|
HC SOM PROTOPORPH FR RBC
|
Facility
|
OP
|
$126.77
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900911168
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$170.74 |
| Rate for Payer: Adventist Health Commercial |
$25.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$78.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.74
|
| Rate for Payer: Blue Shield of California Commercial |
$145.32
|
| Rate for Payer: Blue Shield of California EPN |
$116.56
|
| Rate for Payer: Cash Price |
$126.77
|
| Rate for Payer: Cash Price |
$126.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$82.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.47
|
| Rate for Payer: Heritage Provider Network Senior |
$78.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$60.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$95.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.09
|
| Rate for Payer: TriValley Medical Group Senior |
$24.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM PROTOPORPH FR RBC
|
Facility
|
IP
|
$126.77
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900911168
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$95.08 |
| Rate for Payer: Adventist Health Commercial |
$25.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.64
|
| Rate for Payer: Cash Price |
$126.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.82
|
| Rate for Payer: Heritage Provider Network Senior |
$85.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.69
|
| Rate for Payer: Multiplan Commercial |
$95.08
|
|
|
HC SOM PROTRIPTYLINE (VIVACTYL)
|
Facility
|
OP
|
$62.99
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900911246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$163.00 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.00
|
| Rate for Payer: Cash Price |
$62.99
|
| Rate for Payer: Cash Price |
$62.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$53.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.99
|
| Rate for Payer: Heritage Provider Network Senior |
$38.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$30.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$44.09
|
| Rate for Payer: Multiplan Commercial |
$47.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.54
|
| Rate for Payer: Vantage Medical Group Senior |
$53.54
|
|
|
HC SOM PROTRIPTYLINE (VIVACTYL)
|
Facility
|
IP
|
$62.99
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900911246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$47.24 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.57
|
| Rate for Payer: Cash Price |
$62.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.64
|
| Rate for Payer: Heritage Provider Network Senior |
$42.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.75
|
| Rate for Payer: Multiplan Commercial |
$47.24
|
|
|
HC SOM PSA ULTRASENSITIVE
|
Facility
|
IP
|
$123.40
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900913953
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.34 |
| Max. Negotiated Rate |
$92.55 |
| Rate for Payer: Adventist Health Commercial |
$24.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.47
|
| Rate for Payer: Cash Price |
$123.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.54
|
| Rate for Payer: Heritage Provider Network Senior |
$83.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.85
|
| Rate for Payer: Multiplan Commercial |
$92.55
|
|
|
HC SOM PSA ULTRASENSITIVE
|
Facility
|
OP
|
$123.40
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900913953
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$174.63 |
| Rate for Payer: Adventist Health Commercial |
$24.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$76.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.63
|
| Rate for Payer: Blue Shield of California Commercial |
$148.03
|
| Rate for Payer: Blue Shield of California EPN |
$118.73
|
| Rate for Payer: Cash Price |
$123.40
|
| Rate for Payer: Cash Price |
$123.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$80.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.38
|
| Rate for Payer: Heritage Provider Network Senior |
$76.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$58.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.64
|
| Rate for Payer: Multiplan Commercial |
$92.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.39
|
| Rate for Payer: TriValley Medical Group Senior |
$18.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
|
|
HC SOM PST
|
Facility
|
OP
|
$103.35
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900914755
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$145.55 |
| Rate for Payer: Adventist Health Commercial |
$20.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.55
|
| Rate for Payer: Blue Shield of California Commercial |
$123.32
|
| Rate for Payer: Blue Shield of California EPN |
$98.91
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$67.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.98
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.97
|
| Rate for Payer: Heritage Provider Network Senior |
$63.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$49.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.53
|
| Rate for Payer: Multiplan Commercial |
$77.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.32
|
| Rate for Payer: TriValley Medical Group Senior |
$15.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Vantage Medical Group Senior |
$15.32
|
|
|
HC SOM PST
|
Facility
|
IP
|
$103.35
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900914755
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.71 |
| Max. Negotiated Rate |
$77.51 |
| Rate for Payer: Adventist Health Commercial |
$20.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.56
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.97
|
