|
HC SOM CHROMOSOMES LYMPHOID
|
Facility
IP
|
$36.56
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912548
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$27.42 |
| Rate for Payer: Adventist Health Commercial |
$7.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.12
|
| Rate for Payer: Cash Price |
$16.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.75
|
| Rate for Payer: Heritage Provider Network Senior |
$24.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.14
|
| Rate for Payer: Multiplan Commercial |
$27.42
|
|
|
HC SOM CHROMOSOMES LYMPHOID
|
Facility
OP
|
$36.56
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912548
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$156.37 |
| Rate for Payer: Adventist Health Commercial |
$7.31
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.37
|
| Rate for Payer: Blue Shield of California Commercial |
$22.70
|
| Rate for Payer: Blue Shield of California EPN |
$21.46
|
| Rate for Payer: Cash Price |
$16.45
|
| Rate for Payer: Cash Price |
$16.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.08
|
| Rate for Payer: Dignity Health Senior |
$31.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.63
|
| Rate for Payer: Heritage Provider Network Senior |
$22.63
|
| Rate for Payer: IEHP Medi-Cal |
$21.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.14
|
| Rate for Payer: Multiplan Commercial |
$27.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.08
|
| Rate for Payer: Vantage Medical Group Senior |
$31.08
|
|
|
HC SOM CHROMOSOMES SKIN BIOPSY
|
Facility
IP
|
$276.95
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912547
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$50.13 |
| Max. Negotiated Rate |
$207.71 |
| Rate for Payer: Adventist Health Commercial |
$55.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$190.26
|
| Rate for Payer: Cash Price |
$124.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$187.50
|
| Rate for Payer: Heritage Provider Network Senior |
$187.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.24
|
| Rate for Payer: Multiplan Commercial |
$207.71
|
|
|
HC SOM CHROMOSOMES SKIN BIOPSY
|
Facility
OP
|
$276.95
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912547
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$235.41 |
| Rate for Payer: Adventist Health Commercial |
$55.39
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$190.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$235.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$152.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$207.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.37
|
| Rate for Payer: Blue Shield of California Commercial |
$171.99
|
| Rate for Payer: Blue Shield of California EPN |
$162.57
|
| Rate for Payer: Cash Price |
$124.63
|
| Rate for Payer: Cash Price |
$124.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$180.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$235.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$235.41
|
| Rate for Payer: Dignity Health Senior |
$235.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$171.43
|
| Rate for Payer: Heritage Provider Network Senior |
$171.43
|
| Rate for Payer: IEHP Medi-Cal |
$21.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$133.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.24
|
| Rate for Payer: Multiplan Commercial |
$207.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$235.41
|
| Rate for Payer: Vantage Medical Group Senior |
$235.41
|
|
|
HC SOM CHRONIC URTICARIA INDEX
|
Facility
OP
|
$160.00
|
|
|
Service Code
|
CPT 86343
|
| Hospital Charge Code |
900912840
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$36.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$109.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.92
|
| Rate for Payer: Blue Shield of California Commercial |
$97.32
|
| Rate for Payer: Blue Shield of California EPN |
$76.08
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$104.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.71
|
| Rate for Payer: Dignity Health Senior |
$12.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$99.04
|
| Rate for Payer: Heritage Provider Network Senior |
$99.04
|
| Rate for Payer: Humana Medicare |
$12.46
|
| Rate for Payer: IEHP Medi-Cal |
$17.27
|
| Rate for Payer: IEHP Medicare Advantage |
$12.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.70
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.46
|
| Rate for Payer: TriValley Medical Group Senior |
$12.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: Vantage Medical Group Senior |
$12.46
|
|
|
HC SOM CHRONIC URTICARIA INDEX
|
Facility
IP
|
$160.00
|
|
|
Service Code
|
CPT 86343
|
| Hospital Charge Code |
900912840
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.96 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$109.92
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.32
|
| Rate for Payer: Heritage Provider Network Senior |
$108.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
|
|
HC SOM CHRTI CULTURE 02
|
Facility
OP
|
$176.99
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915283
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.04 |
| Max. Negotiated Rate |
$1,099.16 |
| Rate for Payer: Adventist Health Commercial |
$35.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$409.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$121.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$211.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$999.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1,099.16
|
| Rate for Payer: Blue Shield of California EPN |
$859.27
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$115.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: Dignity Health Senior |
$140.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$140.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.56
|
| Rate for Payer: Heritage Provider Network Senior |
$109.56
|
| Rate for Payer: Humana Medicare |
$140.73
|
| Rate for Payer: IEHP Medi-Cal |
$195.12
|
| Rate for Payer: IEHP Medicare Advantage |
$140.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$267.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$177.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$177.32
|
| Rate for Payer: Multiplan Commercial |
$132.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$140.73
|
| Rate for Payer: TriValley Medical Group Senior |
$140.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$151.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$151.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
|
|
HC SOM CHRTI CULTURE 02
|
Facility
IP
|
$176.99
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915283
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.04 |
| Max. Negotiated Rate |
$132.74 |
