: Heritage Provider Network Senior |
$24.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36.33
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.11
|
| Rate for Payer: TriValley Medical Group Senior |
$27.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Vantage Medical Group Senior |
$27.11
|
|
|
HC SOM ITRACONAZOLE LEVEL
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 80189
|
| Hospital Charge Code |
900911379
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.76
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.08
|
| Rate for Payer: Heritage Provider Network Senior |
$27.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
|
|
HC SOM JAK 2 V617F MUTATION
|
Facility
|
OP
|
$214.37
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
900912994
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$459.15 |
| Rate for Payer: Adventist Health Commercial |
$42.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$132.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$91.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$459.15
|
| Rate for Payer: Blue Shield of California Commercial |
$130.77
|
| Rate for Payer: Blue Shield of California EPN |
$104.61
|
| Rate for Payer: Cash Price |
$214.37
|
| Rate for Payer: Cash Price |
$214.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$139.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$91.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.34
|
| Rate for Payer: EPIC Health Plan Medicare |
$91.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.70
|
| Rate for Payer: Heritage Provider Network Senior |
$132.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$91.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$102.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$122.82
|
| Rate for Payer: Multiplan Commercial |
$160.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$91.66
|
| Rate for Payer: TriValley Medical Group Senior |
$91.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$98.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$98.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$100.83
|
| Rate for Payer: Vantage Medical Group Senior |
$91.66
|
|
|
HC SOM JAK 2 V617F MUTATION
|
Facility
|
IP
|
$214.37
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
900912994
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$160.78 |
| Rate for Payer: Adventist Health Commercial |
$42.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$138.05
|
| Rate for Payer: Cash Price |
$214.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.13
|
| Rate for Payer: Heritage Provider Network Senior |
$145.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.59
|
| Rate for Payer: Multiplan Commercial |
$160.78
|
|
|
HC SOM JC VIRUS BY PCR
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912607
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.37
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.74
|
| Rate for Payer: Heritage Provider Network Senior |
$48.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
|
|
HC SOM JC VIRUS BY PCR
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912607
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.50
|
| 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 |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.80
|
| 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 |
$42.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.57
|
| Rate for Payer: Heritage Provider Network Senior |
$44.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$34.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| 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 KAPPA LIGHT CHAINS
|
Facility
|
OP
|
$13.39
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
900910385
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$99.48 |
| Rate for Payer: Adventist Health Commercial |
$2.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.28
|
| 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 |
$46.15
|
| Rate for Payer: Blue Shield of California Commercial |
$99.48
|
| Rate for Payer: Blue Shield of California EPN |
$79.79
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.70
|
| 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 |
$7.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.29
|
| Rate for Payer: Heritage Provider Network Senior |
$8.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$10.04
|
| 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 KAPPA LIGHT CHAINS
|
Facility
|
IP
|
$13.39
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
900910385
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$10.04 |
| Rate for Payer: Adventist Health Commercial |
$2.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.62
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.07
|
| Rate for Payer: Heritage Provider Network Senior |
$9.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.35
|
| Rate for Payer: Multiplan Commercial |
$10.04
|
|
|
HC SOM KARYOTYPES GT 2
|
Facility
|
IP
|
$7.50
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
900915302
|
|
Hospital Revenue Code
|
310
|
| 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 KARYOTYPES GT 2
|
Facility
|
OP
|
$7.50
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
900915302
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$238.30 |
| Rate for Payer: Adventist Health Commercial |
$1.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$238.30
|
| Rate for Payer: Blue Shield of California Commercial |
$202.00
|
| Rate for Payer: Blue Shield of California EPN |
$162.02
|
| 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 |
$50.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$33.47
|
| 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 |
$33.47
|
| 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 |
$38.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$44.85
|
| Rate for Payer: Multiplan Commercial |
$5.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$33.47
|
| Rate for Payer: TriValley Medical Group Senior |
$33.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Vantage Medical Group Senior |
$33.47
|
|
|
HC SOM KPNRP 87798
|
Facility
|
IP
|
$157.95
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915274
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.59 |
| Max. Negotiated Rate |
$118.46 |
| Rate for Payer: Adventist Health Commercial |
$31.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$101.72
|
| Rate for Payer: Cash Price |
$157.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.93
|
| Rate for Payer: Heritage Provider Network Senior |
$106.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.49
|
| Rate for Payer: Multiplan Commercial |
$118.46
|
|
|
HC SOM KPNRP 87798
|
Facility
|
OP
|
$157.95
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915274
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.59 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Multiplan Commercial |
$118.46
|
| Rate for Payer: Adventist Health Commercial |
$31.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$97.61
|
| 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 |
$157.95
|
| Rate for Payer: Cash Price |
