|
HC SOM Y ENTEROCOL AB A G M
|
Facility
|
IP
|
$224.65
|
|
|
Service Code
|
CPT 86793
|
| Hospital Charge Code |
900914716
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.66 |
| Max. Negotiated Rate |
$168.49 |
| Rate for Payer: Adventist Health Commercial |
$44.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.67
|
| Rate for Payer: Cash Price |
$224.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$152.09
|
| Rate for Payer: Heritage Provider Network Senior |
$152.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.16
|
| Rate for Payer: Multiplan Commercial |
$168.49
|
|
|
HC SOM Y ENTEROCOL AB A G M
|
Facility
|
OP
|
$224.65
|
|
|
Service Code
|
CPT 86793
|
| Hospital Charge Code |
900914716
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$168.49 |
| Rate for Payer: Adventist Health Commercial |
$44.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$138.83
|
| 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 |
$224.65
|
| Rate for Payer: Cash Price |
$224.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$146.02
|
| 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 |
$132.54
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$139.06
|
| Rate for Payer: Heritage Provider Network Senior |
$139.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$107.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$168.49
|
| 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 ZINC
|
Facility
|
OP
|
$12.17
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
900911152
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$108.16 |
| Rate for Payer: Adventist Health Commercial |
$2.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.16
|
| Rate for Payer: Blue Shield of California Commercial |
$91.64
|
| Rate for Payer: Blue Shield of California EPN |
$73.50
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.53
|
| Rate for Payer: Heritage Provider Network Senior |
$7.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.26
|
| Rate for Payer: Multiplan Commercial |
$9.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.39
|
| Rate for Payer: TriValley Medical Group Senior |
$11.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.53
|
| Rate for Payer: Vantage Medical Group Senior |
$11.39
|
|
|
HC SOM ZINC
|
Facility
|
IP
|
$12.17
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
900911152
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.13 |
| Rate for Payer: Adventist Health Commercial |
$2.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.84
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.24
|
| Rate for Payer: Heritage Provider Network Senior |
$8.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$9.13
|
|
|
HC SOM ZINC TRANSPORTER 8 AUTOAB
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915260
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$146.00 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$76.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.00
|
| Rate for Payer: Blue Shield of California Commercial |
$133.75
|
| Rate for Payer: Blue Shield of California EPN |
$107.28
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$80.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$23.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.76
|
| Rate for Payer: Heritage Provider Network Senior |
$76.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$59.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31.58
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.57
|
| Rate for Payer: TriValley Medical Group Senior |
$23.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM ZINC TRANSPORTER 8 AUTOAB
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915260
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.86
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.95
|
| Rate for Payer: Heritage Provider Network Senior |
$83.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
|
|
HC SOM ZINC URINE
|
Facility
|
IP
|
$35.72
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
900911153
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Adventist Health Commercial |
$7.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.00
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.18
|
| Rate for Payer: Heritage Provider Network Senior |
$24.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.93
|
| Rate for Payer: Multiplan Commercial |
$26.79
|
|
|
HC SOM ZINC URINE
|
Facility
|
OP
|
$35.72
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
900911153
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$108.16 |
| Rate for Payer: Adventist Health Commercial |
$7.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.16
|
| Rate for Payer: Blue Shield of California Commercial |
$91.64
|
| Rate for Payer: Blue Shield of California EPN |
$73.50
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.07
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.11
|
| Rate for Payer: Heritage Provider Network Senior |
$22.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.26
|
| Rate for Payer: Multiplan Commercial |
$26.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.39
|
| Rate for Payer: TriValley Medical Group Senior |
$11.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.53
|
| Rate for Payer: Vantage Medical Group Senior |
$11.39
|
|
|
HC SOM ZONISAMIDE LEVEL
|
Facility
|
OP
|
$49.82
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
900912714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$104.20 |
| Rate for Payer: Adventist Health Commercial |
$9.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.68
|
| 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 |
$49.82
|
| Rate for Payer: Cash Price |
$49.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.84
|
| Rate for Payer: Heritage Provider Network Senior |
$30.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.75
|
| Rate for Payer: Multiplan Commercial |
