|
HC SOM 11-DEOXYCORTISOL (COMPOUNDS)
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 82633
|
| Hospital Charge Code |
900911027
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.24
|
| Rate for Payer: Heritage Provider Network Senior |
$81.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
|
|
HC SOM 11-DEOXYCORTISOL (COMPOUNDS)
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 82633
|
| Hospital Charge Code |
900911027
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$273.63 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$273.63
|
| Rate for Payer: Blue Shield of California Commercial |
$249.29
|
| Rate for Payer: Blue Shield of California EPN |
$199.95
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.08
|
| Rate for Payer: Dignity Health Senior |
$30.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$30.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.28
|
| Rate for Payer: Heritage Provider Network Senior |
$74.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$44.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$57.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.03
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$30.98
|
| Rate for Payer: TriValley Medical Group Senior |
$30.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$33.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$33.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.08
|
| Rate for Payer: Vantage Medical Group Senior |
$30.98
|
|
|
HC SOM 17-OH-PROGESTERONE
|
Facility
|
OP
|
$17.55
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
900911017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$248.00 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$248.00
|
| Rate for Payer: Blue Shield of California Commercial |
$218.59
|
| Rate for Payer: Blue Shield of California EPN |
$175.33
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.89
|
| Rate for Payer: Dignity Health Senior |
$27.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$27.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.86
|
| Rate for Payer: Heritage Provider Network Senior |
$10.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.23
|
| Rate for Payer: Multiplan Commercial |
$13.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.17
|
| Rate for Payer: TriValley Medical Group Senior |
$27.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.89
|
| Rate for Payer: Vantage Medical Group Senior |
$27.17
|
|
|
HC SOM 17-OH-PROGESTERONE
|
Facility
|
IP
|
$17.55
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
900911017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$13.16 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.88
|
| Rate for Payer: Heritage Provider Network Senior |
$11.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.39
|
| Rate for Payer: Multiplan Commercial |
$13.16
|
|
|
HC SOM 18-OH CORTICOSTERONE
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910709
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.59 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Adventist Health Commercial |
$33.80
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.41
|
| Rate for Payer: Heritage Provider Network Senior |
$114.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.25
|
| Rate for Payer: Multiplan Commercial |
$126.75
|
|
|
HC SOM 18-OH CORTICOSTERONE
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910709
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$164.17 |
| Rate for Payer: Adventist Health Commercial |
$33.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$90.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.17
|
| Rate for Payer: Blue Shield of California Commercial |
$145.32
|
| Rate for Payer: Blue Shield of California EPN |
$116.56
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$109.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Senior |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$104.61
|
| Rate for Payer: Heritage Provider Network Senior |
$104.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$80.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.35
|
| Rate for Payer: Multiplan Commercial |
$126.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.09
|
| Rate for Payer: TriValley Medical Group Senior |
$24.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM 199PC 86301
|
Facility
|
OP
|
$29.81
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
900914879
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$189.86 |
| Rate for Payer: Adventist Health Commercial |
$5.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.86
|
| Rate for Payer: Blue Shield of California Commercial |
$167.44
|
| Rate for Payer: Blue Shield of California EPN |
$134.30
|
| Rate for Payer: Cash Price |
$29.81
|
| Rate for Payer: Cash Price |
$29.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Senior |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.45
|
| Rate for Payer: Heritage Provider Network Senior |
$18.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.22
|
| Rate for Payer: Multiplan Commercial |
$22.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.81
|
| Rate for Payer: TriValley Medical Group Senior |
$20.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC SOM 199PC 86301
|
Facility
|
IP
|
$29.81
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
900914879
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Adventist Health Commercial |
$5.96
|
| Rate for Payer: Cash Price |
$29.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.18
|
| Rate for Payer: Heritage Provider Network Senior |
$20.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.45
|
| Rate for Payer: Multiplan Commercial |
$22.36
|
|
|
HC SOM 22FP 88271 MULTIPLE
|
Facility
|
IP
|
$19.22
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914753
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$14.41 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.01
|
