|
HC SOM PARANEOPL EVAL PCA2
|
Facility
|
IP
|
$61.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914654
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$45.83 |
| Rate for Payer: Adventist Health Commercial |
$12.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.35
|
| Rate for Payer: Cash Price |
$61.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.37
|
| Rate for Payer: Heritage Provider Network Senior |
$41.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.28
|
| Rate for Payer: Multiplan Commercial |
$45.83
|
|
|
HC SOM PARANEOPL EVAL PCA2
|
Facility
|
OP
|
$61.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914654
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$12.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.48
|
| Rate for Payer: Blue Shield of California Commercial |
$97.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.80
|
| Rate for Payer: Cash Price |
$61.11
|
| Rate for Payer: Cash Price |
$61.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.83
|
| Rate for Payer: Heritage Provider Network Senior |
$37.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$29.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$45.83
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| 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 |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PARANEOPL EVAL PCATR
|
Facility
|
IP
|
$61.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$45.83 |
| Rate for Payer: Adventist Health Commercial |
$12.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.35
|
| Rate for Payer: Cash Price |
$61.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.37
|
| Rate for Payer: Heritage Provider Network Senior |
$41.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.28
|
| Rate for Payer: Multiplan Commercial |
$45.83
|
|
|
HC SOM PARANEOPL EVAL PCATR
|
Facility
|
OP
|
$61.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$12.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.48
|
| Rate for Payer: Blue Shield of California Commercial |
$97.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.80
|
| Rate for Payer: Cash Price |
$61.11
|
| Rate for Payer: Cash Price |
$61.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.83
|
| Rate for Payer: Heritage Provider Network Senior |
$37.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$29.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$45.83
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| 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 |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PARANEOPL EVAL P/Q AB
|
Facility
|
OP
|
$30.37
|
|
|
Service Code
|
CPT 86596
|
| Hospital Charge Code |
900914658
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$105.98 |
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| 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 |
$30.37
|
| Rate for Payer: Cash Price |
$30.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.92
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.80
|
| Rate for Payer: Heritage Provider Network Senior |
$18.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$22.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PARANEOPL EVAL P/Q AB
|
Facility
|
IP
|
$30.37
|
|
|
Service Code
|
CPT 86596
|
| Hospital Charge Code |
900914658
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$22.78 |
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.56
|
| Rate for Payer: Cash Price |
$30.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.56
|
| Rate for Payer: Heritage Provider Network Senior |
$20.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.59
|
| Rate for Payer: Multiplan Commercial |
$22.78
|
|
|
HC SOM PARANEOPL EVAL STR AB
|
Facility
|
IP
|
$30.33
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900915359
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.53
|
| Rate for Payer: Cash Price |
$30.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.53
|
| Rate for Payer: Heritage Provider Network Senior |
$20.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.58
|
| Rate for Payer: Multiplan Commercial |
$22.75
|
|
|
HC SOM PARANEOPL EVAL STR AB
|
Facility
|
OP
|
$30.33
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900915359
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$122.92 |
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.92
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Cash Price |
$30.33
|
| Rate for Payer: Cash Price |
$30.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.89
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.77
|
| Rate for Payer: Heritage Provider Network Senior |
$18.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$22.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.27
|
| Rate for Payer: TriValley Medical Group Senior |
$17.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM PARASITIC EXAM CONC
|
Facility
|
OP
|
$28.71
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
900914691
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$63.41 |
| Rate for Payer: Adventist Health Commercial |
$5.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.41
|
| Rate for Payer: Blue Shield of California Commercial |
$53.74
|
| Rate for Payer: Blue Shield of California EPN |
$43.10
|
| Rate for Payer: Cash Price |
$28.71
|
| Rate for Payer: Cash Price |
$28.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.77
|
| Rate for Payer: Heritage Provider Network Senior |
$17.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.95
|
| Rate for Payer: Multiplan Commercial |
$21.53
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.68
|
| Rate for Payer: TriValley Medical Group Senior |
$6.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Vantage Medical Group Senior |
$6.68
|
|
|
HC SOM PARASITIC EXAM CONC
|
Facility
|
IP
|
$28.71
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
900914691
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$21.53 |
| Rate for Payer: Adventist Health Commercial |
$5.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.49
|
| Rate for Payer: Cash Price |
$28.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.44
|
| Rate for Payer: Heritage Provider Network Senior |
$19.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.18
|
| Rate for Payer: Multiplan Commercial |
$21.53
|
|
|
HC SOM PARASITIC EXAM STAIN
|
Facility
|
IP
|
$77.27
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
900914692
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$57.95 |
| Rate for Payer: Adventist Health Commercial |
$15.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.76
|
| Rate for Payer: Cash Price |
$77.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.31
|
| Rate for Payer: Heritage Provider Network Senior |
$52.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.32
|
| Rate for Payer: Multiplan Commercial |
$57.95
|
|
|
HC SOM PARASITIC EXAM STAIN
|
Facility
|
OP
|
$77.27
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
900914692
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$166.90 |
| Rate for Payer: Adventist Health Commercial |
$15.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.90
|
| Rate for Payer: Blue Shield of California Commercial |
$144.63
|
| Rate for Payer: Blue Shield of California EPN |
$116.01
|
| Rate for Payer: Cash Price |
$77.27
|
| Rate for Payer: Cash Price |
$77.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.83
|
| Rate for Payer: Heritage Provider Network Senior |
$47.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$36.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$57.95
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.98
|
| Rate for Payer: TriValley Medical Group Senior |
$17.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.78