| Rate for Payer: Adventist Health Commercial |
$35.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$121.59
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$119.82
|
| Rate for Payer: Heritage Provider Network Senior |
$119.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.25
|
| Rate for Payer: Multiplan Commercial |
$132.74
|
|
|
HC SOM CIRC TUMOR PROS FLOW
|
Facility
IP
|
$325.24
|
|
|
Service Code
|
CPT 86152
|
| Hospital Charge Code |
900914391
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.87 |
| Max. Negotiated Rate |
$243.93 |
| Rate for Payer: Adventist Health Commercial |
$65.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$223.44
|
| Rate for Payer: Cash Price |
$146.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$220.19
|
| Rate for Payer: Heritage Provider Network Senior |
$220.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.31
|
| Rate for Payer: Multiplan Commercial |
$243.93
|
|
|
HC SOM CIRC TUMOR PROS FLOW
|
Facility
OP
|
$325.24
|
|
|
Service Code
|
CPT 86152
|
| Hospital Charge Code |
900914391
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.87 |
| Max. Negotiated Rate |
$1,687.92 |
| Rate for Payer: Adventist Health Commercial |
$65.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,687.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$223.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$376.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$250.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$713.97
|
| Rate for Payer: Blue Shield of California Commercial |
$201.97
|
| Rate for Payer: Blue Shield of California EPN |
$190.92
|
| Rate for Payer: Cash Price |
$146.36
|
| Rate for Payer: Cash Price |
$146.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$211.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$376.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.86
|
| Rate for Payer: Dignity Health Senior |
$250.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$201.32
|
| Rate for Payer: Heritage Provider Network Senior |
$201.32
|
| Rate for Payer: Humana Medicare |
$250.78
|
| Rate for Payer: IEHP Medicare Advantage |
$250.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$476.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.98
|
| Rate for Payer: Multiplan Commercial |
$243.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$250.78
|
| Rate for Payer: TriValley Medical Group Senior |
$250.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$270.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$270.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$376.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.86
|
| Rate for Payer: Vantage Medical Group Senior |
$250.78
|
|
|
HC SOM CIRC TUMOR PROS MARK
|
Facility
IP
|
$325.24
|
|
|
Service Code
|
CPT 86153
|
| Hospital Charge Code |
900914392
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.87 |
| Max. Negotiated Rate |
$243.93 |
| Rate for Payer: Adventist Health Commercial |
$65.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$223.44
|
| Rate for Payer: Cash Price |
$146.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$220.19
|
| Rate for Payer: Heritage Provider Network Senior |
$220.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.31
|
| Rate for Payer: Multiplan Commercial |
$243.93
|
|
|
HC SOM CIRC TUMOR PROS MARK
|
Facility
OP
|
$325.24
|
|
|
Service Code
|
CPT 86153
|
| Hospital Charge Code |
900914392
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.87 |
| Max. Negotiated Rate |
$364.84 |
| Rate for Payer: Adventist Health Commercial |
$65.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$364.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$223.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$276.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$178.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$243.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$178.01
|
| Rate for Payer: Blue Shield of California Commercial |
$201.97
|
| Rate for Payer: Blue Shield of California EPN |
$190.92
|
| Rate for Payer: Cash Price |
$146.36
|
| Rate for Payer: Cash Price |
$146.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$211.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$276.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$276.45
|
| Rate for Payer: Dignity Health Senior |
$276.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$201.32
|
| Rate for Payer: Heritage Provider Network Senior |
$201.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$156.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.31
|
| Rate for Payer: Multiplan Commercial |
$243.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$276.45
|
| Rate for Payer: Vantage Medical Group Senior |
$276.45
|
|
|
HC SOM CITRIC ACID URINE
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
900911053
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$232.67 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$80.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$41.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$30.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.67
|
| Rate for Payer: Blue Shield of California Commercial |
$217.17
|
| Rate for Payer: Blue Shield of California EPN |
$169.77
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.58
|
| Rate for Payer: Dignity Health Senior |
$27.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$27.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Humana Medicare |
$27.80
|
| Rate for Payer: IEHP Medi-Cal |
$38.55
|
| Rate for Payer: IEHP Medicare Advantage |
$27.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$52.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.03
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.80
|
| Rate for Payer: TriValley Medical Group Senior |
$27.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$30.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$30.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.58
|
| Rate for Payer: Vantage Medical Group Senior |
$27.80
|
|
|
HC SOM CITRIC ACID URINE
|
Facility
IP
|
$20.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
900911053
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC SOM CLONAZEPAM (CLONOPIN)
|
Facility
IP
|
$29.65
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.37 |
| Max. Negotiated Rate |
$22.24 |
| Rate for Payer: Adventist Health Commercial |
$5.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.37
|
| Rate for Payer: Cash Price |
$13.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.07
|
| Rate for Payer: Heritage Provider Network Senior |
$20.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.41
|
| Rate for Payer: Multiplan Commercial |
$22.24
|
|
|
HC SOM CLONAZEPAM (CLONOPIN)
|
Facility
OP
|
$29.65
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$148.48 |
