|
HC SOM CSF IGG INDEX ALB CSF
|
Facility
|
OP
|
$8.66
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
900914411
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$43.28 |
| Rate for Payer: Adventist Health Commercial |
$1.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.28
|
| Rate for Payer: Blue Shield of California Commercial |
$40.42
|
| Rate for Payer: Blue Shield of California EPN |
$31.60
|
| Rate for Payer: Cash Price |
$3.90
|
| Rate for Payer: Cash Price |
$3.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.56
|
| Rate for Payer: Dignity Health Senior |
$7.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.36
|
| Rate for Payer: Heritage Provider Network Senior |
$5.36
|
| Rate for Payer: Humana Medicare |
$7.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$6.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.78
|
| Rate for Payer: TriValley Medical Group Senior |
$7.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Vantage Medical Group Senior |
$7.78
|
|
|
HC SOM CSF IGG INDEX ALB S
|
Facility
|
IP
|
$5.51
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
900914410
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.79
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.73
|
| Rate for Payer: Heritage Provider Network Senior |
$3.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$4.13
|
|
|
HC SOM CSF IGG INDEX ALB S
|
Facility
|
OP
|
$5.51
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
900914410
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$41.47 |
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.47
|
| Rate for Payer: Blue Shield of California Commercial |
$38.68
|
| Rate for Payer: Blue Shield of California EPN |
$30.24
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.44
|
| Rate for Payer: Dignity Health Senior |
$4.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.58
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.41
|
| Rate for Payer: Heritage Provider Network Senior |
$3.41
|
| Rate for Payer: Humana Medicare |
$4.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$4.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.95
|
| Rate for Payer: TriValley Medical Group Senior |
$4.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.44
|
| Rate for Payer: Vantage Medical Group Senior |
$4.95
|
|
|
HC SOM CSF IGG INDEX IGG, S
|
Facility
|
OP
|
$10.35
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900914409
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$72.61 |
| Rate for Payer: Adventist Health Commercial |
$2.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.11
|
| 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 |
$64.86
|
| Rate for Payer: Blue Shield of California Commercial |
$72.61
|
| Rate for Payer: Blue Shield of California EPN |
$56.77
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Senior |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.73
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.41
|
| Rate for Payer: Heritage Provider Network Senior |
$6.41
|
| Rate for Payer: Humana Medicare |
$9.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.72
|
| Rate for Payer: Multiplan Commercial |
$7.76
|
| 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 SOM CSF IGG INDEX IGG, S
|
Facility
|
IP
|
$10.35
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900914409
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: Adventist Health Commercial |
$2.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.11
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.01
|
| Rate for Payer: Heritage Provider Network Senior |
$7.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$7.76
|
|
|
HC SOM C-TELOPEPTIDE
|
Facility
|
IP
|
$19.34
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
900912783
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Adventist Health Commercial |
$3.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.29
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.09
|
| Rate for Payer: Heritage Provider Network Senior |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.84
|
| Rate for Payer: Multiplan Commercial |
$14.50
|
|
|
HC SOM C-TELOPEPTIDE
|
Facility
|
OP
|
$19.34
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
900912783
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$230.64 |
| Rate for Payer: Adventist Health Commercial |
$3.87
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$230.64
|
| Rate for Payer: Blue Shield of California Commercial |
$144.84
|
| Rate for Payer: Blue Shield of California EPN |
$113.23
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.55
|
| Rate for Payer: Dignity Health Senior |
$18.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.57
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.97
|
| Rate for Payer: Heritage Provider Network Senior |
$11.97
|
| Rate for Payer: Humana Medicare |
$18.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.54
|
| Rate for Payer: Multiplan Commercial |
$14.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.68
|
| Rate for Payer: TriValley Medical Group Senior |
$18.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.55
|
| Rate for Payer: Vantage Medical Group Senior |
$18.68
|
|
|
HC SOM C. TRACHOMATIS, IGG
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
900912801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$108.02 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$34.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.02
|
| Rate for Payer: Blue Shield of California Commercial |
$92.35
|
| Rate for Payer: Blue Shield of California EPN |
$72.19
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.00
|
| Rate for Payer: Dignity Health Senior |
$11.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.33
|
| Rate for Payer: Heritage Provider Network Senior |
$4.33
|
| Rate for Payer: Humana Medicare |
$11.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.89
|
| Rate for Payer: Multiplan Commercial |
$5.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.82
|
| Rate for Payer: TriValley Medical Group Senior |
$11.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11.82
|
|
|
HC SOM C. TRACHOMATIS, IGG
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
900912801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.81
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.74
|
| Rate for Payer: Heritage Provider Network Senior |
$4.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$5.25
|
|
|
HC SOM C. TRACHOMATIS IGM
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912799
