|
HC SOM COCCIDIOIDES AB IGG BY ID
|
Facility
|
OP
|
$13.50
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900911752
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$106.21 |
| Rate for Payer: Adventist Health Commercial |
$2.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.21
|
| Rate for Payer: Blue Shield of California Commercial |
$92.33
|
| Rate for Payer: Blue Shield of California EPN |
$74.06
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Senior |
$11.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.36
|
| Rate for Payer: Heritage Provider Network Senior |
$8.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.45
|
| Rate for Payer: Multiplan Commercial |
$10.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.47
|
| Rate for Payer: TriValley Medical Group Senior |
$11.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COCCIDIOIDES AB IGM BY ID
|
Facility
|
OP
|
$13.50
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912668
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$106.21 |
| Rate for Payer: Adventist Health Commercial |
$2.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.21
|
| Rate for Payer: Blue Shield of California Commercial |
$92.33
|
| Rate for Payer: Blue Shield of California EPN |
$74.06
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Senior |
$11.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.36
|
| Rate for Payer: Heritage Provider Network Senior |
$8.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.45
|
| Rate for Payer: Multiplan Commercial |
$10.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.47
|
| Rate for Payer: TriValley Medical Group Senior |
$11.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COCCIDIOIDES AB IGM BY ID
|
Facility
|
IP
|
$13.50
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912668
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$10.12 |
| Rate for Payer: Adventist Health Commercial |
$2.70
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.14
|
| Rate for Payer: Heritage Provider Network Senior |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.38
|
| Rate for Payer: Multiplan Commercial |
$10.12
|
|
|
HC SOM COCCIDOIDES PCR
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.86 |
| Max. Negotiated Rate |
$310.02 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$88.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$113.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.02
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$107.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.14
|
| Rate for Payer: Heritage Provider Network Senior |
$102.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$78.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM COCCIDOIDES PCR
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.86 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.70
|
| Rate for Payer: Heritage Provider Network Senior |
$111.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.25
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
|
|
HC SOM COLONIES 1-6
|
Facility
|
IP
|
$93.75
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
900915300
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$16.97 |
| Max. Negotiated Rate |
$70.31 |
| Rate for Payer: Adventist Health Commercial |
$18.75
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.47
|
| Rate for Payer: Heritage Provider Network Senior |
$63.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.44
|
| Rate for Payer: Multiplan Commercial |
$70.31
|
|
|
HC SOM COLONIES 1-6
|
Facility
|
OP
|
$93.75
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
900915300
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$16.97 |
| Max. Negotiated Rate |
$1,518.32 |
| Rate for Payer: Adventist Health Commercial |
$18.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$191.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,518.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1,338.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,073.60
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.03
|
| Rate for Payer: Dignity Health Senior |
$173.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$173.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.03
|
| Rate for Payer: Heritage Provider Network Senior |
$58.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$239.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$173.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$199.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$218.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$218.81
|
| Rate for Payer: Multiplan Commercial |
$70.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$173.66
|
| Rate for Payer: TriValley Medical Group Senior |
$173.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$187.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$187.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$260.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.03
|
| Rate for Payer: Vantage Medical Group Senior |
$173.66
|
|
|
HC SOM COMPLEMENT C1Q
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900911109
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$109.59 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.59
|
| Rate for Payer: Blue Shield of California Commercial |
$96.65
|
| Rate for Payer: Blue Shield of California EPN |
$77.52
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: Dignity Health Senior |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.47
|
| Rate for Payer: Heritage Provider Network Senior |
$15.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.12
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
|
|
HC SOM COMPLEMENT C1Q
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900911109
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.93
|
| Rate for Payer: Heritage Provider Network Senior |
$16.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SOM COMPLEMENT C1Q BINDING
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900911097
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$222.50 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.50
|
| Rate for Payer: Blue Shield of California Commercial |
$196.13
|
| Rate for Payer: Blue Shield of California EPN |
$157.31
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.81
|
| Rate for Payer: Dignity Health Senior |
$24.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.23
|
| Rate for Payer: Heritage Provider Network Senior |
$53.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.71
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.37
|
| Rate for Payer: TriValley Medical Group Senior |
$24.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: Vantage Medical Group Senior |
$24.37
|
|
|
HC SOM COMPLEMENT C1Q BINDING
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900911097
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.22
|
| Rate for Payer: Heritage Provider Network Senior |
$58.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
|
|
HC SOM COMPLEMENT C-2
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
900911110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$109.59 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.59
|
| Rate for Payer: Blue Shield of California Commercial |
$96.65
|
| Rate for Payer: Blue Shield of California EPN |
$77.52
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: Dignity Health Senior |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.12
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
|
|
HC SOM COMPLEMENT C-2
