|
HC SOM BICARBONATE URINE
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
900910363
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$60.75 |
| Rate for Payer: Adventist Health Commercial |
$16.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.73
|
| Rate for Payer: Blue Shield of California Commercial |
$38.18
|
| Rate for Payer: Blue Shield of California EPN |
$29.85
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$52.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.37
|
| Rate for Payer: Dignity Health Senior |
$4.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.14
|
| Rate for Payer: Heritage Provider Network Senior |
$50.14
|
| Rate for Payer: Humana Medicare |
$4.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.15
|
| Rate for Payer: Multiplan Commercial |
$60.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.88
|
| Rate for Payer: TriValley Medical Group Senior |
$4.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: Vantage Medical Group Senior |
$4.88
|
|
|
HC SOM BICARBONATE URINE
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
900910363
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.66 |
| Max. Negotiated Rate |
$60.75 |
| Rate for Payer: Adventist Health Commercial |
$16.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.65
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.84
|
| Rate for Payer: Heritage Provider Network Senior |
$54.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$60.75
|
|
|
HC SOM BILE ACIDS TOTAL
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 82239
|
| Hospital Charge Code |
900911123
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$144.77 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.77
|
| Rate for Payer: Blue Shield of California Commercial |
$133.82
|
| Rate for Payer: Blue Shield of California EPN |
$104.62
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.83
|
| Rate for Payer: Dignity Health Senior |
$17.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.57
|
| Rate for Payer: Heritage Provider Network Senior |
$18.57
|
| Rate for Payer: Humana Medicare |
$17.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.57
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.12
|
| Rate for Payer: TriValley Medical Group Senior |
$17.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.83
|
| Rate for Payer: Vantage Medical Group Senior |
$17.12
|
|
|
HC SOM BILE ACIDS TOTAL
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 82239
|
| Hospital Charge Code |
900911123
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.31
|
| Rate for Payer: Heritage Provider Network Senior |
$20.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
|
|
HC SOM BK VIRUS DNA QUANT PCR
|
Facility
|
OP
|
$65.90
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912559
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$334.56 |
| Rate for Payer: Adventist Health Commercial |
$13.18
|
| Rate for Payer: Aetna of CA Gatekeeper |
$124.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$216.56
|
| Rate for Payer: Blue Shield of California Commercial |
$334.56
|
| Rate for Payer: Blue Shield of California EPN |
$261.54
|
| Rate for Payer: Cash Price |
$29.66
|
| Rate for Payer: Cash Price |
$29.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Senior |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.84
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.79
|
| Rate for Payer: Heritage Provider Network Senior |
$40.79
|
| Rate for Payer: Humana Medicare |
$42.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$59.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$81.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.98
|
| Rate for Payer: Multiplan Commercial |
$49.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.84
|
| Rate for Payer: TriValley Medical Group Senior |
$42.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC SOM BK VIRUS DNA QUANT PCR
|
Facility
|
IP
|
$65.90
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912559
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$49.42 |
| Rate for Payer: Adventist Health Commercial |
$13.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.27
|
| Rate for Payer: Cash Price |
$29.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.61
|
| Rate for Payer: Heritage Provider Network Senior |
$44.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.48
|
| Rate for Payer: Multiplan Commercial |
$49.42
|
|
|
HC SOM BLASTOMYCES AB IMMUNODIFFUSION
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
900912686
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.39
|
| Rate for Payer: Blue Shield of California Commercial |
$100.79
|
| Rate for Payer: Blue Shield of California EPN |
$78.79
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.19
|
| Rate for Payer: Dignity Health Senior |
$12.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.86
|
| Rate for Payer: Heritage Provider Network Senior |
$27.86
|
| Rate for Payer: Humana Medicare |
$12.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.25
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.90
|
| Rate for Payer: TriValley Medical Group Senior |
$12.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Vantage Medical Group Senior |
$12.90
|
|
|
HC SOM BLASTOMYCES AB IMMUNODIFFUSION
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
900912686
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.92
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.46
|
| Rate for Payer: Heritage Provider Network Senior |
$30.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
|
|
HC SOM BLOOM CULTURE 01
|
Facility
|
OP
|
$937.09
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900915282
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$116.49 |
| Max. Negotiated Rate |
$909.88 |
| Rate for Payer: Adventist Health Commercial |
$187.42
|
| Rate for Payer: Aetna of CA Gatekeeper |
$338.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$643.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$827.85
|
| Rate for Payer: Blue Shield of California Commercial |
$909.88
|
| Rate for Payer: Blue Shield of California EPN |
$711.30
|
| Rate for Payer: Cash Price |
$421.69
|
| Rate for Payer: Cash Price |
$421.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$609.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.14