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$108.02 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$36.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.02
|
| Rate for Payer: Blue Shield of California Commercial |
$99.17
|
| Rate for Payer: Blue Shield of California EPN |
$77.52
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.95
|
| Rate for Payer: Dignity Health Senior |
$12.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.33
|
| Rate for Payer: Heritage Provider Network Senior |
$4.33
|
| Rate for Payer: Humana Medicare |
$12.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.98
|
| Rate for Payer: Multiplan Commercial |
$5.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.68
|
| Rate for Payer: TriValley Medical Group Senior |
$12.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.95
|
| Rate for Payer: Vantage Medical Group Senior |
$12.68
|
|
|
HC SOM C. TRACHOMATIS IGM
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912799
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.81
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.74
|
| Rate for Payer: Heritage Provider Network Senior |
$4.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$5.25
|
|
|
HC SOM CUCRU 82525
|
Facility
|
IP
|
$85.80
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900914747
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.53 |
| Max. Negotiated Rate |
$64.35 |
| Rate for Payer: Adventist Health Commercial |
$17.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.94
|
| Rate for Payer: Cash Price |
$38.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.09
|
| Rate for Payer: Heritage Provider Network Senior |
$58.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.45
|
| Rate for Payer: Multiplan Commercial |
$64.35
|
|
|
HC SOM CUCRU 82525
|
Facility
|
OP
|
$85.80
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900914747
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.41 |
| Max. Negotiated Rate |
$104.14 |
| Rate for Payer: Adventist Health Commercial |
$17.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$36.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.14
|
| Rate for Payer: Blue Shield of California Commercial |
$96.93
|
| Rate for Payer: Blue Shield of California EPN |
$75.78
|
| Rate for Payer: Cash Price |
$38.61
|
| Rate for Payer: Cash Price |
$38.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.65
|
| Rate for Payer: Dignity Health Senior |
$12.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.77
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.11
|
| Rate for Payer: Heritage Provider Network Senior |
$53.11
|
| Rate for Payer: Humana Medicare |
$12.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.64
|
| Rate for Payer: Multiplan Commercial |
$64.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.41
|
| Rate for Payer: TriValley Medical Group Senior |
$12.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Vantage Medical Group Senior |
$12.41
|
|
|
HC SOM CULTURE 05
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900915288
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$131.25 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.22
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.48
|
| Rate for Payer: Heritage Provider Network Senior |
$118.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.75
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
|
|
HC SOM CULTURE 05
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900915288
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$1,194.87 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$429.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,194.87
|
| Rate for Payer: Blue Shield of California Commercial |
$1,152.21
|
| Rate for Payer: Blue Shield of California EPN |
$900.74
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$113.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.27
|
| Rate for Payer: Dignity Health Senior |
$147.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$147.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.32
|
| Rate for Payer: Heritage Provider Network Senior |
$108.32
|
| Rate for Payer: Humana Medicare |
$147.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$204.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$147.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$280.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$174.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.88
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$147.52
|
| Rate for Payer: TriValley Medical Group Senior |
$147.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$159.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$159.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Vantage Medical Group Senior |
$147.52
|
|
|
HC SOM CYANIDE
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 82600
|
| Hospital Charge Code |
900911136
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$162.40 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.40
|
| Rate for Payer: Blue Shield of California Commercial |
$151.54
|
| Rate for Payer: Blue Shield of California EPN |
$118.47
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.34
|
| Rate for Payer: Dignity Health Senior |
$19.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.09
|
| Rate for Payer: Heritage Provider Network Senior |
$55.09
|
| Rate for Payer: Humana Medicare |
$19.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.44
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.40
|
| Rate for Payer: TriValley Medical Group Senior |
$19.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.34
|
| Rate for Payer: Vantage Medical Group Senior |
$19.40
|
|
|
HC SOM CYANIDE
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 82600
|
| Hospital Charge Code |
900911136
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.14
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.25
|
| Rate for Payer: Heritage Provider Network Senior |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.25
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
|
|
HC SOM CYSTATIN C WITH EGFR, S
|
Facility
|
OP
|
$37.23
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
900915362
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$113.83 |
| Rate for Payer: Adventist Health Commercial |
$7.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.83
|
| Rate for Payer: Blue Shield of California Commercial |
$106.21
|
| Rate for Payer: Blue Shield of California EPN |
$83.03
|
| Rate for Payer: Cash Price |