$37.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.25
|
| Rate for Payer: TriValley Medical Group Senior |
$13.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
|
HC SOM ZONISAMIDE LEVEL
|
Facility
|
IP
|
$49.82
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
900912714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$37.37 |
| Rate for Payer: Adventist Health Commercial |
$9.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.08
|
| Rate for Payer: Cash Price |
$49.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.73
|
| Rate for Payer: Heritage Provider Network Senior |
$33.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$37.37
|
|
|
HC SON ASPARAGINASE ASSAY
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900915353
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.77 |
| Max. Negotiated Rate |
$206.25 |
| Rate for Payer: Adventist Health Commercial |
$55.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$177.10
|
| Rate for Payer: Cash Price |
$123.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.18
|
| Rate for Payer: Heritage Provider Network Senior |
$186.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.75
|
| Rate for Payer: Multiplan Commercial |
$206.25
|
|
|
HC SON ASPARAGINASE ASSAY
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900915353
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.17 |
| Max. Negotiated Rate |
$206.25 |
| Rate for Payer: Adventist Health Commercial |
$55.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$169.95
|
| 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 |
$123.75
|
| Rate for Payer: Cash Price |
$123.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$178.75
|
| 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 |
$162.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$170.22
|
| Rate for Payer: Heritage Provider Network Senior |
$170.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$131.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.71
|
| Rate for Payer: Multiplan Commercial |
$206.25
|
| 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 SONGI 14011200 HCV PCR QL
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 87521
|
| Hospital Charge Code |
900914766
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$145.23
|
| 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 |
$105.75
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$152.75
|
| 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 |
$138.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.47
|
| Rate for Payer: Heritage Provider Network Senior |
$145.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$112.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
| 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 SONGI 14011200 HCV PCR QL
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 87521
|
| Hospital Charge Code |
900914766
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.53 |
| Max. Negotiated Rate |
$176.25 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$151.34
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$159.09
|
| Rate for Payer: Heritage Provider Network Senior |
$159.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.75
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
|
|
HC SONOHYSTEROGRAPHY W COLOR DOPP
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
CPT 76831
|
| Hospital Charge Code |
950402003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$180.09 |
| Max. Negotiated Rate |
$746.25 |
| Rate for Payer: Adventist Health Commercial |
$199.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$614.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$497.70
|
| Rate for Payer: Blue Shield of California Commercial |
$321.50
|
| Rate for Payer: Blue Shield of California EPN |
$258.54
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$646.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$587.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.90
|
| Rate for Payer: Heritage Provider Network Senior |
$615.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$474.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$180.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$746.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.88
|
| Rate for Payer: TriValley Medical Group Senior |
$306.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$243.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$243.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC SONOHYSTEROGRAPHY W COLOR DOPP
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
CPT 76831
|
| Hospital Charge Code |
950402003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$180.09 |
| Max. Negotiated Rate |
$746.25 |
| Rate for Payer: Adventist Health Commercial |
$199.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$640.78
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$673.62
|
| Rate for Payer: Heritage Provider Network Senior |
$673.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$180.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.75
|
| Rate for Payer: Multiplan Commercial |
$746.25
|
|
|
HC SOP CELIAC PLUS
|
Facility
|
IP
|
$127.50
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
900914910
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$23.08 |
| Max. Negotiated Rate |
$95.62 |
| Rate for Payer: Adventist Health Commercial |
$25.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.11
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.32
|
| Rate for Payer: Heritage Provider Network Senior |
$86.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.88
|
| Rate for Payer: Multiplan Commercial |
$95.62
|
|
|
HC SOP CELIAC PLUS
|
Facility
|
OP
|
$127.50
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
900914910
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$23.08 |
| Max. Negotiated Rate |
$328.68 |
| Rate for Payer: Adventist Health Commercial |
