|
HC SOM VON WILLEBRAND FACTOR ACTIVITY
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
900912874
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.42
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.23
|
| Rate for Payer: Heritage Provider Network Senior |
$37.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
|
|
HC SOM VON WILLEBRAND FACTOR MULTIMER P
|
Facility
|
OP
|
$51.10
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
900910113
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.25 |
| Max. Negotiated Rate |
$217.85 |
| Rate for Payer: Adventist Health Commercial |
$10.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.58
|
| 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 |
$51.10
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.22
|
| 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 |
$30.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.63
|
| Rate for Payer: Heritage Provider Network Senior |
$31.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$24.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30.74
|
| Rate for Payer: Multiplan Commercial |
$38.33
|
| 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 VON WILLEBRAND FACTOR MULTIMER P
|
Facility
|
IP
|
$51.10
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
900910113
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.25 |
| Max. Negotiated Rate |
$38.33 |
| Rate for Payer: Adventist Health Commercial |
$10.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.91
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.59
|
| Rate for Payer: Heritage Provider Network Senior |
$34.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.78
|
| Rate for Payer: Multiplan Commercial |
$38.33
|
|
|
HC SOM VORICONAZOLE LEVEL
|
Facility
|
OP
|
$27.11
|
|
|
Service Code
|
CPT 80285
|
| Hospital Charge Code |
900912707
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$156.15 |
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.22
|
| Rate for Payer: Blue Shield of California Commercial |
$156.15
|
| Rate for Payer: Blue Shield of California EPN |
$125.25
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.99
|
| Rate for Payer: EPIC Health Plan Medicare |
$27.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.78
|
| Rate for Payer: Heritage Provider Network Senior |
$16.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36.33
|
| Rate for Payer: Multiplan Commercial |
$20.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.11
|
| Rate for Payer: TriValley Medical Group Senior |
$27.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Vantage Medical Group Senior |
$27.11
|
|
|
HC SOM VORICONAZOLE LEVEL
|
Facility
|
IP
|
$27.11
|
|
|
Service Code
|
CPT 80285
|
| Hospital Charge Code |
900912707
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$20.33 |
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.46
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.35
|
| Rate for Payer: Heritage Provider Network Senior |
$18.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.78
|
| Rate for Payer: Multiplan Commercial |
$20.33
|
|
|
HC SOM VPHIV 87900
|
Facility
|
IP
|
$174.30
|
|
|
Service Code
|
CPT 87900
|
| Hospital Charge Code |
900914741
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$31.55 |
| Max. Negotiated Rate |
$130.72 |
| Rate for Payer: Adventist Health Commercial |
$34.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$112.25
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.00
|
| Rate for Payer: Heritage Provider Network Senior |
$118.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.58
|
| Rate for Payer: Multiplan Commercial |
$130.72
|
|
|
HC SOM VPHIV 87900
|
Facility
|
OP
|
$174.30
|
|
|
Service Code
|
CPT 87900
|
| Hospital Charge Code |
900914741
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$31.55 |
| Max. Negotiated Rate |
$1,210.62 |
| Rate for Payer: Adventist Health Commercial |
$34.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$107.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$130.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,210.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1,048.95
|
| Rate for Payer: Blue Shield of California EPN |
$841.35
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$113.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$130.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.89
|
| Rate for Payer: Heritage Provider Network Senior |
$107.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$130.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$83.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$149.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$174.67
|
| Rate for Payer: Multiplan Commercial |
$130.72
|
| Rate for Payer: TriValley Medical Group Commercial |
$130.35
|
| Rate for Payer: TriValley Medical Group Senior |
$130.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$140.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$140.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.38
|
| Rate for Payer: Vantage Medical Group Senior |
$130.35
|
|
|
HC SOM WESTERN EQUINE ENCEPH AB IGG
|
Facility
|
OP
|
$28.17
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
900911337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$5.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$106.16
|
| Rate for Payer: Blue Shield of California EPN |
$85.15
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.44
|
| Rate for Payer: Heritage Provider Network Senior |
$17.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$21.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.19
|
| Rate for Payer: TriValley Medical Group Senior |
$13.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC SOM WESTERN EQUINE ENCEPH AB IGG
|
Facility
|
IP
|
$28.17
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
900911337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$21.13 |
| Rate for Payer: Adventist Health Commercial |
$5.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.14
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.07
|
| Rate for Payer: Heritage Provider Network Senior |
$19.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.04
|
| Rate for Payer: Multiplan Commercial |
$21.13
|
|
|
HC SOM WESTERN EQUINE ENCEPH AB IGM
|
Facility
|
OP
|
$28.17
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
900912651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$5.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$106.16
|
| Rate for Payer: Blue Shield of California EPN |
$85.15
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.44
|
| Rate for Payer: Heritage Provider Network Senior |
$17.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$21.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.19
|
| Rate for Payer: TriValley Medical Group Senior |
$13.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC SOM WESTERN EQUINE ENCEPH AB IGM
|
Facility
|
IP
|
$28.17
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
900912651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$21.13 |
| Rate for Payer: Adventist Health Commercial |
$5.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.14
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.07
|
| Rate for Payer: Heritage Provider Network Senior |
$19.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.04
|
| Rate for Payer: Multiplan Commercial |
$21.13
|
|
|
HC SOM WEST NILE VIRUS AB
|
Facility
|
IP
|
$18.38
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
900912544
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$13.79 |
| Rate for Payer: Adventist Health Commercial |
$3.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.84
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.44