$157.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$102.67
|
| 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 |
$93.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.77
|
| Rate for Payer: Heritage Provider Network Senior |
$97.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$75.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| 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 LACTOFERR DET EIA STOOL
|
Facility
|
IP
|
$96.22
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
900914704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$72.17 |
| Rate for Payer: Adventist Health Commercial |
$19.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.97
|
| Rate for Payer: Cash Price |
$96.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.14
|
| Rate for Payer: Heritage Provider Network Senior |
$65.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.05
|
| Rate for Payer: Multiplan Commercial |
$72.17
|
|
|
HC SOM LACTOFERR DET EIA STOOL
|
Facility
|
OP
|
$96.22
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
900914704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$157.94 |
| Rate for Payer: Adventist Health Commercial |
$19.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.42
|
| Rate for Payer: Blue Shield of California Commercial |
$157.94
|
| Rate for Payer: Blue Shield of California EPN |
$126.68
|
| Rate for Payer: Cash Price |
$96.22
|
| Rate for Payer: Cash Price |
$96.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$62.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.77
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.56
|
| Rate for Payer: Heritage Provider Network Senior |
$59.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$45.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$72.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.70
|
| Rate for Payer: TriValley Medical Group Senior |
$19.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.67
|
| Rate for Payer: Vantage Medical Group Senior |
$19.70
|
|
|
HC SOM LAMBDA LIGHT CHAINS
|
Facility
|
IP
|
$13.39
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
900910386
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$10.04 |
| Rate for Payer: Adventist Health Commercial |
$2.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.62
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.07
|
| Rate for Payer: Heritage Provider Network Senior |
$9.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.35
|
| Rate for Payer: Multiplan Commercial |
$10.04
|
|
|
HC SOM LAMBDA LIGHT CHAINS
|
Facility
|
OP
|
$13.39
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
900910386
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$99.48 |
| Rate for Payer: Adventist Health Commercial |
$2.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.28
|
| 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 |
$46.15
|
| Rate for Payer: Blue Shield of California Commercial |
$99.48
|
| Rate for Payer: Blue Shield of California EPN |
$79.79
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.70
|
| 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 |
$7.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.29
|
| Rate for Payer: Heritage Provider Network Senior |
$8.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$10.04
|
| 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 LAMICTAL (LAMOTRIGINE)
|
Facility
|
OP
|
$14.32
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
900910411
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$104.20 |
| Rate for Payer: Adventist Health Commercial |
$2.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.68
|
| 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 |
$14.32
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.86
|
| Rate for Payer: Heritage Provider Network Senior |
$8.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.75
|
| Rate for Payer: Multiplan Commercial |
$10.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.25
|
| Rate for Payer: TriValley Medical Group Senior |
$13.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
|
HC SOM LAMICTAL (LAMOTRIGINE)
|
Facility
|
IP
|
$14.32
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
900910411
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$10.74 |
| Rate for Payer: Adventist Health Commercial |
$2.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.22
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.69
|
| Rate for Payer: Heritage Provider Network Senior |
$9.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.58
|
| Rate for Payer: Multiplan Commercial |
$10.74
|
|
|
HC SOM LASIX
|
Facility
|
OP
|
$119.28
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911247
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$138.26 |
| Rate for Payer: Adventist Health Commercial |
$23.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.26
|
| Rate for Payer: Blue Shield of California Commercial |
$110.19
|
| Rate for Payer: Blue Shield of California EPN |
$88.38
|
| Rate for Payer: Cash Price |
$119.28
|
| Rate for Payer: Cash Price |
$119.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$77.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.83
|
| Rate for Payer: Heritage Provider Network Senior |
$73.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$56.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$89.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.64
|
| Rate for Payer: TriValley Medical Group Senior |
$18.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM LASIX
|
Facility
|
IP
|
$119.28
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911247
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.59 |
| Max. Negotiated Rate |
$89.46 |
| Rate for Payer: Adventist Health Commercial |
$23.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$76.82
|
| Rate for Payer: Cash Price |
$119.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$80.75
|
| Rate for Payer: Heritage Provider Network Senior |
$80.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.82
|
| Rate for Payer: Multiplan Commercial |
$89.46
|
|
|
HC SOM LD ACTIVITY TOTAL
|
Facility
|
OP
|
$11.23
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
900912823
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$57.15 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.15
|
| Rate for Payer: Blue Shield of California Commercial |
$48.61
|
| Rate for Payer: Blue Shield of California EPN |
$38.99
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.95
|
| Rate for Payer: Heritage Provider Network Senior |
$6.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.09
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.04
|
| Rate for Payer: TriValley Medical Group Senior |
$6.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.64
|
| Rate for Payer: Vantage Medical Group Senior |
$6.04
|
|
|
HC SOM LD ACTIVITY TOTAL
|
Facility
|
IP
|
$11.23
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
900912823
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.23
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.60
|
| Rate for Payer: Heritage Provider Network Senior |
$7.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
|