| Rate for Payer: Heritage Provider Network Senior |
$69.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.84
|
| Rate for Payer: Multiplan Commercial |
$77.51
|
|
|
HC SOM PTH RELATED PROTEIN
|
Facility
|
OP
|
$15.62
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900911417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$134.17 |
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.17
|
| Rate for Payer: Blue Shield of California Commercial |
$113.70
|
| Rate for Payer: Blue Shield of California EPN |
$91.20
|
| Rate for Payer: Cash Price |
$15.62
|
| Rate for Payer: Cash Price |
$15.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.67
|
| Rate for Payer: Heritage Provider Network Senior |
$9.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.92
|
| Rate for Payer: Multiplan Commercial |
$11.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.12
|
| Rate for Payer: TriValley Medical Group Senior |
$14.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Vantage Medical Group Senior |
$14.12
|
|
|
HC SOM PTH RELATED PROTEIN
|
Facility
|
IP
|
$15.62
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900911417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$11.71 |
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.06
|
| Rate for Payer: Cash Price |
$15.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.57
|
| Rate for Payer: Heritage Provider Network Senior |
$10.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: Multiplan Commercial |
$11.71
|
|
|
HC SOM PWDNA 81331
|
Facility
|
OP
|
$561.17
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
900914888
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$51.07 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Adventist Health Commercial |
$112.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$346.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$382.57
|
| Rate for Payer: Blue Shield of California Commercial |
$342.31
|
| Rate for Payer: Blue Shield of California EPN |
$273.85
|
| Rate for Payer: Cash Price |
$561.17
|
| Rate for Payer: Cash Price |
$561.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$364.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$347.36
|
| Rate for Payer: Heritage Provider Network Senior |
$347.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$267.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$101.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.43
|
| Rate for Payer: Multiplan Commercial |
$420.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.07
|
| Rate for Payer: TriValley Medical Group Senior |
$51.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.18
|
| Rate for Payer: Vantage Medical Group Senior |
$51.07
|
|
|
HC SOM PWDNA 81331
|
Facility
|
IP
|
$561.17
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
900914888
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$101.57 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Adventist Health Commercial |
$112.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$361.39
|
| Rate for Payer: Cash Price |
$561.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$379.91
|
| Rate for Payer: Heritage Provider Network Senior |
$379.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$101.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.29
|
| Rate for Payer: Multiplan Commercial |
$420.88
|
|
|
HC SOM PYRUVATE KINASE
|
Facility
|
OP
|
$64.76
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
900911491
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$89.55 |
| Rate for Payer: Adventist Health Commercial |
$12.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.55
|
| Rate for Payer: Blue Shield of California Commercial |
$75.92
|
| Rate for Payer: Blue Shield of California EPN |
$60.89
|
| Rate for Payer: Cash Price |
$64.76
|
| Rate for Payer: Cash Price |
$64.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.21
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.09
|
| Rate for Payer: Heritage Provider Network Senior |
$40.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$30.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.65
|
| Rate for Payer: Multiplan Commercial |
$48.57
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.44
|
| Rate for Payer: TriValley Medical Group Senior |
$9.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.38
|
| Rate for Payer: Vantage Medical Group Senior |
$9.44
|
|
|
HC SOM PYRUVATE KINASE
|
Facility
|
IP
|
$64.76
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
900911491
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$48.57 |
| Rate for Payer: Adventist Health Commercial |
$12.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.71
|
| Rate for Payer: Cash Price |
$64.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.84
|
| Rate for Payer: Heritage Provider Network Senior |
$43.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.19
|
| Rate for Payer: Multiplan Commercial |
$48.57
|
|
|
HC SOM Q FEVER AB SCREEN
|
Facility
|
IP
|
$40.10
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900915440
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$30.07 |
| Rate for Payer: Adventist Health Commercial |
$8.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.82
|
| Rate for Payer: Cash Price |
$40.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.15
|
| Rate for Payer: Heritage Provider Network Senior |
$27.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.03
|
| Rate for Payer: Multiplan Commercial |
$30.07
|
|
|
HC SOM Q FEVER AB SCREEN
|
Facility
|
OP
|
$40.10
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900915440
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$119.85 |
| Rate for Payer: Adventist Health Commercial |
$8.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.85
|
| Rate for Payer: Blue Shield of California Commercial |
