|
HC SOM MCLON IFE U
|
Facility
|
IP
|
$28.86
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
900912768
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Adventist Health Commercial |
$5.77
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.54
|
| Rate for Payer: Heritage Provider Network Senior |
$19.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.21
|
| Rate for Payer: Multiplan Commercial |
$21.64
|
|
|
HC SOM MCLON PROT ELEC. U
|
Facility
|
IP
|
$17.53
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$13.15 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Cash Price |
$17.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.87
|
| Rate for Payer: Heritage Provider Network Senior |
$11.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.38
|
| Rate for Payer: Multiplan Commercial |
$13.15
|
|
|
HC SOM MCLON PROT ELEC. U
|
Facility
|
OP
|
$17.53
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$159.50 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.50
|
| Rate for Payer: Blue Shield of California Commercial |
$143.54
|
| Rate for Payer: Blue Shield of California EPN |
$115.13
|
| Rate for Payer: Cash Price |
$17.53
|
| Rate for Payer: Cash Price |
$17.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.61
|
| Rate for Payer: Dignity Health Senior |
$17.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.85
|
| Rate for Payer: Heritage Provider Network Senior |
$10.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.47
|
| Rate for Payer: Multiplan Commercial |
$13.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.83
|
| Rate for Payer: TriValley Medical Group Senior |
$17.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Vantage Medical Group Senior |
$17.83
|
|
|
HC SOM MCLON T. PROT U
|
Facility
|
IP
|
$3.61
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.71 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.44
|
| Rate for Payer: Heritage Provider Network Senior |
$2.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$2.71
|
|
|
HC SOM MCLON T. PROT U
|
Facility
|
OP
|
$3.61
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$33.56 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.56
|
| Rate for Payer: Blue Shield of California Commercial |
$29.49
|
| Rate for Payer: Blue Shield of California EPN |
$23.65
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: Dignity Health Senior |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$2.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.67
|
| Rate for Payer: TriValley Medical Group Senior |
$3.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
HC SOM MEASLES AB CSF IGG
|
Facility
|
IP
|
$22.50
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900911355
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$16.88 |
| Rate for Payer: Adventist Health Commercial |
$4.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.23
|
| Rate for Payer: Heritage Provider Network Senior |
$15.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.62
|
| Rate for Payer: Multiplan Commercial |
$16.88
|
|
|
HC SOM MEASLES AB CSF IGG
|
Facility
|
OP
|
$22.50
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900911355
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$117.64 |
| Rate for Payer: Adventist Health Commercial |
$4.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.64
|
| Rate for Payer: Blue Shield of California Commercial |
$103.68
|
| Rate for Payer: Blue Shield of California EPN |
$83.16
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.93
|
| Rate for Payer: Heritage Provider Network Senior |
$13.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$16.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.88
|
| Rate for Payer: TriValley Medical Group Senior |
$12.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM MEASLES AB IGM CSF
|
Facility
|
IP
|
$22.50
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900912655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$16.88 |
| Rate for Payer: Adventist Health Commercial |
$4.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.23
|
| Rate for Payer: Heritage Provider Network Senior |
$15.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.62
|
| Rate for Payer: Multiplan Commercial |
$16.88
|
|
|
HC SOM MEASLES AB IGM CSF
|
Facility
|
OP
|
$22.50
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900912655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$117.64 |
| Rate for Payer: Adventist Health Commercial |
$4.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.64
|
| Rate for Payer: Blue Shield of California Commercial |
$103.68
|
| Rate for Payer: Blue Shield of California EPN |
$83.16
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.93
|
| Rate for Payer: Heritage Provider Network Senior |
$13.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$16.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.88
|
| Rate for Payer: TriValley Medical Group Senior |
$12.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM MECONIUM AMPHETAMINE CONFIRM
|
Facility
|
OP
|
$35.08
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
900912830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$136.14 |
| Rate for Payer: Adventist Health Commercial |
$7.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.14
|
| Rate for Payer: Cash Price |
$35.08
|
| Rate for Payer: Cash Price |
$35.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.82
|
| Rate for Payer: Dignity Health Senior |
$29.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.71
|
| Rate for Payer: Heritage Provider Network Senior |
$21.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.56
|
| Rate for Payer: Multiplan Commercial |
