|
HC SOM QUANTIFERON TB GOLD
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
900912882
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$575.62 |
| Rate for Payer: EPIC Health Plan Commercial |
$17.70
|
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$575.62
|
| Rate for Payer: Blue Shield of California Commercial |
$498.76
|
| Rate for Payer: Blue Shield of California EPN |
$400.05
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.98
|
| Rate for Payer: EPIC Health Plan Medicare |
$61.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.57
|
| Rate for Payer: Heritage Provider Network Senior |
$18.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$61.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$83.05
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$61.98
|
| Rate for Payer: TriValley Medical Group Senior |
$61.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$66.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.18
|
| Rate for Payer: Vantage Medical Group Senior |
$61.98
|
|
|
HC SOM RENIN ACT PLASMA
|
Facility
|
OP
|
$13.72
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
900910955
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$208.83 |
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$208.83
|
| Rate for Payer: Blue Shield of California Commercial |
$177.00
|
| Rate for Payer: Blue Shield of California EPN |
$141.97
|
| Rate for Payer: Cash Price |
$13.72
|
| Rate for Payer: Cash Price |
$13.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.49
|
| Rate for Payer: Heritage Provider Network Senior |
$8.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.47
|
| Rate for Payer: Multiplan Commercial |
$10.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.99
|
| Rate for Payer: TriValley Medical Group Senior |
$21.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.19
|
| Rate for Payer: Vantage Medical Group Senior |
$21.99
|
|
|
HC SOM RENIN ACT PLASMA
|
Facility
|
IP
|
$13.72
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
900910955
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$10.29 |
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.84
|
| Rate for Payer: Cash Price |
$13.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.29
|
| Rate for Payer: Heritage Provider Network Senior |
$9.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.43
|
| Rate for Payer: Multiplan Commercial |
$10.29
|
|
|
HC SOM REPTILASE TIME
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 85635
|
| Hospital Charge Code |
900910114
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$93.52 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.52
|
| Rate for Payer: Blue Shield of California Commercial |
$79.26
|
| Rate for Payer: Blue Shield of California EPN |
$63.57
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.76
|
| Rate for Payer: Heritage Provider Network Senior |
$24.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.85
|
| Rate for Payer: TriValley Medical Group Senior |
$9.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.84
|
| Rate for Payer: Vantage Medical Group Senior |
$9.85
|
|
|
HC SOM REPTILASE TIME
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 85635
|
| Hospital Charge Code |
900910114
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.76
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.08
|
| Rate for Payer: Heritage Provider Network Senior |
$27.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
|
|
HC SOM RESPIRATORY PANEL VARIES
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
900915466
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.68 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$180.32
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$189.56
|
| Rate for Payer: Heritage Provider Network Senior |
$189.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
|
|
HC SOM RESPIRATORY PANEL VARIES
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
900915466
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.68 |
| Max. Negotiated Rate |
$3,299.96 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$173.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,132.56
|
| Rate for Payer: Blue Shield of California Commercial |
$3,299.96
|
| Rate for Payer: Blue Shield of California EPN |
$2,646.84
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$182.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$416.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$416.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$173.32
|
| Rate for Payer: Heritage Provider Network Senior |
$173.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$416.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$133.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$479.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$558.49
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$416.78
|
| Rate for Payer: TriValley Medical Group Senior |
$416.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$450.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$450.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
|
|
HC SOM RIBOSOMAL P AB
|
Facility
|
IP
|
$44.68
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911367
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$33.51 |
| Rate for Payer: Adventist Health Commercial |
$8.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.77
|
| Rate for Payer: Cash Price |
$44.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.25
|
| Rate for Payer: Heritage Provider Network Senior |
$30.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.17
|
| Rate for Payer: Multiplan Commercial |
$33.51
|
|
|
HC SOM RIBOSOMAL P AB
|
Facility
|
OP
|
$44.68
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911367
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$222.13 |
| Rate for Payer: Adventist Health Commercial |
$8.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.61
|
