|
HC SOM SCHISTOSOMIASIS AB IGG
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$124.65 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.65
|
| Rate for Payer: Blue Shield of California Commercial |
$104.66
|
| Rate for Payer: Blue Shield of California EPN |
$83.95
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.28
|
| Rate for Payer: Heritage Provider Network Senior |
$35.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$27.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.43
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.01
|
| Rate for Payer: TriValley Medical Group Senior |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13.01
|
|
|
HC SOM SCHISTOSOMIASIS AB IGG
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.71
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.59
|
| Rate for Payer: Heritage Provider Network Senior |
$38.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.25
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
|
|
HC SOM SEBV EBNA
|
Facility
|
OP
|
$7.42
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
900915457
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$147.40 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.40
|
| Rate for Payer: Blue Shield of California Commercial |
$123.15
|
| Rate for Payer: Blue Shield of California EPN |
$98.78
|
| Rate for Payer: Cash Price |
$7.42
|
| Rate for Payer: Cash Price |
$7.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.59
|
| Rate for Payer: Heritage Provider Network Senior |
$4.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.49
|
| Rate for Payer: Multiplan Commercial |
$5.57
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.29
|
| Rate for Payer: TriValley Medical Group Senior |
$15.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.82
|
| Rate for Payer: Vantage Medical Group Senior |
$15.29
|
|
|
HC SOM SEBV EBNA
|
Facility
|
IP
|
$7.42
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
900915457
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$5.57 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.78
|
| Rate for Payer: Cash Price |
$7.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.02
|
| Rate for Payer: Heritage Provider Network Senior |
$5.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.85
|
| Rate for Payer: Multiplan Commercial |
$5.57
|
|
|
HC SOM SEBV IGG
|
Facility
|
IP
|
$8.79
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900915456
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$6.59 |
| Rate for Payer: Adventist Health Commercial |
$1.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.66
|
| Rate for Payer: Cash Price |
$8.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.95
|
| Rate for Payer: Heritage Provider Network Senior |
$5.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$6.59
|
|
|
HC SOM SEBV IGG
|
Facility
|
OP
|
$8.79
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900915456
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$153.09 |
| Rate for Payer: Adventist Health Commercial |
$1.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.09
|
| Rate for Payer: Blue Shield of California Commercial |
$140.26
|
| Rate for Payer: Blue Shield of California EPN |
$112.50
|
| Rate for Payer: Cash Price |
$8.79
|
| Rate for Payer: Cash Price |
$8.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.71
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.44
|
| Rate for Payer: Heritage Provider Network Senior |
$5.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.31
|
| Rate for Payer: Multiplan Commercial |
$6.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.14
|
| Rate for Payer: TriValley Medical Group Senior |
$18.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: Vantage Medical Group Senior |
$18.14
|
|
|
HC SOM SEBV IGM
|
Facility
|
OP
|
$8.79
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900915455
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$153.09 |
| Rate for Payer: Adventist Health Commercial |
$1.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.09
|
| Rate for Payer: Blue Shield of California Commercial |
$140.26
|
| Rate for Payer: Blue Shield of California EPN |
$112.50
|
| Rate for Payer: Cash Price |
$8.79
|
| Rate for Payer: Cash Price |
$8.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.71
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.44
|
| Rate for Payer: Heritage Provider Network Senior |
$5.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.31
|
| Rate for Payer: Multiplan Commercial |
$6.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.14
|
| Rate for Payer: TriValley Medical Group Senior |
$18.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: Vantage Medical Group Senior |
$18.14
|
|
|
HC SOM SEBV IGM
|
Facility
|
IP
|
$8.79
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900915455
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$6.59 |
| Rate for Payer: Adventist Health Commercial |
$1.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.66
|
| Rate for Payer: Cash Price |
$8.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.95
|
| Rate for Payer: Heritage Provider Network Senior |
$5.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$6.59
|
|
|
HC SOM SECOBARBITAL
|
Facility
|
IP
|
$134.40
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910552
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.33 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Adventist Health Commercial |
$26.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.55
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.99
|
| Rate for Payer: Heritage Provider Network Senior |
$90.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
|
|
HC SOM SECOBARBITAL
|
Facility
|
OP
|
$134.40
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910552
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$138.26 |
| Rate for Payer: Adventist Health Commercial |
$26.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.26
|
| Rate for Payer: Blue Shield of California Commercial |
$110.19
|
| Rate for Payer: Blue Shield of California EPN |
$88.38
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.19
|
| Rate for Payer: Heritage Provider Network Senior |
$83.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$64.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.64
|
| Rate for Payer: TriValley Medical Group Senior |
$18.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM SELENIUM URINE
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
900911019
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$242.46 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$242.46
|
| Rate for Payer: Blue Shield of California Commercial |
$205.46
|
| Rate for Payer: Blue Shield of California EPN |
$164.80
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.29
|
| Rate for Payer: Heritage Provider Network Senior |
$9.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.21
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.53
|
| Rate for Payer: TriValley Medical Group Senior |
$25.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.08
|
| Rate for Payer: Vantage Medical Group Senior |
$25.53
|
|
|
HC SOM SELENIUM URINE
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
900911019
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.66
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.15
|
| Rate for Payer: Heritage Provider Network Senior |
$10.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
|
|
HC SOM SEROTONIN BLOOD
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
900911033
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.54
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.70
|
| Rate for Payer: Heritage Provider Network Senior |
$23.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
