|
HC SOM MUMPS AB IGM CSF
|
Facility
|
OP
|
$27.38
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900912679
|
|
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 MUR 85549
|
Facility
|
OP
|
$26.87
|
|
|
Service Code
|
CPT 85549
|
| Hospital Charge Code |
900914739
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$178.09 |
| Rate for Payer: Adventist Health Commercial |
$5.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$178.09
|
| Rate for Payer: Blue Shield of California Commercial |
$150.97
|
| Rate for Payer: Blue Shield of California EPN |
$121.09
|
| Rate for Payer: Cash Price |
$26.87
|
| Rate for Payer: Cash Price |
$26.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.63
|
| Rate for Payer: Heritage Provider Network Senior |
$16.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.12
|
| Rate for Payer: Multiplan Commercial |
$20.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Senior |
$18.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.62
|
| Rate for Payer: Vantage Medical Group Senior |
$18.75
|
|
|
HC SOM MUR 85549
|
Facility
|
IP
|
$26.87
|
|
|
Service Code
|
CPT 85549
|
| Hospital Charge Code |
900914739
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Adventist Health Commercial |
$5.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.30
|
| Rate for Payer: Cash Price |
$26.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.19
|
| Rate for Payer: Heritage Provider Network Senior |
$18.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$20.15
|
|
|
HC SOM MURAMIDASE SERUM
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 85549
|
| Hospital Charge Code |
900911063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.46
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.25
|
| Rate for Payer: Heritage Provider Network Senior |
$16.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
|
|
HC SOM MURAMIDASE SERUM
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 85549
|
| Hospital Charge Code |
900911063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$178.09 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$178.09
|
| Rate for Payer: Blue Shield of California Commercial |
$150.97
|
| Rate for Payer: Blue Shield of California EPN |
$121.09
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.86
|
| Rate for Payer: Heritage Provider Network Senior |
$14.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.12
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Senior |
$18.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.62
|
| Rate for Payer: Vantage Medical Group Senior |
$18.75
|
|
|
HC SOM MUSK AUTOANTIBODY
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT 86366
|
| Hospital Charge Code |
900915423
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$95.03 |
| Max. Negotiated Rate |
$393.75 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$338.10
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$355.43
|
| Rate for Payer: Heritage Provider Network Senior |
$355.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.25
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
|
|
HC SOM MUSK AUTOANTIBODY
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT 86366
|
| Hospital Charge Code |
900915423
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$393.75 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$324.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.16
|
| Rate for Payer: Blue Shield of California Commercial |
$105.98
|
| Rate for Payer: Blue Shield of California EPN |
$85.01
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$341.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$324.98
|
| Rate for Payer: Heritage Provider Network Senior |
$324.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$250.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.40
|
| Rate for Payer: TriValley Medical Group Senior |
$18.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$262.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$262.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM MYCOPHENOLIC ACID
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 80180
|
| Hospital Charge Code |
900910761
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.17
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.89
|
| Rate for Payer: Heritage Provider Network Senior |
$14.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
|
|
HC SOM MYCOPHENOLIC ACID
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 80180
|
| Hospital Charge Code |
900910761
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$141.87 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.11
|
| Rate for Payer: Blue Shield of California Commercial |
$141.87
|
| Rate for Payer: Blue Shield of California EPN |
$113.79
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.98
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.62
|
| Rate for Payer: Heritage Provider Network Senior |
$13.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.19
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.05
|
| Rate for Payer: TriValley Medical Group Senior |
$18.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.86
|
| Rate for Payer: Vantage Medical Group Senior |
$18.05
|
|
|
HC SOM MYCOPLASMA PNEUMONIAE AB IGG
|
Facility
|
IP
|
$11.94
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900911589
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$8.96 |
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.69
|
| Rate for Payer: Cash Price |
$11.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.08
|
| Rate for Payer: Heritage Provider Network Senior |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Multiplan Commercial |
$8.96
|
|
|
HC SOM MYCOPLASMA PNEUMONIAE AB IGG
|
Facility
|
OP
|
$11.94
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900911589
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.38
|
| 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 |
$11.94
|
| Rate for Payer: Cash Price |
$11.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.76
|
| 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 |
$7.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.39
|
| Rate for Payer: Heritage Provider Network Senior |
$7.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$8.96
|
| 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 MYCOPLASMA PNEUMONIAE AB IGM
|
Facility
|
IP
|
$11.94
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900912639
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$8.96 |
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.69
|
| Rate for Payer: Cash Price |
$11.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.08
|
| Rate for Payer: Heritage Provider Network Senior |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Multiplan Commercial |
$8.96
|
|
|
HC SOM MYCOPLASMA PNEUMONIAE AB IGM
|
Facility
|
OP
|
$11.94
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900912639
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.38
|
| 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 |
$11.94
|
| Rate for Payer: Cash Price |
$11.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.76
|
| 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 |
$7.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.39
|
| Rate for Payer: Heritage Provider Network Senior |
$7.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$8.96
|
| 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 MYCOPLASMA PNEUMON IGA
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900914684
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.68
|
| 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 |
$82.00
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$53.30
|
| 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 |
$48.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.76
|
| Rate for Payer: Heritage Provider Network Senior |
$50.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$39.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| 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 MYCOPLASMA PNEUMON IGA
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900914684
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$61.50 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.81