| Rate for Payer: Adventist Health Commercial |
$5.93
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.48
|
| Rate for Payer: Cash Price |
$13.34
|
| Rate for Payer: Cash Price |
$13.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.20
|
| Rate for Payer: Dignity Health Senior |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.35
|
| Rate for Payer: Heritage Provider Network Senior |
$18.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.41
|
| Rate for Payer: Multiplan Commercial |
$22.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.20
|
| Rate for Payer: Vantage Medical Group Senior |
$25.20
|
|
|
HC SOM CLOZAPINE LEVEL
|
Facility
OP
|
$31.59
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
900911438
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$141.04 |
| Rate for Payer: Adventist Health Commercial |
$6.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.15
|
| Rate for Payer: Blue Shield of California Commercial |
$141.04
|
| Rate for Payer: Blue Shield of California EPN |
$110.26
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.16
|
| Rate for Payer: Dignity Health Senior |
$20.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.55
|
| Rate for Payer: Heritage Provider Network Senior |
$19.55
|
| Rate for Payer: Humana Medicare |
$20.15
|
| Rate for Payer: IEHP Medi-Cal |
$25.65
|
| Rate for Payer: IEHP Medicare Advantage |
$20.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.39
|
| Rate for Payer: Multiplan Commercial |
$23.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.15
|
| Rate for Payer: TriValley Medical Group Senior |
$20.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.16
|
| Rate for Payer: Vantage Medical Group Senior |
$20.15
|
|
|
HC SOM CLOZAPINE LEVEL
|
Facility
IP
|
$31.59
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
900911438
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$23.69 |
| Rate for Payer: Adventist Health Commercial |
$6.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.70
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.39
|
| Rate for Payer: Heritage Provider Network Senior |
$21.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.90
|
| Rate for Payer: Multiplan Commercial |
$23.69
|
|
|
HC SOM CMV PCR NON-BLOOD
|
Facility
IP
|
$55.00
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
900912519
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.24
|
| Rate for Payer: Heritage Provider Network Senior |
$37.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
|
|
HC SOM CMV PCR NON-BLOOD
|
Facility
OP
|
$55.00
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
900912519
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$284.23 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.23
|
| Rate for Payer: Blue Shield of California Commercial |
$274.13
|
| Rate for Payer: Blue Shield of California EPN |
$214.30
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.04
|
| Rate for Payer: Heritage Provider Network Senior |
$34.04
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: IEHP Medi-Cal |
$48.66
|
| Rate for Payer: IEHP Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| 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 |
$41.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM CMVQU 87497
|
Facility
OP
|
$333.90
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
900915269
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$334.56 |
| Rate for Payer: Adventist Health Commercial |
$66.78
|
| Rate for Payer: Aetna of CA Gatekeeper |
$124.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$229.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$216.56
|
| Rate for Payer: Blue Shield of California Commercial |
$334.56
|
| Rate for Payer: Blue Shield of California EPN |
$261.54
|
| Rate for Payer: Cash Price |
$150.26
|
| Rate for Payer: Cash Price |
$150.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$217.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Senior |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$206.68
|
| Rate for Payer: Heritage Provider Network Senior |
$206.68
|
| Rate for Payer: Humana Medicare |
$42.84
|
| Rate for Payer: IEHP Medi-Cal |
$59.40
|
| Rate for Payer: IEHP Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$81.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.98
|
| Rate for Payer: Multiplan Commercial |
$250.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.84
|
| Rate for Payer: TriValley Medical Group Senior |
$42.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC SOM CMVQU 87497
|
Facility
IP
|
$333.90
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
900915269
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.44 |
| Max. Negotiated Rate |
$250.42 |
| Rate for Payer: Adventist Health Commercial |
$66.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$229.39
|
| Rate for Payer: Cash Price |
$150.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$226.05
|
| Rate for Payer: Heritage Provider Network Senior |
$226.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.48
|
| Rate for Payer: Multiplan Commercial |
$250.42
|
|
|
HC SOM CNS DEMYELINATING MOG FACS
|
Facility
IP
|
$300.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915331
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$206.10
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.10
|
| Rate for Payer: Heritage Provider Network Senior |
$203.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
|
|
HC SOM CNS DEMYELINATING MOG FACS
|
Facility
OP
|
$300.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915331
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$206.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.92
|
| Rate for Payer: Blue Shield of California Commercial |
$94.14
|
| Rate for Payer: Blue Shield of California EPN |
$73.59
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$195.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$185.70
|
| Rate for Payer: Heritage Provider Network Senior |
$185.70
|
| Rate for Payer: Humana Medicare |
$12.05
|
| Rate for Payer: IEHP Medi-Cal |
$13.46
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM CNS DEMYELINATING NMO/AQP4 FACS
|
Facility
OP
|
$300.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915330
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$206.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.92
|
| Rate for Payer: Blue Shield of California Commercial |
$94.14
|
| Rate for Payer: Blue Shield of California EPN |
$73.59
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$195.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$185.70
|
| Rate for Payer: Heritage Provider Network Senior |
$185.70
|
| Rate for Payer: Humana Medicare |
$12.05
|
| Rate for Payer: IEHP Medi-Cal |
$13.46
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