| 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 |
$44.68
|
| Rate for Payer: Cash Price |
$44.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.04
|
| 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 |
$26.36
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.66
|
| Rate for Payer: Heritage Provider Network Senior |
$27.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$33.51
|
| 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 RISPERIDONE
|
Facility
|
IP
|
$85.96
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
900910787
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$64.47 |
| Rate for Payer: Adventist Health Commercial |
$17.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.36
|
| Rate for Payer: Cash Price |
$85.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.19
|
| Rate for Payer: Heritage Provider Network Senior |
$58.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.49
|
| Rate for Payer: Multiplan Commercial |
$64.47
|
|
|
HC SOM RISPERIDONE
|
Facility
|
OP
|
$85.96
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
900910787
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$141.84 |
| Rate for Payer: Adventist Health Commercial |
$17.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.84
|
| Rate for Payer: Cash Price |
$85.96
|
| Rate for Payer: Cash Price |
$85.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.21
|
| Rate for Payer: Heritage Provider Network Senior |
$53.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$41.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$60.17
|
| Rate for Payer: Multiplan Commercial |
$64.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$42.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$42.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.07
|
| Rate for Payer: Vantage Medical Group Senior |
$73.07
|
|
|
HC SOM RISTOCETIN-WILLEBRAND FACTOR
|
Facility
|
OP
|
$40.30
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
900911282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.29 |
| Max. Negotiated Rate |
$217.85 |
| Rate for Payer: Adventist Health Commercial |
$8.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.85
|
| Rate for Payer: Blue Shield of California Commercial |
$184.67
|
| Rate for Payer: Blue Shield of California EPN |
$148.12
|
| Rate for Payer: Cash Price |
$40.30
|
| Rate for Payer: Cash Price |
$40.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.95
|
| Rate for Payer: Heritage Provider Network Senior |
$24.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30.74
|
| Rate for Payer: Multiplan Commercial |
$30.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.94
|
| Rate for Payer: TriValley Medical Group Senior |
$22.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: Vantage Medical Group Senior |
$22.94
|
|
|
HC SOM RISTOCETIN-WILLEBRAND FACTOR
|
Facility
|
IP
|
$40.30
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
900911282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.29 |
| Max. Negotiated Rate |
$30.23 |
| Rate for Payer: Adventist Health Commercial |
$8.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.95
|
| Rate for Payer: Cash Price |
$40.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.28
|
| Rate for Payer: Heritage Provider Network Senior |
$27.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.07
|
| Rate for Payer: Multiplan Commercial |
$30.23
|
|
|
HC SOM SACCHAROMY CEREVI AB, IGA
|
Facility
|
OP
|
$169.30
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
900913805
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$126.97 |
| Rate for Payer: Adventist Health Commercial |
$33.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$104.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.35
|
| Rate for Payer: Blue Shield of California Commercial |
$98.67
|
| Rate for Payer: Blue Shield of California EPN |
$79.14
|
| Rate for Payer: Cash Price |
$169.30
|
| Rate for Payer: Cash Price |
$169.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$110.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.89
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$104.80
|
| Rate for Payer: Heritage Provider Network Senior |
$104.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$80.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.41
|
| Rate for Payer: Multiplan Commercial |
$126.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.25
|
| Rate for Payer: TriValley Medical Group Senior |
$12.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.47
|
| Rate for Payer: Vantage Medical Group Senior |
$12.25
|
|
|
HC SOM SACCHAROMY CEREVI AB, IGA
|
Facility
|
IP
|
$169.30
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
900913805
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.64 |
| Max. Negotiated Rate |
$126.97 |
| Rate for Payer: Adventist Health Commercial |
$33.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$109.03
|
| Rate for Payer: Cash Price |
$169.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.62
|
| Rate for Payer: Heritage Provider Network Senior |
$114.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.33
|
| Rate for Payer: Multiplan Commercial |
$126.97
|
|
|
HC SOM SACCHAROMY CEREVI AB, IGA
|
Facility
|
OP
|
$18.54
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
900913806
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$122.35 |
| Rate for Payer: Adventist Health Commercial |
$3.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.35
|
| Rate for Payer: Blue Shield of California Commercial |
$98.67
|
| Rate for Payer: Blue Shield of California EPN |
$79.14
|
| Rate for Payer: Cash Price |
$18.54
|
| Rate for Payer: Cash Price |
$18.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.48
|
| Rate for Payer: Heritage Provider Network Senior |
$11.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.41
|
| Rate for Payer: Multiplan Commercial |
$13.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.25
|
