|
HC SOM TOXOPLASMA AB CSF IGM
|
Facility
OP
|
$87.49
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
900914413
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$124.65 |
| Rate for Payer: Adventist Health Commercial |
$17.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.65
|
| Rate for Payer: Blue Shield of California Commercial |
$112.47
|
| Rate for Payer: Blue Shield of California EPN |
$87.92
|
| Rate for Payer: Cash Price |
$39.37
|
| Rate for Payer: Cash Price |
$39.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$56.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.85
|
| Rate for Payer: Dignity Health Senior |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.87
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.16
|
| Rate for Payer: Heritage Provider Network Senior |
$54.16
|
| Rate for Payer: Humana Medicare |
$14.41
|
| Rate for Payer: IEHP Medi-Cal |
$19.97
|
| Rate for Payer: IEHP Medicare Advantage |
$14.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.16
|
| Rate for Payer: Multiplan Commercial |
$65.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.41
|
| Rate for Payer: TriValley Medical Group Senior |
$14.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
|
|
HC SOM TOXOPLASMA AB CSF IGM
|
Facility
IP
|
$87.49
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
900914413
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.84 |
| Max. Negotiated Rate |
$65.62 |
| Rate for Payer: Adventist Health Commercial |
$17.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.11
|
| Rate for Payer: Cash Price |
$39.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.23
|
| Rate for Payer: Heritage Provider Network Senior |
$59.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.87
|
| Rate for Payer: Multiplan Commercial |
$65.62
|
|
|
HC SOM TPMT
|
Facility
OP
|
$25.86
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900914732
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$150.51 |
| Rate for Payer: Adventist Health Commercial |
$5.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.51
|
| Rate for Payer: Blue Shield of California Commercial |
$141.04
|
| Rate for Payer: Blue Shield of California EPN |
$110.26
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.39
|
| Rate for Payer: Dignity Health Senior |
$22.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.01
|
| Rate for Payer: Heritage Provider Network Senior |
$16.01
|
| Rate for Payer: Humana Medicare |
$22.17
|
| Rate for Payer: IEHP Medi-Cal |
$27.67
|
| Rate for Payer: IEHP Medicare Advantage |
$22.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$42.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.93
|
| Rate for Payer: Multiplan Commercial |
$19.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.17
|
| Rate for Payer: TriValley Medical Group Senior |
$22.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22.17
|
|
|
HC SOM TPMT
|
Facility
IP
|
$25.86
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900914732
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Adventist Health Commercial |
$5.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.77
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.51
|
| Rate for Payer: Heritage Provider Network Senior |
$17.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.46
|
| Rate for Payer: Multiplan Commercial |
$19.40
|
|
|
HC SOM TPMT ACTIVITY PROFILE
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
CPT 84433
|
| Hospital Charge Code |
900915441
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.17 |
| Max. Negotiated Rate |
$123.93 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.15
|
| Rate for Payer: Blue Shield of California Commercial |
$123.93
|
| Rate for Payer: Blue Shield of California EPN |
$96.88
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.39
|
| Rate for Payer: Dignity Health Senior |
$22.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.56
|
| Rate for Payer: Heritage Provider Network Senior |
$83.56
|
| Rate for Payer: Humana Medicare |
$22.17
|
| Rate for Payer: IEHP Medicare Advantage |
$22.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$42.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.93
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.17
|
| Rate for Payer: TriValley Medical Group Senior |
$22.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22.17
|
|
|
HC SOM TPMT ACTIVITY PROFILE
|
Facility
IP
|
$135.00
|
|
|
Service Code
|
CPT 84433
|
| Hospital Charge Code |
900915441
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.44 |
| Max. Negotiated Rate |
$101.25 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.74
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.40
|
| Rate for Payer: Heritage Provider Network Senior |
$91.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
|
|
HC SOM TPPA 86780
|
Facility
OP
|
$37.51
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
900914807
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$145.22 |
| Rate for Payer: Adventist Health Commercial |
$7.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.22
|
| Rate for Payer: Blue Shield of California Commercial |
$106.04
|
| Rate for Payer: Blue Shield of California EPN |
$82.90
|
| Rate for Payer: Cash Price |
$16.88
|
| Rate for Payer: Cash Price |
$16.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: Dignity Health Senior |
$13.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.22
|
| Rate for Payer: Heritage Provider Network Senior |
$23.22
|
| Rate for Payer: Humana Medicare |
$13.24
|
| Rate for Payer: IEHP Medi-Cal |
$17.78
|
| Rate for Payer: IEHP Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.68
|
| Rate for Payer: Multiplan Commercial |
$28.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.24
|
| Rate for Payer: TriValley Medical Group Senior |
$13.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC SOM TPPA 86780
|
Facility
IP
|
$37.51
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
900914807
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Adventist Health Commercial |
$7.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.77
|
| Rate for Payer: Cash Price |
$16.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.39
|