|
| Rate for Payer: Vantage Medical Group Senior |
$17.98
|
|
|
HC SOM PARIETAL CELL AB
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911267
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$222.13 |
| Rate for Payer: Adventist Health Commercial |
$5.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.69
|
| 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 |
$25.39
|
| Rate for Payer: Cash Price |
$25.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.50
|
| 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 |
$14.98
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.72
|
| Rate for Payer: Heritage Provider Network Senior |
$15.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$19.04
|
| 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 PARIETAL CELL AB
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911267
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Adventist Health Commercial |
$5.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.35
|
| Rate for Payer: Cash Price |
$25.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.19
|
| Rate for Payer: Heritage Provider Network Senior |
$17.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.35
|
| Rate for Payer: Multiplan Commercial |
$19.04
|
|
|
HC SOM PARVOVIRUS B19 AB IGG
|
Facility
|
OP
|
$11.23
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
900912538
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$142.93 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.93
|
| Rate for Payer: Blue Shield of California Commercial |
$120.96
|
| Rate for Payer: Blue Shield of California EPN |
$97.02
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.95
|
| Rate for Payer: Heritage Provider Network Senior |
$6.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.14
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.03
|
| Rate for Payer: TriValley Medical Group Senior |
$15.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.53
|
| Rate for Payer: Vantage Medical Group Senior |
$15.03
|
|
|
HC SOM PARVOVIRUS B19 AB IGG
|
Facility
|
IP
|
$11.23
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
900912538
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.23
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.60
|
| Rate for Payer: Heritage Provider Network Senior |
$7.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
|
|
HC SOM PARVOVIRUS B19 AB IGM
|
Facility
|
IP
|
$11.23
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
900912694
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.23
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.60
|
| Rate for Payer: Heritage Provider Network Senior |
$7.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
|
|
HC SOM PARVOVIRUS B19 AB IGM
|
Facility
|
OP
|
$11.23
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
900912694
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$142.93 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.93
|
| Rate for Payer: Blue Shield of California Commercial |
$120.96
|
| Rate for Payer: Blue Shield of California EPN |
$97.02
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.95
|
| Rate for Payer: Heritage Provider Network Senior |
$6.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.14
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.03
|
| Rate for Payer: TriValley Medical Group Senior |
$15.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.53
|
| Rate for Payer: Vantage Medical Group Senior |
$15.03
|
|
|
HC SOM PARVOVIRUS B19 PCR BF
|
Facility
|
IP
|
$41.48
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912782
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$31.11 |
| Rate for Payer: Adventist Health Commercial |
$8.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.71
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.08
|
| Rate for Payer: Heritage Provider Network Senior |
$28.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.37
|
| Rate for Payer: Multiplan Commercial |
$31.11
|
|
|
HC SOM PARVOVIRUS B19 PCR BF
|
Facility
|
OP
|
$41.48
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912782
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$8.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.63
|
| 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 |
$41.48
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.96
|
| 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 |
$24.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.68
|
| Rate for Payer: Heritage Provider Network Senior |
$25.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$31.11
|
| 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 PARVOVIRUS PCR
|
Facility
|
OP
|
$41.48
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911590
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$8.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.63
|
| 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 |
$41.48
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.96
|
| 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 |
$24.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.68
|
| Rate for Payer: Heritage Provider Network Senior |
$25.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$31.11
|
| 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 PARVOVIRUS PCR
|
Facility
|
IP
|
$41.48
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911590
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$31.11 |
| Rate for Payer: Adventist Health Commercial |
$8.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.71
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.08
|
| Rate for Payer: Heritage Provider Network Senior |
$28.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.37
|
| Rate for Payer: Multiplan Commercial |
$31.11
|
|
|
HC SOM PASSION FRUIT IGE
|
Facility
|
IP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914703
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.81
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.06
|
| Rate for Payer: Heritage Provider Network Senior |
$5.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
|
|
HC SOM PASSION FRUIT IGE
|
Facility
|
OP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914703
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$150.09 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.09
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.62
|
| Rate for Payer: Heritage Provider Network Senior |
$4.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| 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 PCA3 U
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900913905
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$90.50 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$309.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$425.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.10
|
| Rate for Payer: Blue Shield of California Commercial |
$305.00
|
| Rate for Payer: Blue Shield of California EPN |
$244.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$325.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$425.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$425.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$309.50
|
| Rate for Payer: Heritage Provider Network Senior |
$309.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$238.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$90.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$350.00
|
| Rate for Payer: Multiplan Commercial |
$375.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$250.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$250.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$425.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.00
|
| Rate for Payer: Vantage Medical Group Senior |
$425.00
|
|