|
| Rate for Payer: Dignity Health Senior |
$116.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$609.11
|
| Rate for Payer: EPIC Health Plan Medicare |
$116.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$580.06
|
| Rate for Payer: Heritage Provider Network Senior |
$580.06
|
| Rate for Payer: Humana Medicare |
$116.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$157.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$116.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$221.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$146.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$146.78
|
| Rate for Payer: Multiplan Commercial |
$702.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$116.49
|
| Rate for Payer: TriValley Medical Group Senior |
$116.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$125.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$125.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Vantage Medical Group Senior |
$116.49
|
|
|
HC SOM BLOOM CULTURE 01
|
Facility
|
IP
|
$937.09
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900915282
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$169.61 |
| Max. Negotiated Rate |
$702.82 |
| Rate for Payer: Adventist Health Commercial |
$187.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$643.78
|
| Rate for Payer: Cash Price |
$421.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$634.41
|
| Rate for Payer: Heritage Provider Network Senior |
$634.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.27
|
| Rate for Payer: Multiplan Commercial |
$702.82
|
|
|
HC SOM BNP 83880
|
Facility
|
IP
|
$170.78
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
900914724
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.91 |
| Max. Negotiated Rate |
$128.08 |
| Rate for Payer: Adventist Health Commercial |
$34.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$117.33
|
| Rate for Payer: Cash Price |
$76.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.62
|
| Rate for Payer: Heritage Provider Network Senior |
$115.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.70
|
| Rate for Payer: Multiplan Commercial |
$128.08
|
|
|
HC SOM BNP 83880
|
Facility
|
OP
|
$170.78
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
900914724
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.91 |
| Max. Negotiated Rate |
$284.18 |
| Rate for Payer: Adventist Health Commercial |
$34.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$117.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.18
|
| Rate for Payer: Blue Shield of California Commercial |
$265.13
|
| Rate for Payer: Blue Shield of California EPN |
$207.27
|
| Rate for Payer: Cash Price |
$76.85
|
| Rate for Payer: Cash Price |
$76.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$111.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.19
|
| Rate for Payer: Dignity Health Senior |
$39.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.01
|
| Rate for Payer: EPIC Health Plan Medicare |
$39.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.71
|
| Rate for Payer: Heritage Provider Network Senior |
$105.71
|
| Rate for Payer: Humana Medicare |
$39.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$39.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$74.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.47
|
| Rate for Payer: Multiplan Commercial |
$128.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$39.26
|
| Rate for Payer: TriValley Medical Group Senior |
$39.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$42.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$42.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.19
|
| Rate for Payer: Vantage Medical Group Senior |
$39.26
|
|
|
HC SOM BONE ALKALINE PHOSPHATASE
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
900915326
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.49
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.25
|
| Rate for Payer: Heritage Provider Network Senior |
$16.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
|
|
HC SOM BONE ALKALINE PHOSPHATASE
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
900915326
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$123.80 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.80
|
| Rate for Payer: Blue Shield of California Commercial |
$115.49
|
| Rate for Payer: Blue Shield of California EPN |
$90.28
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.26
|
| Rate for Payer: Dignity Health Senior |
$14.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.86
|
| Rate for Payer: Heritage Provider Network Senior |
$14.86
|
| Rate for Payer: Humana Medicare |
$14.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.62
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.78
|
| Rate for Payer: TriValley Medical Group Senior |
$14.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14.78
|
|
|
HC SOM BORDETELLA PCR
|
Facility
|
OP
|
$38.80
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914165
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$284.23 |
| Rate for Payer: Adventist Health Commercial |
$7.76
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.64
|
| 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 |
$284.23
|
| Rate for Payer: Blue Shield of California Commercial |
$274.13
|
| Rate for Payer: Blue Shield of California EPN |
$214.30
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.02
|
| Rate for Payer: Heritage Provider Network Senior |
$24.02
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$29.10
|
| 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 |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM BORDETELLA PCR
|
Facility
|
IP
|
$38.80
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914165
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$29.10 |
| Rate for Payer: Adventist Health Commercial |
$7.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.66
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.27
|
| Rate for Payer: Heritage Provider Network Senior |
$26.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.70
|
| Rate for Payer: Multiplan Commercial |
$29.10
|
|
|
HC SOM BORIC ACID
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
900911050
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$171.50 |
