|
HC SOM APOLIPOPROTEIN E GENOTYPING
|
Facility
|
IP
|
$203.61
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
900914646
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$152.71 |
| Rate for Payer: Adventist Health Commercial |
$40.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$139.88
|
| Rate for Payer: Cash Price |
$91.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$137.84
|
| Rate for Payer: Heritage Provider Network Senior |
$137.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.90
|
| Rate for Payer: Multiplan Commercial |
$152.71
|
|
|
HC SOM APOLIPOPROTEIN E GENOTYPING
|
Facility
|
OP
|
$203.61
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
900914646
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$264.85 |
| Rate for Payer: Adventist Health Commercial |
$40.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$94.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$139.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$264.85
|
| Rate for Payer: Blue Shield of California Commercial |
$126.44
|
| Rate for Payer: Blue Shield of California EPN |
$119.52
|
| Rate for Payer: Cash Price |
$91.62
|
| Rate for Payer: Cash Price |
$91.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$132.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.70
|
| Rate for Payer: Dignity Health Senior |
$137.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$126.03
|
| Rate for Payer: Heritage Provider Network Senior |
$126.03
|
| Rate for Payer: Humana Medicare |
$137.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$213.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$161.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$172.62
|
| Rate for Payer: Multiplan Commercial |
$152.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.00
|
| Rate for Payer: TriValley Medical Group Senior |
$137.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$147.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$147.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.00
|
|
|
HC SOM ARSENIC BLOOD
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
900910563
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$158.80 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$55.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.80
|
| Rate for Payer: Blue Shield of California Commercial |
$148.19
|
| Rate for Payer: Blue Shield of California EPN |
$115.85
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.87
|
| Rate for Payer: Dignity Health Senior |
$18.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.48
|
| Rate for Payer: Heritage Provider Network Senior |
$15.48
|
| Rate for Payer: Humana Medicare |
$18.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.90
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.97
|
| Rate for Payer: TriValley Medical Group Senior |
$18.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.87
|
| Rate for Payer: Vantage Medical Group Senior |
$18.97
|
|
|
HC SOM ARSENIC BLOOD
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
900910563
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.92
|
| Rate for Payer: Heritage Provider Network Senior |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SOM ARSENIC URINE QUANT
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
900911289
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.92
|
| Rate for Payer: Heritage Provider Network Senior |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SOM ARSENIC URINE QUANT
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
900911289
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$158.80 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$55.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.80
|
| Rate for Payer: Blue Shield of California Commercial |
$148.19
|
| Rate for Payer: Blue Shield of California EPN |
$115.85
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.87
|
| Rate for Payer: Dignity Health Senior |
$18.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.48
|
| Rate for Payer: Heritage Provider Network Senior |
$15.48
|
| Rate for Payer: Humana Medicare |
$18.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.90
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.97
|
| Rate for Payer: TriValley Medical Group Senior |
$18.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.87
|
| Rate for Payer: Vantage Medical Group Senior |
$18.97
|
|
|
HC SOM ARYLSULFATASE A, URINE
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900910723
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.62
|
| Rate for Payer: Heritage Provider Network Senior |
$84.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
|
|
HC SOM ARYLSULFATASE A, URINE
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900910723
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.55
|
| Rate for Payer: Blue Shield of California Commercial |
$54.61
|
| Rate for Payer: Blue Shield of California EPN |
$42.69
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.91
|
| Rate for Payer: Dignity Health Senior |
$8.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.38
|
| Rate for Payer: Heritage Provider Network Senior |
$77.38
|
| Rate for Payer: Humana Medicare |
$8.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.21
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.10
|
| Rate for Payer: TriValley Medical Group Senior |
$8.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Vantage Medical Group Senior |
$8.10
|
|
|
HC SOM ASPERGILLUS(GALACT)ANTIGEN
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 87305
|
| Hospital Charge Code |
900912574
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$76.07 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.07
|
| Rate for Payer: Blue Shield of California Commercial |
$72.56
|
| Rate for Payer: Blue Shield of California EPN |
$56.72
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Humana Medicare |
$11.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.09
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC SOM ASPERGILLUS(GALACT)ANTIGEN
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 87305
|
| Hospital Charge Code |
900912574
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC SOM ATIVAN
|
Facility
|
OP
|
$63.59
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$148.48 |
| Rate for Payer: Adventist Health Commercial |
$12.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.48
|
| Rate for Payer: Cash Price |
$28.62
|
| Rate for Payer: Cash Price |
$28.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.05
|
| Rate for Payer: Dignity Health Senior |
$54.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.36
|
| Rate for Payer: Heritage Provider Network Senior |
$39.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.90
|
| Rate for Payer: Multiplan Commercial |
$47.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.05
|
| Rate for Payer: Vantage Medical Group Senior |
$54.05
|
|
|
HC SOM ATIVAN
|
Facility
|
IP
|
$63.59
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$47.69 |
| Rate for Payer: Adventist Health Commercial |
$12.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.69
|
| Rate for Payer: Cash Price |
$28.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.05
|
| Rate for Payer: Heritage Provider Network Senior |
$43.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.90
|
| Rate for Payer: Multiplan Commercial |
$47.69
|
|
|
HC SOM BACLOFEN 83789
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900915259
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$239.25 |
| Rate for Payer: Adventist Health Commercial |
$63.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$219.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.51
|
| Rate for Payer: Blue Shield of California Commercial |
$141.04
|
| Rate for Payer: Blue Shield of California EPN |
$110.26
