|
HC SOM AMEBIASIS AB TITER
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
900911754
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$111.99 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.99
|
| Rate for Payer: Blue Shield of California Commercial |
$99.76
|
| Rate for Payer: Blue Shield of California EPN |
$80.02
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.63
|
| Rate for Payer: Dignity Health Senior |
$12.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.57
|
| Rate for Payer: Heritage Provider Network Senior |
$18.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.61
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.39
|
| Rate for Payer: TriValley Medical Group Senior |
$12.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.63
|
| Rate for Payer: Vantage Medical Group Senior |
$12.39
|
|
|
HC SOM AMEBIASIS AB TITER
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
900911754
|
|
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: Cash Price |
$30.00
|
| 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 AMINO ACID QUANT UR RANDOM
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
900911210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.70
|
| Rate for Payer: Heritage Provider Network Senior |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
|
|
HC SOM AMINO ACID QUANT UR RANDOM
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
900911210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$153.29 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.29
|
| Rate for Payer: Blue Shield of California Commercial |
$135.76
|
| Rate for Payer: Blue Shield of California EPN |
$108.89
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$65.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.56
|
| Rate for Payer: Dignity Health Senior |
$16.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.90
|
| Rate for Payer: Heritage Provider Network Senior |
$61.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.26
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.87
|
| Rate for Payer: TriValley Medical Group Senior |
$16.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Vantage Medical Group Senior |
$16.87
|
|
|
HC SOM AMINO ACIDS PLASMA
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
900910486
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$153.29 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$40.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$51.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.29
|
| Rate for Payer: Blue Shield of California Commercial |
$135.76
|
| Rate for Payer: Blue Shield of California EPN |
$108.89
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.56
|
| Rate for Payer: Dignity Health Senior |
$16.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.42
|
| Rate for Payer: Heritage Provider Network Senior |
$46.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.26
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.87
|
| Rate for Payer: TriValley Medical Group Senior |
$16.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Vantage Medical Group Senior |
$16.87
|
|
|
HC SOM AMINO ACIDS PLASMA
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
900910486
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.77
|
| Rate for Payer: Heritage Provider Network Senior |
$50.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
|
|
HC SOM AMIODARONE
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 80151
|
| Hospital Charge Code |
900911286
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$107.37 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.23
|
| Rate for Payer: Blue Shield of California Commercial |
$107.37
|
| Rate for Payer: Blue Shield of California EPN |
$86.12
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.57
|
| Rate for Payer: Heritage Provider Network Senior |
$18.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.49
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.64
|
| Rate for Payer: TriValley Medical Group Senior |
$18.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM AMIODARONE
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 80151
|
| Hospital Charge Code |
900911286
|
|
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: Cash Price |
$30.00
|
| 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 AMITRIPTYLINE LEVEL
|
Facility
|
IP
|
$234.83
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900912504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.50 |
| Max. Negotiated Rate |
$176.12 |
| Rate for Payer: Adventist Health Commercial |
$46.97
|
| Rate for Payer: Cash Price |
$234.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$158.98
|
| Rate for Payer: Heritage Provider Network Senior |
$158.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.71
|
| Rate for Payer: Multiplan Commercial |
$176.12
|
|
|
HC SOM AMITRIPTYLINE LEVEL
|
Facility
|
OP
|
$234.83
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900912504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.50 |
| Max. Negotiated Rate |
$199.61 |
| Rate for Payer: Adventist Health Commercial |
$46.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$125.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$161.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$199.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$176.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.73
|
| Rate for Payer: Cash Price |
$234.83
|
| Rate for Payer: Cash Price |
$234.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$152.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$199.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.61
|
| Rate for Payer: Dignity Health Senior |
$199.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.36
|
| Rate for Payer: Heritage Provider Network Senior |
$145.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$112.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$164.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$164.38
|
| Rate for Payer: Multiplan Commercial |
$176.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$117.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$117.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$199.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.61
|
| Rate for Payer: Vantage Medical Group Senior |
$199.61
|
|
|
HC SOM AMOBARBITAL
|
Facility
|
IP
|
$285.90
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900910550
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.75 |
| Max. Negotiated Rate |
$214.43 |
| Rate for Payer: Adventist Health Commercial |
$57.18
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$193.55
|
| Rate for Payer: Heritage Provider Network Senior |
$193.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.47
|
| Rate for Payer: Multiplan Commercial |
$214.43
|
|
|
HC SOM AMOBARBITAL
|
Facility
|
OP
|
$285.90
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900910550
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.75 |
| Max. Negotiated Rate |
$243.01 |
| Rate for Payer: Adventist Health Commercial |
$57.18
|
| Rate for Payer: Aetna of CA Gatekeeper |
$152.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$196.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$243.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$157.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$214.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.31
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$185.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$243.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$243.01
|
| Rate for Payer: Dignity Health Senior |
$243.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$176.97
|
| Rate for Payer: Heritage Provider Network Senior |