$26.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Vantage Medical Group Senior |
$29.82
|
|
|
HC SOM MECONIUM AMPHETAMINE CONFIRM
|
Facility
|
IP
|
$35.08
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
900912830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$26.31 |
| Rate for Payer: Adventist Health Commercial |
$7.02
|
| Rate for Payer: Cash Price |
$35.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.75
|
| Rate for Payer: Heritage Provider Network Senior |
$23.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.77
|
| Rate for Payer: Multiplan Commercial |
$26.31
|
|
|
HC SOM MECONIUM COCAINE CONFIRM
|
Facility
|
IP
|
$96.01
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
900912832
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$72.01 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Cash Price |
$96.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.00
|
| Rate for Payer: Heritage Provider Network Senior |
$65.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$72.01
|
|
|
HC SOM MECONIUM COCAINE CONFIRM
|
Facility
|
OP
|
$96.01
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
900912832
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$132.76 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.76
|
| Rate for Payer: Cash Price |
$96.01
|
| Rate for Payer: Cash Price |
$96.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$62.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.61
|
| Rate for Payer: Dignity Health Senior |
$81.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.43
|
| Rate for Payer: Heritage Provider Network Senior |
$59.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.21
|
| Rate for Payer: Multiplan Commercial |
$72.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$48.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$48.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.61
|
| Rate for Payer: Vantage Medical Group Senior |
$81.61
|
|
|
HC SOM MECONIUM METHAMPHETAMINE CONF
|
Facility
|
IP
|
$23.42
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
900912831
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$17.57 |
| Rate for Payer: Adventist Health Commercial |
$4.68
|
| Rate for Payer: Cash Price |
$23.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.86
|
| Rate for Payer: Heritage Provider Network Senior |
$15.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.86
|
| Rate for Payer: Multiplan Commercial |
$17.57
|
|
|
HC SOM MECONIUM METHAMPHETAMINE CONF
|
Facility
|
OP
|
$23.42
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
900912831
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$136.14 |
| Rate for Payer: Adventist Health Commercial |
$4.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.14
|
| Rate for Payer: Cash Price |
$23.42
|
| Rate for Payer: Cash Price |
$23.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.91
|
| Rate for Payer: Dignity Health Senior |
$19.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.50
|
| Rate for Payer: Heritage Provider Network Senior |
$14.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.39
|
| Rate for Payer: Multiplan Commercial |
$17.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.91
|
| Rate for Payer: Vantage Medical Group Senior |
$19.91
|
|
|
HC SOM MECONIUM OPIATE CONFIRM
|
Facility
|
IP
|
$49.07
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
900912833
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$36.80 |
| Rate for Payer: Adventist Health Commercial |
$9.81
|
| Rate for Payer: Cash Price |
$49.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.22
|
| Rate for Payer: Heritage Provider Network Senior |
$33.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.27
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
|
|
HC SOM MECONIUM OPIATE CONFIRM
|
Facility
|
OP
|
$49.07
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
900912833
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$170.38 |
| Rate for Payer: Adventist Health Commercial |
$9.81
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.38
|
| Rate for Payer: Cash Price |
$49.07
|
| Rate for Payer: Cash Price |
$49.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.71
|
| Rate for Payer: Dignity Health Senior |
$41.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.37
|
| Rate for Payer: Heritage Provider Network Senior |
$30.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.35
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.71
|
| Rate for Payer: Vantage Medical Group Senior |
$41.71
|
|
|
HC SOM MECONIUM PCP CONFIRM
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900912835
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.58 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$96.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.82
|
| Rate for Payer: Blue Shield of California Commercial |
$112.26
|
| Rate for Payer: Blue Shield of California EPN |
$90.04
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$117.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.00
|
| Rate for Payer: Dignity Health Senior |
$153.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.42
|
| Rate for Payer: Heritage Provider Network Senior |
$111.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$85.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$126.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$40.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$40.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.00
|
| Rate for Payer: Vantage Medical Group Senior |
$153.00
|
|
|
HC SOM MECONIUM PCP CONFIRM
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900912835
