|
HC SOM MMRV 86787
|
Facility
|
OP
|
$29.73
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900914959
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$122.35 |
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.35
|
| Rate for Payer: Blue Shield of California Commercial |
$103.68
|
| Rate for Payer: Blue Shield of California EPN |
$83.16
|
| Rate for Payer: Cash Price |
$29.73
|
| Rate for Payer: Cash Price |
$29.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.54
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.40
|
| Rate for Payer: Heritage Provider Network Senior |
$18.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$22.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.88
|
| Rate for Payer: TriValley Medical Group Senior |
$12.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM MMRV 86787
|
Facility
|
IP
|
$29.73
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900914959
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$22.30 |
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.15
|
| Rate for Payer: Cash Price |
$29.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.13
|
| Rate for Payer: Heritage Provider Network Senior |
$20.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.43
|
| Rate for Payer: Multiplan Commercial |
$22.30
|
|
|
HC SOM MOGS FACS
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
900915461
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$247.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.22
|
| Rate for Payer: Blue Shield of California Commercial |
$69.41
|
| Rate for Payer: Blue Shield of California EPN |
$55.67
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$260.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$247.60
|
| Rate for Payer: Heritage Provider Network Senior |
$247.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$190.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.73
|
| Rate for Payer: TriValley Medical Group Senior |
$37.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC SOM MOGS FACS
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
900915461
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.40 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$257.60
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$270.80
|
| Rate for Payer: Heritage Provider Network Senior |
$270.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
|
|
HC SOM MOGS FACS TITER
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
900915462
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$69.41 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.22
|
| Rate for Payer: Blue Shield of California Commercial |
$69.41
|
| Rate for Payer: Blue Shield of California EPN |
$55.67
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.42
|
| Rate for Payer: Heritage Provider Network Senior |
$46.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$35.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.73
|
| Rate for Payer: TriValley Medical Group Senior |
$37.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC SOM MOGS FACS TITER
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
900915462
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.30
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.77
|
| Rate for Payer: Heritage Provider Network Senior |
$50.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
|
|
HC SOM MONKEYPOX DNA PCR
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
900915425
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.02
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.28
|
| Rate for Payer: Heritage Provider Network Senior |
$74.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$57.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.31
|
| Rate for Payer: TriValley Medical Group Senior |
$51.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HC SOM MONKEYPOX DNA PCR
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
900915425
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.28
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.24
|
| Rate for Payer: Heritage Provider Network Senior |
$81.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
|
|
HC SOM M PNEUMONIAE AB IGM S IFA
|
Facility
|
OP
|
$53.32
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900913940
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.65 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$10.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$106.62
|
| Rate for Payer: Blue Shield of California EPN |
$85.52
|
| Rate for Payer: Cash Price |
$53.32
|
| Rate for Payer: Cash Price |
$53.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.46
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.01
|
| Rate for Payer: Heritage Provider Network Senior |
$33.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$25.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$39.99
|
| 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 M PNEUMONIAE AB IGM S IFA
|
Facility
|
IP
|
$53.32
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900913940
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.65 |
| Max. Negotiated Rate |
$39.99 |
| Rate for Payer: Adventist Health Commercial |
$10.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.34
|
| Rate for Payer: Cash Price |
$53.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.10
|
| Rate for Payer: Heritage Provider Network Senior |
$36.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.33
|
| Rate for Payer: Multiplan Commercial |
$39.99
|
|
|
HC SOM M PNEUMONIAE PCR
|
Facility
|
OP
|
$185.46
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
900915468
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.57 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$37.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.61
|
| 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 |
$185.46
|
| Rate for Payer: Cash Price |
$185.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.55
|
| 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 |
$120.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.80
|
| Rate for Payer: Heritage Provider Network Senior |
$114.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$88.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$139.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM M PNEUMONIAE PCR
|
Facility
|
IP
|
$185.46
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
900915468
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.57 |
| Max. Negotiated Rate |
$139.09 |
| Rate for Payer: Adventist Health Commercial |
$37.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.44
|
| Rate for Payer: Cash Price |
$185.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.56
|
| Rate for Payer: Heritage Provider Network Senior |
$125.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.37
|
| Rate for Payer: Multiplan Commercial |
$139.09
|
|
|
HC SOM M PROTEIN MASS FIX
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 0077U
|
| Hospital Charge Code |
900915454
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$249.30 |
| 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 |
$65.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$249.30
|
| 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 |
$65.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$43.43
|
| 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 |
$43.43
|
| 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 |
$49.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$58.20
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$43.43
|
| Rate for Payer: TriValley Medical Group Senior |
$43.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$65.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.77
|
| Rate for Payer: Vantage Medical Group Senior |
$43.43
|
|
|
HC SOM M PROTEIN MASS FIX
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 0077U
|
| Hospital Charge Code |
900915454
|
|
Hospital Revenue Code
|
310
|
| 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 MTB PCR COMPLEX SPUTUM
|
Facility
|
OP
|
$243.39