$176.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$136.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$200.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$200.13
|
| Rate for Payer: Multiplan Commercial |
$214.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$142.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$142.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$243.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$243.01
|
| Rate for Payer: Vantage Medical Group Senior |
$243.01
|
|
|
HC SOM AMOXAPINE
|
Facility
|
OP
|
$65.46
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900911071
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$156.73 |
| Rate for Payer: Adventist Health Commercial |
$13.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$34.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.73
|
| Rate for Payer: Cash Price |
$65.46
|
| Rate for Payer: Cash Price |
$65.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.64
|
| Rate for Payer: Dignity Health Senior |
$55.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.52
|
| Rate for Payer: Heritage Provider Network Senior |
$40.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.82
|
| Rate for Payer: Multiplan Commercial |
$49.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$32.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.64
|
| Rate for Payer: Vantage Medical Group Senior |
$55.64
|
|
|
HC SOM AMOXAPINE
|
Facility
|
IP
|
$65.46
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900911071
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$49.09 |
| Rate for Payer: Adventist Health Commercial |
$13.09
|
| Rate for Payer: Cash Price |
$65.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.32
|
| Rate for Payer: Heritage Provider Network Senior |
$44.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.36
|
| Rate for Payer: Multiplan Commercial |
$49.09
|
|
|
HC SOM AMPHETAMINE QUANT
|
Facility
|
OP
|
$20.78
|
|
|
Service Code
|
CPT 80325
|
| Hospital Charge Code |
900910720
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$149.72 |
| Rate for Payer: Adventist Health Commercial |
$4.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$149.72
|
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.66
|
| Rate for Payer: Dignity Health Senior |
$17.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.86
|
| Rate for Payer: Heritage Provider Network Senior |
$12.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.55
|
| Rate for Payer: Multiplan Commercial |
$15.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.66
|
| Rate for Payer: Vantage Medical Group Senior |
$17.66
|
|
|
HC SOM AMPHETAMINE QUANT
|
Facility
|
IP
|
$20.78
|
|
|
Service Code
|
CPT 80325
|
| Hospital Charge Code |
900910720
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$15.59 |
| Rate for Payer: Adventist Health Commercial |
$4.16
|
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.07
|
| Rate for Payer: Heritage Provider Network Senior |
$14.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$15.59
|
|
|
HC SOM AMYLASE BF
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900914004
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.25
|
| Rate for Payer: Blue Shield of California Commercial |
$52.19
|
| Rate for Payer: Blue Shield of California EPN |
$41.86
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Senior |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.19
|
| Rate for Payer: Heritage Provider Network Senior |
$6.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.16
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Senior |
$6.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
HC SOM AMYLASE BF
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900914004
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.77
|
| Rate for Payer: Heritage Provider Network Senior |
$6.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
|
|
HC SOM ANDROSTENEDIONE
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
900911011
|
|
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: 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 ANDROSTENEDIONE
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
900911011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$267.18 |
| 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 |
$43.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.18
|
| Rate for Payer: Blue Shield of California Commercial |
$235.58
|
| Rate for Payer: Blue Shield of California EPN |
$188.96
|
| 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 |
$43.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.21
|
| Rate for Payer: Dignity Health Senior |
$29.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$29.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.86
|
| Rate for Payer: Heritage Provider Network Senior |
$14.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.89
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.28
|
| Rate for Payer: TriValley Medical Group Senior |
$29.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Vantage Medical Group Senior |
$29.28
|
|
|
HC SOM ANGIOTENSIN 1 CONVERTING ENZYM
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
900911119
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.25
|
| Rate for Payer: Blue Shield of California Commercial |
$117.45
|
| Rate for Payer: Blue Shield of California EPN |
$94.20
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.06
|
| Rate for Payer: Dignity Health Senior |
$14.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.43
|
| Rate for Payer: Heritage Provider Network Senior |
$7.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.60
|
| Rate for Payer: TriValley Medical Group Senior |
$14.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.06
|
| Rate for Payer: Vantage Medical Group Senior |
$14.60
|
|
|
HC SOM ANGIOTENSIN 1 CONVERTING ENZYM
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
900911119
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.12
|
| Rate for Payer: Heritage Provider Network Senior |
$8.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
|
|
HC SOM ANGIOTENSIN CONVERT ENZ CS
|
Facility
|
OP
|
$68.50
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
900913826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Adventist Health Commercial |
$13.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$36.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.25
|
| Rate for Payer: Blue Shield of California Commercial |
$117.45
|
| Rate for Payer: Blue Shield of California EPN |
$94.20
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.06
|
| Rate for Payer: Dignity Health Senior |
$14.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.40
|
| Rate for Payer: Heritage Provider Network Senior |
$42.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$51.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.60
|
| Rate for Payer: TriValley Medical Group Senior |
$14.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.06
|
| Rate for Payer: Vantage Medical Group Senior |
$14.60
|
|
|
HC SOM ANGIOTENSIN CONVERT ENZ CS
|
Facility
|
IP
|
$68.50
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
900913826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$51.38 |
| Rate for Payer: Adventist Health Commercial |
$13.70
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.37
|
| Rate for Payer: Heritage Provider Network Senior |
$46.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.12
|
| Rate for Payer: Multiplan Commercial |
$51.38
|
|
|
HC SOM ANTI-DIURETIC HORMONE
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 84588
|
| Hospital Charge Code |
900911035
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Adventist Health Commercial |
$16.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.16
|
| Rate for Payer: Heritage Provider Network Senior |
$54.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
|