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$207.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.52
|
| Rate for Payer: Dignity Health Senior |
$24.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$197.46
|
| Rate for Payer: Heritage Provider Network Senior |
$197.46
|
| Rate for Payer: Humana Medicare |
$24.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.38
|
| Rate for Payer: Multiplan Commercial |
$239.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.11
|
| Rate for Payer: TriValley Medical Group Senior |
$24.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Vantage Medical Group Senior |
$24.11
|
|
|
HC SOM BACLOFEN 83789
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900915259
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$239.25 |
| Rate for Payer: Adventist Health Commercial |
$63.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$219.15
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$215.96
|
| Rate for Payer: Heritage Provider Network Senior |
$215.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.75
|
| Rate for Payer: Multiplan Commercial |
$239.25
|
|
|
HC SOM BARBITURATE CONFIRM, U
|
Facility
|
OP
|
$61.25
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900912916
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$91.96 |
| Rate for Payer: Adventist Health Commercial |
$12.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.96
|
| Rate for Payer: Cash Price |
$27.56
|
| Rate for Payer: Cash Price |
$27.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.06
|
| Rate for Payer: Dignity Health Senior |
$52.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.91
|
| Rate for Payer: Heritage Provider Network Senior |
$37.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.31
|
| Rate for Payer: Multiplan Commercial |
$45.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.06
|
| Rate for Payer: Vantage Medical Group Senior |
$52.06
|
|
|
HC SOM BARBITURATE CONFIRM, U
|
Facility
|
IP
|
$61.25
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900912916
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$45.94 |
| Rate for Payer: Adventist Health Commercial |
$12.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.08
|
| Rate for Payer: Cash Price |
$27.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.47
|
| Rate for Payer: Heritage Provider Network Senior |
$41.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.31
|
| Rate for Payer: Multiplan Commercial |
$45.94
|
|
|
HC SOM BARTONELLA HENSELAE AB IGG
|
Facility
|
IP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900911386
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$7.37 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.75
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.65
|
| Rate for Payer: Heritage Provider Network Senior |
$6.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
|
|
HC SOM BARTONELLA HENSELAE AB IGG
|
Facility
|
OP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900911386
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$85.09 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.09
|
| Rate for Payer: Blue Shield of California Commercial |
$79.49
|
| Rate for Payer: Blue Shield of California EPN |
$62.14
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Senior |
$10.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.08
|
| Rate for Payer: Heritage Provider Network Senior |
$6.08
|
| Rate for Payer: Humana Medicare |
$10.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.83
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.18
|
| Rate for Payer: TriValley Medical Group Senior |
$10.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
HC SOM BARTONELLA HENSELAE AB IGM
|
Facility
|
IP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900912690
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$7.37 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.75
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.65
|
| Rate for Payer: Heritage Provider Network Senior |
$6.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
|
|
HC SOM BARTONELLA HENSELAE AB IGM
|
Facility
|
OP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900912690
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$85.09 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.09
|
| Rate for Payer: Blue Shield of California Commercial |
$79.49
|
| Rate for Payer: Blue Shield of California EPN |
$62.14
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Senior |
$10.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.08
|
| Rate for Payer: Heritage Provider Network Senior |
$6.08
|
| Rate for Payer: Humana Medicare |
$10.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.83
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.18
|
| Rate for Payer: TriValley Medical Group Senior |
$10.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
HC SOM BARTONELLA QUINTANA AB IGG
|
Facility
|
IP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900912691
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$7.37 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.75
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.65
|
| Rate for Payer: Heritage Provider Network Senior |
$6.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
|
|
HC SOM BARTONELLA QUINTANA AB IGG
|
Facility
|
OP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900912691
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$85.09 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.09
|
| Rate for Payer: Blue Shield of California Commercial |
$79.49
|
| Rate for Payer: Blue Shield of California EPN |
$62.14
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Senior |
$10.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.08
|
| Rate for Payer: Heritage Provider Network Senior |
$6.08
|
| Rate for Payer: Humana Medicare |
$10.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.83
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.18
|
| Rate for Payer: TriValley Medical Group Senior |
$10.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
HC SOM BARTONELLA QUINTANA AB IGM
|
Facility
|
OP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900912692
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$85.09 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.09
|
| Rate for Payer: Blue Shield of California Commercial |
$79.49
|
| Rate for Payer: Blue Shield of California EPN |
$62.14
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Senior |
$10.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.08
|
| Rate for Payer: Heritage Provider Network Senior |
$6.08
|
| Rate for Payer: Humana Medicare |
$10.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.83
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.18
|
| Rate for Payer: TriValley Medical Group Senior |
$10.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
HC SOM BARTONELLA QUINTANA AB IGM
|
Facility
|
IP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900912692
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$7.37 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.75
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.65
|
| Rate for Payer: Heritage Provider Network Senior |
$6.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
|
|
HC SOM B-CELL LYMPH FISH INTERP
|
Facility
|
IP
|
$254.50
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914116
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$46.06 |
| Max. Negotiated Rate |
$190.88 |
| Rate for Payer: Adventist Health Commercial |
$50.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$174.84
|
| Rate for Payer: Cash Price |
$114.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.30
|
| Rate for Payer: Heritage Provider Network Senior |
$172.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.62
|
| Rate for Payer: Multiplan Commercial |
$190.88
|
|