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.58 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.86
|
| Rate for Payer: Heritage Provider Network Senior |
$121.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
|
|
HC SOM MECONIUM THC LAB REF CONFIRM
|
Facility
|
OP
|
$76.10
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
900912834
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$207.44 |
| Rate for Payer: Adventist Health Commercial |
$15.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$40.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$207.44
|
| Rate for Payer: Cash Price |
$76.10
|
| Rate for Payer: Cash Price |
$76.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$49.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.69
|
| Rate for Payer: Dignity Health Senior |
$64.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.11
|
| Rate for Payer: Heritage Provider Network Senior |
$47.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.27
|
| Rate for Payer: Multiplan Commercial |
$57.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$38.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$38.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.69
|
| Rate for Payer: Vantage Medical Group Senior |
$64.69
|
|
|
HC SOM MECONIUM THC LAB REF CONFIRM
|
Facility
|
IP
|
$76.10
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
900912834
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$57.08 |
| Rate for Payer: Adventist Health Commercial |
$15.22
|
| Rate for Payer: Cash Price |
$76.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.52
|
| Rate for Payer: Heritage Provider Network Senior |
$51.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.02
|
| Rate for Payer: Multiplan Commercial |
$57.08
|
|
|
HC SOM MENMS 81405
|
Facility
|
IP
|
$556.35
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914742
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$100.70 |
| Max. Negotiated Rate |
$417.26 |
| Rate for Payer: Adventist Health Commercial |
$111.27
|
| Rate for Payer: Cash Price |
$556.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.65
|
| Rate for Payer: Heritage Provider Network Senior |
$376.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.09
|
| Rate for Payer: Multiplan Commercial |
$417.26
|
|
|
HC SOM MENMS 81405
|
Facility
|
OP
|
$556.35
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914742
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$100.70 |
| Max. Negotiated Rate |
$2,151.57 |
| Rate for Payer: Adventist Health Commercial |
$111.27
|
| Rate for Payer: Aetna of CA Gatekeeper |
$297.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$382.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$331.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$301.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,151.57
|
| Rate for Payer: Blue Shield of California Commercial |
$339.37
|
| Rate for Payer: Blue Shield of California EPN |
$271.50
|
| Rate for Payer: Cash Price |
$556.35
|
| Rate for Payer: Cash Price |
$556.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$361.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$452.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$331.49
|
| Rate for Payer: Dignity Health Senior |
$301.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$301.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$344.38
|
| Rate for Payer: Heritage Provider Network Senior |
$344.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$488.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$301.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$265.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$379.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$379.70
|
| Rate for Payer: Multiplan Commercial |
$417.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$301.35
|
| Rate for Payer: TriValley Medical Group Senior |
$301.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$325.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$325.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$331.49
|
| Rate for Payer: Vantage Medical Group Senior |
$301.35
|
|
|
HC SOM MEPERIDINE
|
Facility
|
IP
|
$98.28
|
|
|
Service Code
|
CPT 80362
|
| Hospital Charge Code |
900910758
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.79 |
| Max. Negotiated Rate |
$73.71 |
| Rate for Payer: Adventist Health Commercial |
$19.66
|
| Rate for Payer: Cash Price |
$98.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.54
|
| Rate for Payer: Heritage Provider Network Senior |
$66.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.57
|
| Rate for Payer: Multiplan Commercial |
$73.71
|
|
|
HC SOM MEPERIDINE
|
Facility
|
OP
|
$98.28
|
|
|
Service Code
|
CPT 80362
|
| Hospital Charge Code |
900910758
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.79 |
| Max. Negotiated Rate |
$170.38 |
| Rate for Payer: Adventist Health Commercial |
$19.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.38
|
| Rate for Payer: Cash Price |
$98.28
|
| Rate for Payer: Cash Price |
$98.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.54
|
| Rate for Payer: Dignity Health Senior |
$83.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.84
|
| Rate for Payer: Heritage Provider Network Senior |
$60.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.80
|
| Rate for Payer: Multiplan Commercial |
$73.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$49.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$49.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$83.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.54
|
| Rate for Payer: Vantage Medical Group Senior |
$83.54
|
|