$97.57
|
| Rate for Payer: Blue Shield of California EPN |
$78.26
|
| Rate for Payer: Cash Price |
$40.10
|
| Rate for Payer: Cash Price |
$40.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.07
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.82
|
| Rate for Payer: Heritage Provider Network Senior |
$24.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.24
|
| Rate for Payer: Multiplan Commercial |
$30.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.12
|
| Rate for Payer: TriValley Medical Group Senior |
$12.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.12
|
|
|
HC SOM Q FEVER IGG PHAS I
|
Facility
|
IP
|
$16.26
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$12.20 |
| Rate for Payer: Adventist Health Commercial |
$3.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.47
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.01
|
| Rate for Payer: Heritage Provider Network Senior |
$11.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.07
|
| Rate for Payer: Multiplan Commercial |
$12.20
|
|
|
HC SOM Q FEVER IGG PHAS I
|
Facility
|
OP
|
$16.26
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$119.85 |
| Rate for Payer: Adventist Health Commercial |
$3.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.85
|
| Rate for Payer: Blue Shield of California Commercial |
$97.57
|
| Rate for Payer: Blue Shield of California EPN |
$78.26
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.06
|
| Rate for Payer: Heritage Provider Network Senior |
$10.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.24
|
| Rate for Payer: Multiplan Commercial |
$12.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.12
|
| Rate for Payer: TriValley Medical Group Senior |
$12.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.12
|
|
|
HC SOM Q FEVER IGG PHAS II
|
Facility
|
OP
|
$16.26
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914334
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$119.85 |
| Rate for Payer: Adventist Health Commercial |
$3.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.85
|
| Rate for Payer: Blue Shield of California Commercial |
$97.57
|
| Rate for Payer: Blue Shield of California EPN |
$78.26
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.06
|
| Rate for Payer: Heritage Provider Network Senior |
$10.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.24
|
| Rate for Payer: Multiplan Commercial |
$12.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.12
|
| Rate for Payer: TriValley Medical Group Senior |
$12.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.12
|
|
|
HC SOM Q FEVER IGG PHAS II
|
Facility
|
IP
|
$16.26
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914334
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$12.20 |
| Rate for Payer: Adventist Health Commercial |
$3.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.47
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.01
|
| Rate for Payer: Heritage Provider Network Senior |
$11.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.07
|
| Rate for Payer: Multiplan Commercial |
$12.20
|
|
|
HC SOM Q FEVER IGM PHAS I
|
Facility
|
IP
|
$16.26
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$12.20 |
| Rate for Payer: Adventist Health Commercial |
$3.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.47
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.01
|
| Rate for Payer: Heritage Provider Network Senior |
$11.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.07
|
| Rate for Payer: Multiplan Commercial |
$12.20
|
|
|
HC SOM Q FEVER IGM PHAS I
|
Facility
|
OP
|
$16.26
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$119.85 |
| Rate for Payer: Adventist Health Commercial |
$3.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.85
|
| Rate for Payer: Blue Shield of California Commercial |
$97.57
|
| Rate for Payer: Blue Shield of California EPN |
$78.26
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.06
|
| Rate for Payer: Heritage Provider Network Senior |
$10.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.24
|
| Rate for Payer: Multiplan Commercial |
$12.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.12
|
| Rate for Payer: TriValley Medical Group Senior |
$12.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.12
|
|
|
HC SOM Q FEVER IGM PHAS II
|
Facility
|
IP
|
$16.26
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$12.20 |
| Rate for Payer: Adventist Health Commercial |
$3.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.47
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.01
|
| Rate for Payer: Heritage Provider Network Senior |
$11.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.07
|
| Rate for Payer: Multiplan Commercial |
$12.20
|
|
|
HC SOM Q FEVER IGM PHAS II
|
Facility
|
OP
|
$16.26
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$119.85 |
| Rate for Payer: Adventist Health Commercial |
$3.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.85
|
| Rate for Payer: Blue Shield of California Commercial |
$97.57
|
| Rate for Payer: Blue Shield of California EPN |
$78.26
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.06
|
| Rate for Payer: Heritage Provider Network Senior |
$10.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.24
|
| Rate for Payer: Multiplan Commercial |
$12.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.12
|
| Rate for Payer: TriValley Medical Group Senior |
$12.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.12
|
|
|
HC SOM QUANTIFERON TB GOLD
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
900912882
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.32
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.31
|
| Rate for Payer: Heritage Provider Network Senior |
$20.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
|