| Rate for Payer: Heritage Provider Network Senior |
$13.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$14.41
|
|
|
HC SOM 22FP 88271 MULTIPLE
|
Facility
|
OP
|
$19.22
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914753
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$1,548.87 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,548.87
|
| Rate for Payer: Blue Shield of California Commercial |
$172.40
|
| Rate for Payer: Blue Shield of California EPN |
$138.28
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Senior |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.49
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.90
|
| Rate for Payer: Heritage Provider Network Senior |
$11.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.99
|
| Rate for Payer: Multiplan Commercial |
$14.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.42
|
| Rate for Payer: TriValley Medical Group Senior |
$21.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC SOM 22FP 88271 SINGLE
|
Facility
|
IP
|
$19.46
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914752
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$14.60 |
| Rate for Payer: Adventist Health Commercial |
$3.89
|
| Rate for Payer: Cash Price |
$19.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.17
|
| Rate for Payer: Heritage Provider Network Senior |
$13.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: Multiplan Commercial |
$14.60
|
|
|
HC SOM 22FP 88271 SINGLE
|
Facility
|
OP
|
$19.46
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914752
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$1,548.87 |
| Rate for Payer: Adventist Health Commercial |
$3.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,548.87
|
| Rate for Payer: Blue Shield of California Commercial |
$172.40
|
| Rate for Payer: Blue Shield of California EPN |
$138.28
|
| Rate for Payer: Cash Price |
$19.46
|
| Rate for Payer: Cash Price |
$19.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Senior |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.05
|
| Rate for Payer: Heritage Provider Network Senior |
$12.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.99
|
| Rate for Payer: Multiplan Commercial |
$14.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.42
|
| Rate for Payer: TriValley Medical Group Senior |
$21.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC SOM 22FP 88275 MULTIPLE
|
Facility
|
IP
|
$19.22
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914754
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$14.41 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.01
|
| Rate for Payer: Heritage Provider Network Senior |
$13.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$14.41
|
|
|
HC SOM 22FP 88275 MULTIPLE
|
Facility
|
OP
|
$19.22
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914754
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$2,389.68 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,389.68
|
| Rate for Payer: Blue Shield of California Commercial |
$323.19
|
| Rate for Payer: Blue Shield of California EPN |
$259.23
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Senior |
$51.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.49
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.90
|
| Rate for Payer: Heritage Provider Network Senior |
$11.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.50
|
| Rate for Payer: Multiplan Commercial |
$14.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.19
|
| Rate for Payer: TriValley Medical Group Senior |
$51.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC SOM 26 ADD FISH PROB 100-300
|
Facility
|
IP
|
$281.76
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914714
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$211.32 |
| Rate for Payer: Adventist Health Commercial |
$56.35
|
| Rate for Payer: Cash Price |
$281.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$190.75
|
| Rate for Payer: Heritage Provider Network Senior |
$190.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.44
|
| Rate for Payer: Multiplan Commercial |
$211.32
|
|
|
HC SOM 26 ADD FISH PROB 100-300
|
Facility
|
OP
|
$281.76
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914714
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$2,389.68 |
| Rate for Payer: Adventist Health Commercial |
$56.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$150.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$193.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,389.68
|
| Rate for Payer: Blue Shield of California Commercial |
$323.19
|
| Rate for Payer: Blue Shield of California EPN |
$259.23
|
| Rate for Payer: Cash Price |
$281.76
|
| Rate for Payer: Cash Price |
$281.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$183.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Senior |
$51.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.41
|
| Rate for Payer: Heritage Provider Network Senior |
$174.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$134.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.50
|
| Rate for Payer: Multiplan Commercial |
$211.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.19
|
| Rate for Payer: TriValley Medical Group Senior |
$51.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC SOM 26 ADD FISH PROBES
|
Facility
|
OP
|
$463.14
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914713
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$1,548.87 |
| Rate for Payer: Adventist Health Commercial |
$92.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$247.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$318.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,548.87
|
| Rate for Payer: Blue Shield of California Commercial |
$172.40
|
| Rate for Payer: Blue Shield of California EPN |
$138.28
|
| Rate for Payer: Cash Price |
$463.14
|
| Rate for Payer: Cash Price |
