|
HC SOM TOXOCARA AB
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911594
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$124.65 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.14
|
| 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 |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.80
|
| 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 |
$30.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.19
|
| Rate for Payer: Heritage Provider Network Senior |
$32.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$24.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.43
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| 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 TOXOCARA AB
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911594
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.49
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.20
|
| Rate for Payer: Heritage Provider Network Senior |
$35.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
|
|
HC SOM TOXOPLASMA AB CSF IGG
|
Facility
|
IP
|
$87.36
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
900911346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.81 |
| Max. Negotiated Rate |
$65.52 |
| Rate for Payer: Adventist Health Commercial |
$17.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.26
|
| Rate for Payer: Cash Price |
$87.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.14
|
| Rate for Payer: Heritage Provider Network Senior |
$59.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.84
|
| Rate for Payer: Multiplan Commercial |
$65.52
|
|
|
HC SOM TOXOPLASMA AB CSF IGG
|
Facility
|
OP
|
$87.36
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
900911346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$136.22 |
| Rate for Payer: Adventist Health Commercial |
$17.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.22
|
| Rate for Payer: Blue Shield of California Commercial |
$115.83
|
| Rate for Payer: Blue Shield of California EPN |
$92.91
|
| Rate for Payer: Cash Price |
$87.36
|
| Rate for Payer: Cash Price |
$87.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$56.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.54
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.08
|
| Rate for Payer: Heritage Provider Network Senior |
$54.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$41.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$65.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.39
|
| Rate for Payer: TriValley Medical Group Senior |
$14.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC SOM TOXOPLASMA AB CSF IGM
|
Facility
|
OP
|
$87.49
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
900914413
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$141.40 |
| Rate for Payer: Adventist Health Commercial |
$17.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.40
|
| Rate for Payer: Blue Shield of California Commercial |
$115.89
|
| Rate for Payer: Blue Shield of California EPN |
$92.95
|
| Rate for Payer: Cash Price |
$87.49
|
| Rate for Payer: Cash Price |
$87.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$56.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.16
|
| Rate for Payer: Heritage Provider Network Senior |
$54.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$41.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.31
|
| Rate for Payer: Multiplan Commercial |
$65.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.41
|
| Rate for Payer: TriValley Medical Group Senior |
$14.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
|
|
HC SOM TOXOPLASMA AB CSF IGM
|
Facility
|
IP
|
$87.49
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
900914413
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.84 |
| Max. Negotiated Rate |
$65.62 |
| Rate for Payer: Adventist Health Commercial |
$17.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.34
|
| Rate for Payer: Cash Price |
$87.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.23
|
| Rate for Payer: Heritage Provider Network Senior |
$59.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.87
|
| Rate for Payer: Multiplan Commercial |
$65.62
|
|
|
HC SOM TOXOPLASMA GONDII BY PCR
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915378
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.42
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.19
|
| Rate for Payer: Heritage Provider Network Senior |
$58.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM TOXOPLASMA GONDII BY PCR
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915378
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.54
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.64
|
| Rate for Payer: Heritage Provider Network Senior |
$63.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
|
|
HC SOM TPMT
|
Facility
|
IP
|
$25.86
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900914732
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$19.39 |
| Rate for Payer: Adventist Health Commercial |
$5.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.65
|
| Rate for Payer: Cash Price |
$25.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.51
|
| Rate for Payer: Heritage Provider Network Senior |
$17.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.46
|
| Rate for Payer: Multiplan Commercial |
$19.39
|
|
|
HC SOM TPMT
|
Facility
|
OP
|
$25.86
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900914732
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$170.74 |
| Rate for Payer: Adventist Health Commercial |
$5.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.17
|
| 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 |
$25.86
|
| Rate for Payer: Cash Price |
$25.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.01
|
| Rate for Payer: Heritage Provider Network Senior |
$16.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.71
|
| Rate for Payer: Multiplan Commercial |
$19.39
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.17
|
| Rate for Payer: TriValley Medical Group Senior |
$22.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22.17
|
|
|
HC SOM TPMT ACTIVITY PROFILE
|
Facility
|
OP
|
$155.25
|
|
|
Service Code
|
CPT 84433
|
| Hospital Charge Code |
900915441
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.17 |
| Max. Negotiated Rate |
$132.89 |
| Rate for Payer: Adventist Health Commercial |
$31.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$95.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.89
|
| Rate for Payer: Blue Shield of California Commercial |
$127.70
|
| Rate for Payer: Blue Shield of California EPN |
$102.43
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$100.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.91
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.10
|
| Rate for Payer: Heritage Provider Network Senior |
$96.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$74.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.71
|
| Rate for Payer: Multiplan Commercial |
$116.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.17
|
| Rate for Payer: TriValley Medical Group Senior |
$22.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22.17
|
|
|
HC SOM TPMT ACTIVITY PROFILE
|
Facility
|
IP
|
$155.25
|
|
|
Service Code
|
CPT 84433
|
| Hospital Charge Code |
900915441
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.10 |
| Max. Negotiated Rate |
$116.44 |
| Rate for Payer: Adventist Health Commercial |
$31.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$99.98
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.10
|
| Rate for Payer: Heritage Provider Network Senior |
$105.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.81
|
| Rate for Payer: Multiplan Commercial |
$116.44
|
|
|
HC SOM TPPA 86780
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
900914807
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.66
|
| Rate for Payer: Heritage Provider Network Senior |
$21.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