| Rate for Payer: Heritage Provider Network Senior |
$25.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.38
|
| Rate for Payer: Multiplan Commercial |
$28.13
|
|
|
HC SOM TPPTL 82657
|
Facility
IP
|
$25.86
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900914893
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Adventist Health Commercial |
$5.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.77
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.51
|
| Rate for Payer: Heritage Provider Network Senior |
$17.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.46
|
| Rate for Payer: Multiplan Commercial |
$19.40
|
|
|
HC SOM TPPTL 82657
|
Facility
OP
|
$25.86
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900914893
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$150.51 |
| Rate for Payer: Adventist Health Commercial |
$5.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.51
|
| Rate for Payer: Blue Shield of California Commercial |
$141.04
|
| Rate for Payer: Blue Shield of California EPN |
$110.26
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.39
|
| Rate for Payer: Dignity Health Senior |
$22.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.01
|
| Rate for Payer: Heritage Provider Network Senior |
$16.01
|
| Rate for Payer: Humana Medicare |
$22.17
|
| Rate for Payer: IEHP Medi-Cal |
$27.67
|
| Rate for Payer: IEHP Medicare Advantage |
$22.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$42.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.93
|
| Rate for Payer: Multiplan Commercial |
$19.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.17
|
| Rate for Payer: TriValley Medical Group Senior |
$22.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22.17
|
|
|
HC SOM TRAM 83925
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
900915271
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$156.20 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$33.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.20
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.25
|
| Rate for Payer: Dignity Health Senior |
$38.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.86
|
| Rate for Payer: Heritage Provider Network Senior |
$27.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.25
|
| Rate for Payer: Vantage Medical Group Senior |
$38.25
|
|
|
HC SOM TRAM 83925
|
Facility
IP
|
$45.00
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
900915271
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.92
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.46
|
| Rate for Payer: Heritage Provider Network Senior |
$30.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
|
|
HC SOM TRANSGLUTAMINASE AB IGG
|
Facility
OP
|
$14.75
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912640
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$195.82 |
| Rate for Payer: Adventist Health Commercial |
$2.95
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.82
|
| Rate for Payer: Blue Shield of California Commercial |
$72.56
|
| Rate for Payer: Blue Shield of California EPN |
$56.72
|
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.13
|
| Rate for Payer: Heritage Provider Network Senior |
$9.13
|
| Rate for Payer: Humana Medicare |
$11.53
|
| Rate for Payer: IEHP Medi-Cal |
$13.42
|
| Rate for Payer: IEHP Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$11.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM TRANSGLUTAMINASE AB IGG
|
Facility
IP
|
$14.75
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912640
|
|
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 |
$10.13
|
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.99
|
| Rate for Payer: Heritage Provider Network Senior |
$9.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.69
|
| Rate for Payer: Multiplan Commercial |
$11.06
|
|
|
HC SOM TREE4 86003
|
Facility
IP
|
$61.13
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914815
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$45.85 |
| Rate for Payer: Adventist Health Commercial |
$12.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.00
|
| Rate for Payer: Cash Price |
$27.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.39
|
| Rate for Payer: Heritage Provider Network Senior |
$41.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.28
|
| Rate for Payer: Multiplan Commercial |
$45.85
|
|
|
HC SOM TREE4 86003
|
Facility
OP
|
$61.13
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914815
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$132.31 |
| Rate for Payer: Adventist Health Commercial |
$12.23
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
| Rate for Payer: Blue Shield of California Commercial |
$40.81
|
| Rate for Payer: Blue Shield of California EPN |
$31.90
|
| Rate for Payer: Cash Price |
$27.51
|
| Rate for Payer: Cash Price |
$27.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.73
|
| 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 |
$39.73
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.84
|
| Rate for Payer: Heritage Provider Network Senior |
$37.84
|
| Rate for Payer: Humana Medicare |
$5.22
|
| Rate for Payer: IEHP Medi-Cal |
$7.24
|
| Rate for Payer: IEHP Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.28
|
| 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 |
$45.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SOM TRSF 84466
|
Facility
IP
|
$27.28
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
900914761
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$20.46 |
| Rate for Payer: Adventist Health Commercial |
$5.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.74
|
| Rate for Payer: Cash Price |
$12.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.47
|
| Rate for Payer: Heritage Provider Network Senior |
$18.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.82
|
| Rate for Payer: Multiplan Commercial |
$20.46
|
|
|
HC SOM TRSF 84466
|
Facility
OP
|
$27.28
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
900914761
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Adventist Health Commercial |
$5.46
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.00
|
| Rate for Payer: Blue Shield of California Commercial |
$99.73
|