$463.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$301.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Senior |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$301.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$286.68
|
| Rate for Payer: Heritage Provider Network Senior |
$286.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$220.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.99
|
| Rate for Payer: Multiplan Commercial |
$347.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.42
|
| Rate for Payer: TriValley Medical Group Senior |
$21.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC SOM 26 ADD FISH PROBES
|
Facility
|
IP
|
$463.14
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914713
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$83.83 |
| Max. Negotiated Rate |
$347.36 |
| Rate for Payer: Adventist Health Commercial |
$92.63
|
| Rate for Payer: Cash Price |
$463.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$313.55
|
| Rate for Payer: Heritage Provider Network Senior |
$313.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.78
|
| Rate for Payer: Multiplan Commercial |
$347.36
|
|
|
HC SOM 28 ADD FISH PROB 100-300
|
Facility
|
OP
|
$302.64
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914712
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$2,389.68 |
| Rate for Payer: Adventist Health Commercial |
$60.53
|
| Rate for Payer: Aetna of CA Gatekeeper |
$161.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$207.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,389.68
|
| Rate for Payer: Blue Shield of California Commercial |
$323.19
|
| Rate for Payer: Blue Shield of California EPN |
$259.23
|
| Rate for Payer: Cash Price |
$302.64
|
| Rate for Payer: Cash Price |
$302.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$196.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Senior |
$51.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.72
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$187.33
|
| Rate for Payer: Heritage Provider Network Senior |
$187.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$144.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.50
|
| Rate for Payer: Multiplan Commercial |
$226.98
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.19
|
| Rate for Payer: TriValley Medical Group Senior |
$51.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC SOM 28 ADD FISH PROB 100-300
|
Facility
|
IP
|
$302.64
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914712
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$54.78 |
| Max. Negotiated Rate |
$226.98 |
| Rate for Payer: Adventist Health Commercial |
$60.53
|
| Rate for Payer: Cash Price |
$302.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$204.89
|
| Rate for Payer: Heritage Provider Network Senior |
$204.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.66
|
| Rate for Payer: Multiplan Commercial |
$226.98
|
|
|
HC SOM 28 ADD FISH PROBES
|
Facility
|
OP
|
$497.56
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914711
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$1,548.87 |
| Rate for Payer: Adventist Health Commercial |
$99.51
|
| Rate for Payer: Aetna of CA Gatekeeper |
$265.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$341.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,548.87
|
| Rate for Payer: Blue Shield of California Commercial |
$172.40
|
| Rate for Payer: Blue Shield of California EPN |
$138.28
|
| Rate for Payer: Cash Price |
$497.56
|
| Rate for Payer: Cash Price |
$497.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$323.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Senior |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$307.99
|
| Rate for Payer: Heritage Provider Network Senior |
$307.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$237.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.99
|
| Rate for Payer: Multiplan Commercial |
$373.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.42
|
| Rate for Payer: TriValley Medical Group Senior |
$21.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC SOM 28 ADD FISH PROBES
|
Facility
|
IP
|
$497.56
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914711
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$90.06 |
| Max. Negotiated Rate |
$373.17 |
| Rate for Payer: Adventist Health Commercial |
$99.51
|
| Rate for Payer: Cash Price |
$497.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$336.85
|
| Rate for Payer: Heritage Provider Network Senior |
$336.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.39
|
| Rate for Payer: Multiplan Commercial |
$373.17
|
|
|
HC SOM 2 DAYS TURNAROUND 6800
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT U0005
|
| Hospital Charge Code |
900915350
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$24.00
|
| 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 2 DAYS TURNAROUND 6800
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT U0005
|
| Hospital Charge Code |
900915350
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$153.66 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.66
|
| Rate for Payer: Blue Shield of California Commercial |
$14.64
|
| Rate for Payer: Blue Shield of California EPN |
$11.71
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Senior |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.86
|
| Rate for Payer: Heritage Provider Network Senior |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.45
|
| 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: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC SOM 5-FLUOROCYTOSINE
|
Facility
|
IP
|
$34.02
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911263
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$25.52 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Cash Price |
$34.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.03
|
| Rate for Payer: Heritage Provider Network Senior |
$23.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.51
|
| Rate for Payer: Multiplan Commercial |
$25.52
|
|