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915433
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: EPIC Health Plan Commercial |
$158.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Adventist Health Commercial |
$48.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$150.42
|
| 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 |
$243.39
|
| Rate for Payer: Cash Price |
$243.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$158.20
|
| 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: Heritage Provider Network Commercial |
$150.66
|
| Rate for Payer: Heritage Provider Network Senior |
$150.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$116.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$182.54
|
| 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 MTB PCR COMPLEX SPUTUM
|
Facility
|
IP
|
$243.39
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915433
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.05 |
| Max. Negotiated Rate |
$182.54 |
| Rate for Payer: Adventist Health Commercial |
$48.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$156.74
|
| Rate for Payer: Cash Price |
$243.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$164.78
|
| Rate for Payer: Heritage Provider Network Senior |
$164.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.85
|
| Rate for Payer: Multiplan Commercial |
$182.54
|
|
|
HC SOM MTB PCR SPUTUM
|
Facility
|
OP
|
$289.11
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
900915432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.68 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$57.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$178.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 |
$289.11
|
| Rate for Payer: Cash Price |
$289.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$187.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.92
|
| Rate for Payer: EPIC Health Plan Medicare |
$41.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$178.96
|
| Rate for Payer: Heritage Provider Network Senior |
$178.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$137.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55.85
|
| Rate for Payer: Multiplan Commercial |
$216.83
|
| Rate for Payer: TriValley Medical Group Commercial |
$41.68
|
| Rate for Payer: TriValley Medical Group Senior |
$41.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$45.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$45.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.85
|
| Rate for Payer: Vantage Medical Group Senior |
$41.68
|
|
|
HC SOM MTB PCR SPUTUM
|
Facility
|
IP
|
$289.11
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
900915432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.33 |
| Max. Negotiated Rate |
$216.83 |
| Rate for Payer: Adventist Health Commercial |
$57.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$186.19
|
| Rate for Payer: Cash Price |
$289.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$195.73
|
| Rate for Payer: Heritage Provider Network Senior |
$195.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.28
|
| Rate for Payer: Multiplan Commercial |
$216.83
|
|
|
HC SOM MTHFR MUTATION DETECTION
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT 81291
|
| Hospital Charge Code |
900914663
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$34.39 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Adventist Health Commercial |
$38.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.36
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$128.63
|
| Rate for Payer: Heritage Provider Network Senior |
$128.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.50
|
| Rate for Payer: Multiplan Commercial |
$142.50
|
|
|
HC SOM MTHFR MUTATION DETECTION
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT 81291
|
| Hospital Charge Code |
900914663
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$34.39 |
| Max. Negotiated Rate |
$434.09 |
| Rate for Payer: Adventist Health Commercial |
$38.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$117.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$98.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$434.09
|
| Rate for Payer: Blue Shield of California Commercial |
$115.90
|
| Rate for Payer: Blue Shield of California EPN |
$92.72
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$123.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$65.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$65.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$117.61
|
| Rate for Payer: Heritage Provider Network Senior |
$117.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$90.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$87.56
|
| Rate for Payer: Multiplan Commercial |
$142.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$65.34
|
| Rate for Payer: TriValley Medical Group Senior |
$65.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$70.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$70.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.87
|
| Rate for Payer: Vantage Medical Group Senior |
$65.34
|
|
|
HC SOM M. TUBERCULOSIS PCR
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
900912875
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$41.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.14
|
| Rate for Payer: Heritage Provider Network Senior |
$37.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55.85
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$41.68
|
| Rate for Payer: TriValley Medical Group Senior |
$41.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$45.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$45.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.85
|
| Rate for Payer: Vantage Medical Group Senior |
$41.68
|
|
|
HC SOM M. TUBERCULOSIS PCR
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
900912875
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.64
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.62
|
| Rate for Payer: Heritage Provider Network Senior |
$40.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
|
|
HC SOM MUMPS AB IGG CSF
|
Facility
|
OP
|
$27.38
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900911356
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.96 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$5.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$105.00
|
| Rate for Payer: Blue Shield of California EPN |
$84.22
|
| Rate for Payer: Cash Price |
$27.38
|
| Rate for Payer: Cash Price |
$27.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.95
|
| Rate for Payer: Heritage Provider Network Senior |
$16.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.49
|
| Rate for Payer: Multiplan Commercial |
$20.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.05
|
| Rate for Payer: TriValley Medical Group Senior |
$13.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Vantage Medical Group Senior |
$13.05
|
|
|
HC SOM MUMPS AB IGG CSF
|
Facility
|
IP
|
$27.38
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900911356
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.96 |
| Max. Negotiated Rate |
$20.54 |
| Rate for Payer: Adventist Health Commercial |
$5.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.63
|
| Rate for Payer: Cash Price |
$27.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.54
|
| Rate for Payer: Heritage Provider Network Senior |
$18.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.84
|
| Rate for Payer: Multiplan Commercial |
$20.54
|
|
|
HC SOM MUMPS AB IGM CSF
|
Facility
|
IP
|
$27.38
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900912679
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.96 |
| Max. Negotiated Rate |
$20.54 |
| Rate for Payer: Adventist Health Commercial |
$5.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.63
|
| Rate for Payer: Cash Price |
$27.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.54
|
| Rate for Payer: Heritage Provider Network Senior |
$18.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.84
|
| Rate for Payer: Multiplan Commercial |
$20.54
|
|