| Rate for Payer: TriValley Medical Group Senior |
$12.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.47
|
| Rate for Payer: Vantage Medical Group Senior |
$12.25
|
|
|
HC SOM SACCHAROMY CEREVI AB, IGA
|
Facility
|
IP
|
$18.54
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
900913806
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$13.90 |
| Rate for Payer: Adventist Health Commercial |
$3.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.94
|
| Rate for Payer: Cash Price |
$18.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.55
|
| Rate for Payer: Heritage Provider Network Senior |
$12.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.63
|
| Rate for Payer: Multiplan Commercial |
$13.90
|
|
|
HC SOM SAL 86606
|
Facility
|
OP
|
$21.57
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
900914751
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$142.93 |
| Rate for Payer: Adventist Health Commercial |
$4.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.93
|
| Rate for Payer: Blue Shield of California Commercial |
$121.13
|
| Rate for Payer: Blue Shield of California EPN |
$97.16
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.73
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.35
|
| Rate for Payer: Heritage Provider Network Senior |
$13.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.17
|
| Rate for Payer: Multiplan Commercial |
$16.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.05
|
| Rate for Payer: TriValley Medical Group Senior |
$15.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
HC SOM SAL 86606
|
Facility
|
IP
|
$21.57
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
900914751
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Adventist Health Commercial |
$4.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.89
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.60
|
| Rate for Payer: Heritage Provider Network Senior |
$14.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$16.18
|
|
|
HC SOM SAL 86671A
|
Facility
|
OP
|
$17.55
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
900914749
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$122.35 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.35
|
| Rate for Payer: Blue Shield of California Commercial |
$98.67
|
| Rate for Payer: Blue Shield of California EPN |
$79.14
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.86
|
| Rate for Payer: Heritage Provider Network Senior |
$10.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.41
|
| Rate for Payer: Multiplan Commercial |
$13.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.25
|
| Rate for Payer: TriValley Medical Group Senior |
$12.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.47
|
| Rate for Payer: Vantage Medical Group Senior |
$12.25
|
|
|
HC SOM SAL 86671A
|
Facility
|
IP
|
$17.55
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
900914749
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$13.16 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.30
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.88
|
| Rate for Payer: Heritage Provider Network Senior |
$11.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.39
|
| Rate for Payer: Multiplan Commercial |
$13.16
|
|
|
HC SOM SAL 86671B
|
Facility
|
IP
|
$17.56
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
900914750
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$13.17 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.31
|
| Rate for Payer: Cash Price |
$17.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.89
|
| Rate for Payer: Heritage Provider Network Senior |
$11.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.39
|
| Rate for Payer: Multiplan Commercial |
$13.17
|
|
|
HC SOM SAL 86671B
|
Facility
|
OP
|
$17.56
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
900914750
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$122.35 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.35
|
| Rate for Payer: Blue Shield of California Commercial |
$98.67
|
| Rate for Payer: Blue Shield of California EPN |
$79.14
|
| Rate for Payer: Cash Price |
$17.56
|
| Rate for Payer: Cash Price |
$17.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.36
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.87
|
| Rate for Payer: Heritage Provider Network Senior |
$10.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.41
|
| Rate for Payer: Multiplan Commercial |
$13.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.25
|
| Rate for Payer: TriValley Medical Group Senior |
$12.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.47
|
| Rate for Payer: Vantage Medical Group Senior |
$12.25
|
|
|
HC SOM SARS-COV-2 IGG
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
900915349
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.69
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.11
|
| Rate for Payer: Heritage Provider Network Senior |
$29.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.75
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
|
|
HC SOM SARS-COV-2 IGG
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
900915349
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$281.26 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$281.26
|
| Rate for Payer: Blue Shield of California Commercial |
$26.23
|
| Rate for Payer: Blue Shield of California EPN |
$20.98
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.37
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.62
|
| Rate for Payer: Heritage Provider Network Senior |
$26.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$56.45
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.13
|
| Rate for Payer: TriValley Medical Group Senior |
$42.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$45.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$45.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.34
|
| Rate for Payer: Vantage Medical Group Senior |
$42.13
|
|