|
| Rate for Payer: Heritage Provider Network Senior |
$12.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.59
|
| Rate for Payer: Multiplan Commercial |
$13.79
|
|
|
HC SOM WEST NILE VIRUS AB
|
Facility
|
OP
|
$18.38
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
900912544
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Adventist Health Commercial |
$3.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.48
|
| Rate for Payer: Blue Shield of California Commercial |
$135.59
|
| Rate for Payer: Blue Shield of California EPN |
$108.75
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.84
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.38
|
| Rate for Payer: Heritage Provider Network Senior |
$11.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.58
|
| Rate for Payer: Multiplan Commercial |
$13.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.85
|
| Rate for Payer: TriValley Medical Group Senior |
$16.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Vantage Medical Group Senior |
$16.85
|
|
|
HC SOM WEST NILE VIRUS AB IGG CSF
|
Facility
|
OP
|
$18.38
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
900912603
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$133.66 |
| Rate for Payer: Adventist Health Commercial |
$3.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.36
|
| 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 |
$133.66
|
| 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 |
$18.38
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.95
|
| 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 |
$10.84
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.38
|
| Rate for Payer: Heritage Provider Network Senior |
$11.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$13.79
|
| 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 WEST NILE VIRUS AB IGG CSF
|
Facility
|
IP
|
$18.38
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
900912603
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$13.79 |
| Rate for Payer: Adventist Health Commercial |
$3.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.84
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.44
|
| Rate for Payer: Heritage Provider Network Senior |
$12.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.59
|
| Rate for Payer: Multiplan Commercial |
$13.79
|
|
|
HC SOM WEST NILE VIRUS AB IGM
|
Facility
|
IP
|
$21.52
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
900912602
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$16.14 |
| Rate for Payer: Adventist Health Commercial |
$4.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.86
|
| Rate for Payer: Cash Price |
$21.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.57
|
| Rate for Payer: Heritage Provider Network Senior |
$14.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.38
|
| Rate for Payer: Multiplan Commercial |
$16.14
|
|
|
HC SOM WEST NILE VIRUS AB IGM
|
Facility
|
OP
|
$21.52
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
900912602
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$133.66 |
| Rate for Payer: Adventist Health Commercial |
$4.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.30
|
| 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 |
$133.66
|
| 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 |
$21.52
|
| Rate for Payer: Cash Price |
$21.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.99
|
| 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 |
$12.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.32
|
| Rate for Payer: Heritage Provider Network Senior |
$13.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$16.14
|
| 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 WEST NILE VIRUS AB IGM CSF
|
Facility
|
IP
|
$21.52
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
900912164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$16.14 |
| Rate for Payer: Adventist Health Commercial |
$4.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.86
|
| Rate for Payer: Cash Price |
$21.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.57
|
| Rate for Payer: Heritage Provider Network Senior |
$14.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.38
|
| Rate for Payer: Multiplan Commercial |
$16.14
|
|
|
HC SOM WEST NILE VIRUS AB IGM CSF
|
Facility
|
OP
|
$21.52
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
900912164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Adventist Health Commercial |
$4.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.48
|
| Rate for Payer: Blue Shield of California Commercial |
$135.59
|
| Rate for Payer: Blue Shield of California EPN |
$108.75
|
| Rate for Payer: Cash Price |
$21.52
|
| Rate for Payer: Cash Price |
$21.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.32
|
| Rate for Payer: Heritage Provider Network Senior |
$13.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.58
|
| Rate for Payer: Multiplan Commercial |
$16.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.85
|
| Rate for Payer: TriValley Medical Group Senior |
$16.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Vantage Medical Group Senior |
$16.85
|
|
|
HC SOM WEST NILE VIRUS PCR
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912543
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.25
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$62.28
|
| Rate for Payer: Heritage Provider Network Senior |
$62.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
|
|
HC SOM WEST NILE VIRUS PCR
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912543
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.86
|
| 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 |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59.80
|
| 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 |
$54.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$56.95
|
| Rate for Payer: Heritage Provider Network Senior |
$56.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$43.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
| 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 WEST NILE VIRUS PCR (CSF)
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912764
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.86
|
| 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 |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59.80
|
| 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 |
$54.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$56.95
|
| Rate for Payer: Heritage Provider Network Senior |
$56.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$43.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
| 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 WEST NILE VIRUS PCR (CSF)
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912764
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.25
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$62.28
|
| Rate for Payer: Heritage Provider Network Senior |
$62.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
|
|
HC SOM WHEY IGE
|
Facility
|
OP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914677
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$150.09 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.09
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.62
|
| Rate for Payer: Heritage Provider Network Senior |
$4.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SOM WHEY IGE
|
Facility
|
IP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914677
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.81
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.06
|
| Rate for Payer: Heritage Provider Network Senior |
$5.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
|