$25.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$78.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.66
|
| Rate for Payer: Blue Shield of California Commercial |
$219.02
|
| Rate for Payer: Blue Shield of California EPN |
$176.13
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$219.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.92
|
| Rate for Payer: Heritage Provider Network Senior |
$78.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$60.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$95.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$219.12
|
| Rate for Payer: TriValley Medical Group Senior |
$219.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$321.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$321.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC SOP CELIAC PLUS 81382
|
Facility
|
IP
|
$276.25
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
900914907
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$207.19 |
| Rate for Payer: Adventist Health Commercial |
$55.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$177.91
|
| Rate for Payer: Cash Price |
$124.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$187.02
|
| Rate for Payer: Heritage Provider Network Senior |
$187.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.06
|
| Rate for Payer: Multiplan Commercial |
$207.19
|
|
|
HC SOP CELIAC PLUS 81382
|
Facility
|
OP
|
$276.25
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
900914907
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$799.66 |
| Rate for Payer: Adventist Health Commercial |
$55.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$170.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$799.66
|
| Rate for Payer: Blue Shield of California Commercial |
$168.51
|
| Rate for Payer: Blue Shield of California EPN |
$134.81
|
| Rate for Payer: Cash Price |
$124.31
|
| Rate for Payer: Cash Price |
$124.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$179.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.56
|
| Rate for Payer: EPIC Health Plan Medicare |
$123.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$171.00
|
| Rate for Payer: Heritage Provider Network Senior |
$171.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$131.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$142.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$165.73
|
| Rate for Payer: Multiplan Commercial |
$207.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$123.68
|
| Rate for Payer: TriValley Medical Group Senior |
$123.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$133.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$133.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
|
|
HC SOP CELIAC PLUS 82784
|
Facility
|
IP
|
$21.26
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900914909
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Adventist Health Commercial |
$4.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.69
|
| Rate for Payer: Cash Price |
$9.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.39
|
| Rate for Payer: Heritage Provider Network Senior |
$14.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.32
|
| Rate for Payer: Multiplan Commercial |
$15.95
|
|
|
HC SOP CELIAC PLUS 82784
|
Facility
|
OP
|
$21.26
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900914909
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$74.82 |
| Rate for Payer: Adventist Health Commercial |
$4.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.57
|
| Rate for Payer: Blue Shield of California Commercial |
$74.82
|
| Rate for Payer: Blue Shield of California EPN |
$60.01
|
| Rate for Payer: Cash Price |
$9.57
|
| Rate for Payer: Cash Price |
$9.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.16
|
| Rate for Payer: Heritage Provider Network Senior |
$13.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$15.95
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.30
|
| Rate for Payer: TriValley Medical Group Senior |
$9.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Senior |
$9.30
|
|
|
HC SOP CELIAC PLUS 83520
|
Facility
|
OP
|
$32.58
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914908
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$122.92 |
| Rate for Payer: Adventist Health Commercial |
$6.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.13
|
| 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 |
$14.66
|
| Rate for Payer: Cash Price |
$14.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21.18
|
| 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 |
$21.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.17
|
| Rate for Payer: Heritage Provider Network Senior |
$20.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$15.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$24.43
|
| 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
|
|
|
HC SOP CELIAC PLUS 83520
|
Facility
|
IP
|
$32.58
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914908
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$24.43 |
| Rate for Payer: Adventist Health Commercial |
$6.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.98
|
| Rate for Payer: Cash Price |
$14.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.06
|
| Rate for Payer: Heritage Provider Network Senior |
$22.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.14
|
| Rate for Payer: Multiplan Commercial |
$24.43
|
|
|
HC SOP CELIAC SEROLOGY
|
Facility
|
IP
|
$127.50
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
900914914
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$23.08 |
| Max. Negotiated Rate |
$95.62 |
| Rate for Payer: Adventist Health Commercial |
$25.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.11
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.32
|
| Rate for Payer: Heritage Provider Network Senior |
$86.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.88
|
| Rate for Payer: Multiplan Commercial |
$95.62
|
|