| Rate for Payer: Blue Shield of California EPN |
$77.96
|
| Rate for Payer: Cash Price |
$12.28
|
| Rate for Payer: Cash Price |
$12.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.04
|
| Rate for Payer: Dignity Health Senior |
$12.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.73
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.89
|
| Rate for Payer: Heritage Provider Network Senior |
$16.89
|
| Rate for Payer: Humana Medicare |
$12.76
|
| Rate for Payer: IEHP Medi-Cal |
$17.18
|
| Rate for Payer: IEHP Medicare Advantage |
$12.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$20.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.76
|
| Rate for Payer: TriValley Medical Group Senior |
$12.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.04
|
| Rate for Payer: Vantage Medical Group Senior |
$12.76
|
|
|
HC SOM TRYPTASE
|
Facility
OP
|
$37.70
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910734
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$108.36 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.36
|
| Rate for Payer: Blue Shield of California Commercial |
$101.12
|
| Rate for Payer: Blue Shield of California EPN |
$79.05
|
| Rate for Payer: Cash Price |
$16.97
|
| Rate for Payer: Cash Price |
$16.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.34
|
| Rate for Payer: Heritage Provider Network Senior |
$23.34
|
| Rate for Payer: Humana Medicare |
$17.27
|
| Rate for Payer: IEHP Medi-Cal |
$15.97
|
| Rate for Payer: IEHP Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.76
|
| Rate for Payer: Multiplan Commercial |
$28.28
|
| 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 |
$25.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM TRYPTASE
|
Facility
IP
|
$37.70
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910734
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$28.28 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.90
|
| Rate for Payer: Cash Price |
$16.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.52
|
| Rate for Payer: Heritage Provider Network Senior |
$25.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.42
|
| Rate for Payer: Multiplan Commercial |
$28.28
|
|
|
HC SOM TSH SENSITIVE, SERUM
|
Facility
IP
|
$24.06
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
900913813
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$18.04 |
| Rate for Payer: Adventist Health Commercial |
$4.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.53
|
| Rate for Payer: Cash Price |
$10.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.29
|
| Rate for Payer: Heritage Provider Network Senior |
$16.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.02
|
| Rate for Payer: Multiplan Commercial |
$18.04
|
|
|
HC SOM TSH SENSITIVE, SERUM
|
Facility
OP
|
$24.06
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
900913813
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Adventist Health Commercial |
$4.81
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.65
|
| Rate for Payer: Blue Shield of California Commercial |
$131.20
|
| Rate for Payer: Blue Shield of California EPN |
$102.56
|
| Rate for Payer: Cash Price |
$10.83
|
| Rate for Payer: Cash Price |
$10.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.48
|
| Rate for Payer: Dignity Health Senior |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.64
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.89
|
| Rate for Payer: Heritage Provider Network Senior |
$14.89
|
| Rate for Payer: Humana Medicare |
$16.80
|
| Rate for Payer: IEHP Medi-Cal |
$23.03
|
| Rate for Payer: IEHP Medicare Advantage |
$16.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.17
|
| Rate for Payer: Multiplan Commercial |
$18.04
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Vantage Medical Group Senior |
$16.80
|
|
|
HC SOM TTFB 84402A
|
Facility
OP
|
$81.10
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
900914762
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.68 |
| Max. Negotiated Rate |
$217.68 |
| Rate for Payer: Adventist Health Commercial |
$16.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.68
|
| Rate for Payer: Blue Shield of California Commercial |
$198.84
|
| Rate for Payer: Blue Shield of California EPN |
$155.44
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$52.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.02
|
| Rate for Payer: Dignity Health Senior |
$25.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.72
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.20
|
| Rate for Payer: Heritage Provider Network Senior |
$50.20
|
| Rate for Payer: Humana Medicare |
$25.47
|
| Rate for Payer: IEHP Medi-Cal |
$35.32
|
| Rate for Payer: IEHP Medicare Advantage |
$25.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$48.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.09
|
| Rate for Payer: Multiplan Commercial |
$60.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.47
|
| Rate for Payer: TriValley Medical Group Senior |
$25.47
|
| 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 |
$38.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.02
|
| Rate for Payer: Vantage Medical Group Senior |
$25.47
|
|
|
HC SOM TTFB 84402A
|
Facility
IP
|
$81.10
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
900914762
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.68 |
| Max. Negotiated Rate |
$60.82 |
| Rate for Payer: Adventist Health Commercial |
$16.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.72
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.90
|
| Rate for Payer: Heritage Provider Network Senior |
$54.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.28
|
| Rate for Payer: Multiplan Commercial |
$60.82
|
|
|
HC SOM TTFB 84402B
|
Facility
IP
|
$81.10
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
900914763
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.68 |
| Max. Negotiated Rate |
$60.82 |
| Rate for Payer: Adventist Health Commercial |
$16.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.72
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.90
|
| Rate for Payer: Heritage Provider Network Senior |
$54.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.28
|
| Rate for Payer: Multiplan Commercial |
$60.82
|
|