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
900911110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.85
|
| Rate for Payer: Heritage Provider Network Senior |
$33.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
|
|
HC SOM COMPLEMENT C-5
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900911042
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$109.59 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.59
|
| Rate for Payer: Blue Shield of California Commercial |
$96.65
|
| Rate for Payer: Blue Shield of California EPN |
$77.52
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: Dignity Health Senior |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.86
|
| Rate for Payer: Heritage Provider Network Senior |
$27.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.12
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
|
|
HC SOM COMPLEMENT C-5
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900911042
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.46
|
| Rate for Payer: Heritage Provider Network Senior |
$30.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
|
|
HC SOM COMPLEMENT TOTAL
|
Facility
|
IP
|
$13.83
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
900915322
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$10.37 |
| Rate for Payer: Adventist Health Commercial |
$2.77
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.36
|
| Rate for Payer: Heritage Provider Network Senior |
$9.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.46
|
| Rate for Payer: Multiplan Commercial |
$10.37
|
|
|
HC SOM COMPLEMENT TOTAL
|
Facility
|
OP
|
$13.83
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
900915322
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$185.43 |
| Rate for Payer: Adventist Health Commercial |
$2.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.43
|
| Rate for Payer: Blue Shield of California Commercial |
$163.53
|
| Rate for Payer: Blue Shield of California EPN |
$131.16
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.35
|
| Rate for Payer: Dignity Health Senior |
$20.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.99
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.56
|
| Rate for Payer: Heritage Provider Network Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.60
|
| Rate for Payer: Multiplan Commercial |
$10.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.32
|
| Rate for Payer: TriValley Medical Group Senior |
$20.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.35
|
| Rate for Payer: Vantage Medical Group Senior |
$20.32
|
|
|
HC SOM CONF HC DRUG ABUSE SUR 12, U
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912913
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.55
|
| Rate for Payer: Heritage Provider Network Senior |
$101.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
|
|
HC SOM CONF HC DRUG ABUSE SUR 12, U
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912913
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$562.57 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$80.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$562.57
|
| Rate for Payer: Blue Shield of California Commercial |
$459.71
|
| Rate for Payer: Blue Shield of California EPN |
$368.72
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$97.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$62.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.85
|
| Rate for Payer: Heritage Provider Network Senior |
$92.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$71.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.30
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.14
|
| Rate for Payer: TriValley Medical Group Senior |
$62.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$67.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC SOM COPPER SERUM
|
Facility
|
OP
|
$14.32
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911099
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$113.58 |
| Rate for Payer: Adventist Health Commercial |
$2.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.61
|
| 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 |
$113.58
|
| Rate for Payer: Blue Shield of California Commercial |
$99.88
|
| Rate for Payer: Blue Shield of California EPN |
$80.11
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.65
|
| Rate for Payer: Dignity Health Senior |
$12.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.31
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.86
|
| Rate for Payer: Heritage Provider Network Senior |
$8.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.58
|
| 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 |
$10.74
|
| 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 |
$18.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Vantage Medical Group Senior |
$12.41
|
|
|
HC SOM COPPER SERUM
|
Facility
|
IP
|
$14.32
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911099
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$10.74 |
| Rate for Payer: Adventist Health Commercial |
$2.86
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.69
|
| Rate for Payer: Heritage Provider Network Senior |
$9.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.58
|
| Rate for Payer: Multiplan Commercial |
$10.74
|
|
|
HC SOM COPPER URINE
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$113.58 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.61
|
| 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 |
$113.58
|
| Rate for Payer: Blue Shield of California Commercial |
$99.88
|
| Rate for Payer: Blue Shield of California EPN |
$80.11
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.65
|
| Rate for Payer: Dignity Health Senior |
$12.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.86
|
| Rate for Payer: Heritage Provider Network Senior |
$27.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| 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 |
$33.75
|
| 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 |
$18.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Vantage Medical Group Senior |
$12.41
|
|
|
HC SOM COPPER URINE
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.46
|
| Rate for Payer: Heritage Provider Network Senior |
$30.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
|
|
HC SOM CORT FREE QUANTITATION
|
Facility
|
OP
|
$19.97
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$164.17 |
| Rate for Payer: Adventist Health Commercial |
$3.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 |
$19.97
|
| Rate for Payer: Cash Price |
$19.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.52
|
| Rate for Payer: Dignity Health Senior |
$24.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.98
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.36
|
| Rate for Payer: Heritage Provider Network Senior |
$12.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.38
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.11
|
| Rate for Payer: TriValley Medical Group Senior |
$24.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Vantage Medical Group Senior |
$24.11
|
|
|
HC SOM CORT FREE QUANTITATION
|
Facility
|
IP
|
$19.97
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$14.98 |
| Rate for Payer: Adventist Health Commercial |
$3.99
|
| Rate for Payer: Cash Price |
$19.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.52
|
| Rate for Payer: Heritage Provider Network Senior |
$13.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.99
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
|