|
|
HC SOM TPPA 86780
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
900914807
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$164.73 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.73
|
| Rate for Payer: Blue Shield of California Commercial |
$109.27
|
| Rate for Payer: Blue Shield of California EPN |
$87.64
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.81
|
| Rate for Payer: Heritage Provider Network Senior |
$19.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$15.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.24
|
| Rate for Payer: TriValley Medical Group Senior |
$13.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC SOM TPPTL 82657
|
Facility
|
OP
|
$25.86
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900914893
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$170.74 |
| Rate for Payer: Adventist Health Commercial |
$5.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.17
|
| 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 |
$25.86
|
| Rate for Payer: Cash Price |
$25.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.26
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.01
|
| Rate for Payer: Heritage Provider Network Senior |
$16.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.71
|
| Rate for Payer: Multiplan Commercial |
$19.39
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.17
|
| Rate for Payer: TriValley Medical Group Senior |
$22.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22.17
|
|
|
HC SOM TPPTL 82657
|
Facility
|
IP
|
$25.86
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900914893
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$19.39 |
| Rate for Payer: Adventist Health Commercial |
$5.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.65
|
| Rate for Payer: Cash Price |
$25.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.51
|
| Rate for Payer: Heritage Provider Network Senior |
$17.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.46
|
| Rate for Payer: Multiplan Commercial |
$19.39
|
|
|
HC SOM TRAM 83925
|
Facility
|
IP
|
$41.20
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
900915271
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$30.90 |
| Rate for Payer: Adventist Health Commercial |
$8.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.53
|
| Rate for Payer: Cash Price |
$41.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.89
|
| Rate for Payer: Heritage Provider Network Senior |
$27.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.30
|
| Rate for Payer: Multiplan Commercial |
$30.90
|
|
|
HC SOM TRAM 83925
|
Facility
|
OP
|
$41.20
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
900915271
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$177.19 |
| Rate for Payer: Adventist Health Commercial |
$8.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.19
|
| Rate for Payer: Cash Price |
$41.20
|
| Rate for Payer: Cash Price |
$41.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.50
|
| Rate for Payer: Heritage Provider Network Senior |
$25.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.84
|
| Rate for Payer: Multiplan Commercial |
$30.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.02
|
| Rate for Payer: Vantage Medical Group Senior |
$35.02
|
|
|
HC SOM TRANSGLUTAMINASE AB IGG
|
Facility
|
IP
|
$13.50
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
900912640
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$10.12 |
| Rate for Payer: Adventist Health Commercial |
$2.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.69
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.14
|
| Rate for Payer: Heritage Provider Network Senior |
$9.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.38
|
| Rate for Payer: Multiplan Commercial |
$10.12
|
|
|
HC SOM TRANSGLUTAMINASE AB IGG
|
Facility
|
OP
|
$13.50
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
900912640
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$66.41 |
| Rate for Payer: Adventist Health Commercial |
$2.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.34
|
| 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 |
$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 |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.78
|
| 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 |
$7.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.36
|
| Rate for Payer: Heritage Provider Network Senior |
$8.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$10.12
|
| 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 TREE4 86003
|
Facility
|
IP
|
$61.13
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914815
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$45.85 |
| Rate for Payer: Adventist Health Commercial |
$12.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.37
|
| Rate for Payer: Cash Price |
$61.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.39
|
| Rate for Payer: Heritage Provider Network Senior |
$41.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.28
|
| Rate for Payer: Multiplan Commercial |
$45.85
|
|
|
HC SOM TREE4 86003
|
Facility
|
OP
|
$61.13
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914815
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$150.09 |
| Rate for Payer: Adventist Health Commercial |
$12.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.09
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$61.13
|
| Rate for Payer: Cash Price |
$61.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.07
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.84
|
| Rate for Payer: Heritage Provider Network Senior |
$37.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$29.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$45.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SOM TRSF 84466
|
Facility
|
OP
|
$27.28
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
900914761
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Adventist Health Commercial |
$5.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.78
|
| Rate for Payer: Blue Shield of California Commercial |
$102.76
|
| Rate for Payer: Blue Shield of California EPN |
$82.42
|
| Rate for Payer: Cash Price |
$27.28
|
| Rate for Payer: Cash Price |
$27.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.89
|
| Rate for Payer: Heritage Provider Network Senior |
$16.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.10
|
| Rate for Payer: Multiplan Commercial |
$20.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.76
|
| Rate for Payer: TriValley Medical Group Senior |
$12.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.04
|
| Rate for Payer: Vantage Medical Group Senior |
$12.76
|
|
|
HC SOM TRSF 84466
|
Facility
|
IP
|
$27.28
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
900914761
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$20.46 |
| Rate for Payer: Adventist Health Commercial |
$5.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.57
|
| Rate for Payer: Cash Price |
$27.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.47
|
| Rate for Payer: Heritage Provider Network Senior |
$18.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.82
|
| Rate for Payer: Multiplan Commercial |
$20.46
|
|
|
HC SOM TRYPTASE
|
Facility
|
OP
|
$37.70
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910734
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$122.92 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.92
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Cash Price |
$37.70
|
| Rate for Payer: Cash Price |
$37.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.24
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.34
|
| Rate for Payer: Heritage Provider Network Senior |
$23.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$28.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.27
|
| Rate for Payer: TriValley Medical Group Senior |
$17.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