$16.75
|
| Rate for Payer: Cash Price |
$16.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.37
|
| Rate for Payer: Dignity Health Senior |
$18.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.05
|
| Rate for Payer: Heritage Provider Network Senior |
$23.05
|
| Rate for Payer: Humana Medicare |
$18.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.34
|
| Rate for Payer: Multiplan Commercial |
$27.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.52
|
| Rate for Payer: TriValley Medical Group Senior |
$18.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.37
|
| Rate for Payer: Vantage Medical Group Senior |
$18.52
|
|
|
HC SOM CYSTATIN C WITH EGFR, S
|
Facility
|
IP
|
$37.23
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
900915362
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$27.92 |
| Rate for Payer: Adventist Health Commercial |
$7.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.58
|
| Rate for Payer: Cash Price |
$16.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.20
|
| Rate for Payer: Heritage Provider Network Senior |
$25.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.31
|
| Rate for Payer: Multiplan Commercial |
$27.92
|
|
|
HC SOM CYSTICERCOSIS AB BLOOD
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911763
|
|
Hospital Revenue Code
|
302
|
| 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 CYSTICERCOSIS AB BLOOD
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911763
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$109.88 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.88
|
| Rate for Payer: Blue Shield of California Commercial |
$101.57
|
| Rate for Payer: Blue Shield of California EPN |
$79.40
|
| 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 |
$19.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: Dignity Health Senior |
$13.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.57
|
| Rate for Payer: Heritage Provider Network Senior |
$18.57
|
| Rate for Payer: Humana Medicare |
$13.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.39
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.01
|
| Rate for Payer: TriValley Medical Group Senior |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13.01
|
|
|
HC SOM CYSTIC FIBROSIS DNA
|
Facility
|
IP
|
$168.38
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
900911481
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.48 |
| Max. Negotiated Rate |
$126.28 |
| Rate for Payer: Adventist Health Commercial |
$33.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$115.68
|
| Rate for Payer: Cash Price |
$75.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.99
|
| Rate for Payer: Heritage Provider Network Senior |
$113.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.10
|
| Rate for Payer: Multiplan Commercial |
$126.28
|
|
|
HC SOM CYSTIC FIBROSIS DNA
|
Facility
|
OP
|
$168.38
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
900911481
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.48 |
| Max. Negotiated Rate |
$3,548.31 |
| Rate for Payer: Adventist Health Commercial |
$33.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,191.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$115.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$834.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$612.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$556.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,548.31
|
| Rate for Payer: Blue Shield of California Commercial |
$104.56
|
| Rate for Payer: Blue Shield of California EPN |
$98.84
|
| Rate for Payer: Cash Price |
$75.77
|
| Rate for Payer: Cash Price |
$75.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$109.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$834.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$612.26
|
| Rate for Payer: Dignity Health Senior |
$556.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$556.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$104.23
|
| Rate for Payer: Heritage Provider Network Senior |
$104.23
|
| Rate for Payer: Humana Medicare |
$556.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$280.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$556.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,057.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$656.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$701.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$701.32
|
| Rate for Payer: Multiplan Commercial |
$126.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$556.60
|
| Rate for Payer: TriValley Medical Group Senior |
$556.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$601.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$601.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$834.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$612.26
|
| Rate for Payer: Vantage Medical Group Senior |
$556.60
|
|
|
HC SOM DCP 83951
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 83951
|
| Hospital Charge Code |
900914920
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$537.25 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$187.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$537.25
|
| Rate for Payer: Blue Shield of California Commercial |
$525.68
|
| Rate for Payer: Blue Shield of California EPN |
$410.95
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.85
|
| Rate for Payer: Dignity Health Senior |
$64.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$64.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.71
|
| Rate for Payer: Heritage Provider Network Senior |
$55.71
|
| Rate for Payer: Humana Medicare |
$64.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$89.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$122.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$81.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$81.16
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$64.41
|
| Rate for Payer: TriValley Medical Group Senior |
$64.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$69.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$69.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.85
|
| Rate for Payer: Vantage Medical Group Senior |
$64.41
|
|
|
HC SOM DCP 83951
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 83951
|
| Hospital Charge Code |
900914920
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.83
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.93
|
| Rate for Payer: Heritage Provider Network Senior |
$60.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
|