|
|
HC SOM SEROTONIN BLOOD
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
900911033
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$294.11 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$294.11
|
| Rate for Payer: Blue Shield of California Commercial |
$249.29
|
| Rate for Payer: Blue Shield of California EPN |
$199.95
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$30.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.66
|
| Rate for Payer: Heritage Provider Network Senior |
$21.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41.51
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$30.98
|
| Rate for Payer: TriValley Medical Group Senior |
$30.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$33.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$33.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.08
|
| Rate for Payer: Vantage Medical Group Senior |
$30.98
|
|
|
HC SOM SEROTONIN RELEASE ASSAY
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900915358
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.30
|
| 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 |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$227.50
|
| 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 |
$227.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.65
|
| Rate for Payer: Heritage Provider Network Senior |
$216.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$166.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| 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 SEROTONIN RELEASE ASSAY
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900915358
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$225.40
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.95
|
| Rate for Payer: Heritage Provider Network Senior |
$236.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
|
|
HC SOM SEX HORMN BINDNG GLOBU SER
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
900913804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$206.21 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.21
|
| Rate for Payer: Blue Shield of California Commercial |
$174.87
|
| Rate for Payer: Blue Shield of California EPN |
$140.26
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.05
|
| Rate for Payer: Heritage Provider Network Senior |
$8.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.12
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.73
|
| Rate for Payer: TriValley Medical Group Senior |
$21.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.90
|
| Rate for Payer: Vantage Medical Group Senior |
$21.73
|
|
|
HC SOM SEX HORMN BINDNG GLOBU SER
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
900913804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.37
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.80
|
| Rate for Payer: Heritage Provider Network Senior |
$8.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
|
|
HC SOM SMA CARRIER BY DEL/DUP
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 81329
|
| Hospital Charge Code |
900915323
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.58 |
| Max. Negotiated Rate |
$808.61 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$808.61
|
| Rate for Payer: Blue Shield of California Commercial |
$109.80
|
| Rate for Payer: Blue Shield of California EPN |
$87.84
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$117.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.42
|
| Rate for Payer: Heritage Provider Network Senior |
$111.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$85.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$157.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$183.58
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.00
|
| Rate for Payer: TriValley Medical Group Senior |
$137.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$147.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$147.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.00
|
|
|
HC SOM SMA CARRIER BY DEL/DUP
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 81329
|
| Hospital Charge Code |
900915323
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.58 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$115.92
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.86
|
| Rate for Payer: Heritage Provider Network Senior |
$121.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
|
|
HC SOM SMOOTH MUSCLE AB TITER REFLEX
|
Facility
|
IP
|
$16.93
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
900915437
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$12.70 |
| Rate for Payer: Adventist Health Commercial |
$3.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.90
|
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.46
|
| Rate for Payer: Heritage Provider Network Senior |
$11.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.23
|
| Rate for Payer: Multiplan Commercial |
$12.70
|
|
|
HC SOM SMOOTH MUSCLE AB TITER REFLEX
|
Facility
|
OP
|
$16.93
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
900915437
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$66.41 |
| Rate for Payer: Adventist Health Commercial |
$3.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.46
|
| 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 |
$30.75
|
| Rate for Payer: Blue Shield of California Commercial |
$66.41
|
| Rate for Payer: Blue Shield of California EPN |
$53.27
|
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.00
|
| 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 |
$11.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.48
|
| Rate for Payer: Heritage Provider Network Senior |
$10.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$12.70
|
| 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 |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| 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 SOMATOSTATIN
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 84307
|
| Hospital Charge Code |
900911327
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$153.75 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$132.02
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.78
|
| Rate for Payer: Heritage Provider Network Senior |
$138.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.25
|
| Rate for Payer: Multiplan Commercial |
$153.75
|
|
|
HC SOM SOMATOSTATIN
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 84307
|
| Hospital Charge Code |
900911327
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.28 |
| Max. Negotiated Rate |
$167.99 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.99
|
| Rate for Payer: Blue Shield of California Commercial |
$147.11
|
| Rate for Payer: Blue Shield of California EPN |
$117.99
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$133.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$126.89
|
| Rate for Payer: Heritage Provider Network Senior |
$126.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$97.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$153.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.28
|
| Rate for Payer: TriValley Medical Group Senior |
$18.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.11
|
| Rate for Payer: Vantage Medical Group Senior |
$18.28
|
|
|
HC SOM SOTALOL
|
Facility
|
IP
|
$82.23
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910789
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$61.67 |
| Rate for Payer: Adventist Health Commercial |
$16.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.96
|
| Rate for Payer: Cash Price |
$82.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.67
|
| Rate for Payer: Heritage Provider Network Senior |
$55.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.56
|
| Rate for Payer: Multiplan Commercial |
$61.67
|
|