| Rate for Payer: Adventist Health Commercial |
$14.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$63.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.98
|
| Rate for Payer: Blue Shield of California Commercial |
$171.50
|
| Rate for Payer: Blue Shield of California EPN |
$134.07
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.16
|
| Rate for Payer: Dignity Health Senior |
$21.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.95
|
| Rate for Payer: Heritage Provider Network Senior |
$43.95
|
| Rate for Payer: Humana Medicare |
$21.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.67
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.96
|
| Rate for Payer: TriValley Medical Group Senior |
$21.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.16
|
| Rate for Payer: Vantage Medical Group Senior |
$21.96
|
|
|
HC SOM BORIC ACID
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
900911050
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$53.25 |
| Rate for Payer: Adventist Health Commercial |
$14.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.78
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.07
|
| Rate for Payer: Heritage Provider Network Senior |
$48.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.75
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
|
|
HC SOM BORON
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
900914503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$54.75 |
| Rate for Payer: Adventist Health Commercial |
$14.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.15
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.42
|
| Rate for Payer: Heritage Provider Network Senior |
$49.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.25
|
| Rate for Payer: Multiplan Commercial |
$54.75
|
|
|
HC SOM BORON
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
900914503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$171.50 |
| Rate for Payer: Adventist Health Commercial |
$14.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$63.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.98
|
| Rate for Payer: Blue Shield of California Commercial |
$171.50
|
| Rate for Payer: Blue Shield of California EPN |
$134.07
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.16
|
| Rate for Payer: Dignity Health Senior |
$21.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.19
|
| Rate for Payer: Heritage Provider Network Senior |
$45.19
|
| Rate for Payer: Humana Medicare |
$21.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.67
|
| Rate for Payer: Multiplan Commercial |
$54.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.96
|
| Rate for Payer: TriValley Medical Group Senior |
$21.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.16
|
| Rate for Payer: Vantage Medical Group Senior |
$21.96
|
|
|
HC SOM BORRELIA BURGDORFERI PCR PROBE
|
Facility
|
IP
|
$26.66
|
|
|
Service Code
|
CPT 87476
|
| Hospital Charge Code |
900912513
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Adventist Health Commercial |
$5.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.32
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.05
|
| Rate for Payer: Heritage Provider Network Senior |
$18.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.66
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
|
|
HC SOM BORRELIA BURGDORFERI PCR PROBE
|
Facility
|
OP
|
$26.66
|
|
|
Service Code
|
CPT 87476
|
| Hospital Charge Code |
900912513
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$284.23 |
| Rate for Payer: Adventist Health Commercial |
$5.33
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.64
|
| 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 |
$284.23
|
| Rate for Payer: Blue Shield of California Commercial |
$274.13
|
| Rate for Payer: Blue Shield of California EPN |
$214.30
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.33
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.50
|
| Rate for Payer: Heritage Provider Network Senior |
$16.50
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| 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 |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM BRUCELLA AB CONFIRMATION
|
Facility
|
OP
|
$116.41
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
900912841
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$87.31 |
| Rate for Payer: Adventist Health Commercial |
$23.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.51
|
| Rate for Payer: Blue Shield of California Commercial |
$68.09
|
| Rate for Payer: Blue Shield of California EPN |
$53.23
|
| Rate for Payer: Cash Price |
$52.38
|
| Rate for Payer: Cash Price |
$52.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$75.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.82
|
| Rate for Payer: Dignity Health Senior |
$8.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$72.06
|
| Rate for Payer: Heritage Provider Network Senior |
$72.06
|
| Rate for Payer: Humana Medicare |
$8.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$87.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.93
|
| Rate for Payer: TriValley Medical Group Senior |
$8.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.82
|
| Rate for Payer: Vantage Medical Group Senior |
$8.93
|
|
|
HC SOM BRUCELLA AB CONFIRMATION
|
Facility
|
IP
|
$116.41
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
900912841
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.07 |
| Max. Negotiated Rate |
$87.31 |
| Rate for Payer: Adventist Health Commercial |
$23.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.97
|
| Rate for Payer: Cash Price |
$52.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.81
|
| Rate for Payer: Heritage Provider Network Senior |
$78.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.10
|
| Rate for Payer: Multiplan Commercial |
$87.31
|
|
|
HC SOM BRUCELLA AB IGG
|
Facility
|
IP
|
$20.74
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
900911628
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$15.56 |
| Rate for Payer: Adventist Health Commercial |
$4.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.25
|
| Rate for Payer: Cash Price |
$9.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.04
|
| Rate for Payer: Heritage Provider Network Senior |
$14.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$15.56
|
|