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.51
|
| Rate for Payer: Heritage Provider Network Senior |
$55.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
|
|
HC SOM MYCO PNEUM DNA PCR
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
900914442
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$108.15
|
| 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 |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$113.75
|
| 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 |
$103.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.33
|
| Rate for Payer: Heritage Provider Network Senior |
$108.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$83.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| 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 MYCO PNEUM DNA PCR
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
900914442
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$131.25 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$112.70
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.47
|
| Rate for Payer: Heritage Provider Network Senior |
$118.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.75
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
|
|
HC SOM MYELOID NEOPLASM NGS
|
Facility
|
IP
|
$1,989.23
|
|
|
Service Code
|
CPT 81450
|
| Hospital Charge Code |
900915522
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$360.05 |
| Max. Negotiated Rate |
$1,491.92 |
| Rate for Payer: Adventist Health Commercial |
$397.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,281.06
|
| Rate for Payer: Cash Price |
$1,989.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,346.71
|
| Rate for Payer: Heritage Provider Network Senior |
$1,346.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$360.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.31
|
| Rate for Payer: Multiplan Commercial |
$1,491.92
|
|
|
HC SOM MYELOID NEOPLASM NGS
|
Facility
|
OP
|
$1,989.23
|
|
|
Service Code
|
CPT 81450
|
| Hospital Charge Code |
900915522
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$360.05 |
| Max. Negotiated Rate |
$20,444.43 |
| Rate for Payer: Multiplan Commercial |
$1,491.92
|
| Rate for Payer: Adventist Health Commercial |
$397.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,229.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,139.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$835.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$759.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20,444.43
|
| Rate for Payer: Cash Price |
$1,989.23
|
| Rate for Payer: Cash Price |
$1,989.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,293.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,139.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$835.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$759.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,293.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$759.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,231.33
|
| Rate for Payer: Heritage Provider Network Senior |
$1,231.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$759.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$948.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$360.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$873.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,017.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$759.53
|
| Rate for Payer: TriValley Medical Group Senior |
$759.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$820.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$820.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,139.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$835.48
|
| Rate for Payer: Vantage Medical Group Senior |
$759.53
|
|
|
HC SOM MYELOPEROXIDASE
|
Facility
|
IP
|
$30.75
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900910578
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$23.06 |
| Rate for Payer: Adventist Health Commercial |
$6.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.80
|
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.82
|
| Rate for Payer: Heritage Provider Network Senior |
$20.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.69
|
| Rate for Payer: Multiplan Commercial |
$23.06
|
|
|
HC SOM MYELOPEROXIDASE
|
Facility
|
OP
|
$30.75
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900910578
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$222.13 |
| Rate for Payer: Adventist Health Commercial |
$6.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.13
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.03
|
| Rate for Payer: Heritage Provider Network Senior |
$19.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$23.06
|
| 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 MYOGLOBINURIA PROFILE
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900914702
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$158.38 |
| Max. Negotiated Rate |
$743.75 |
| Rate for Payer: Adventist Health Commercial |
$175.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$540.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$481.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$656.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$437.68
|
| Rate for Payer: Blue Shield of California Commercial |
$533.75
|
| Rate for Payer: Blue Shield of California EPN |
$427.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$568.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$743.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$743.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$743.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$541.62
|
| Rate for Payer: Heritage Provider Network Senior |
$541.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$417.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$158.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$612.50
|
| Rate for Payer: Multiplan Commercial |
$656.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$437.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$437.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$743.75
|
| Rate for Payer: Vantage Medical Group Senior |
$743.75
|
|
|
HC SOM MYOGLOBINURIA PROFILE
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900914702
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$158.38 |
| Max. Negotiated Rate |
$656.25 |
| Rate for Payer: Adventist Health Commercial |
$175.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$563.50
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$592.38
|
| Rate for Payer: Heritage Provider Network Senior |
$592.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$158.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.75
|
| Rate for Payer: Multiplan Commercial |
$656.25
|
|
|
HC SOM MYOGLOBIN URINE
|
Facility
|
IP
|
$20.21
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
900910762
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$15.16 |
| Rate for Payer: Adventist Health Commercial |
$4.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.02
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.68
|
| Rate for Payer: Heritage Provider Network Senior |
$13.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.05
|
| Rate for Payer: Multiplan Commercial |
$15.16
|
|
|
HC SOM MYOGLOBIN URINE
|
Facility
|
OP
|
$20.21
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
900910762
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$122.99 |
| Rate for Payer: Adventist Health Commercial |
$4.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.99
|
| Rate for Payer: Blue Shield of California Commercial |
$103.91
|
| Rate for Payer: Blue Shield of California EPN |
$83.34
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.92
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.51
|
| Rate for Payer: Heritage Provider Network Senior |
$12.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.31
|
| Rate for Payer: Multiplan Commercial |
$15.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.92
|
| Rate for Payer: TriValley Medical Group Senior |
$12.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.21
|
| Rate for Payer: Vantage Medical Group Senior |
$12.92
|
|
