|
HC SOM META GT 26 CHROM ANAL
|
Facility
|
IP
|
$110.85
|
|
|
Service Code
|
CPT 88245
|
| Hospital Charge Code |
900915292
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$83.14 |
| Rate for Payer: Adventist Health Commercial |
$22.17
|
| Rate for Payer: Cash Price |
$110.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$75.05
|
| Rate for Payer: Heritage Provider Network Senior |
$75.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.71
|
| Rate for Payer: Multiplan Commercial |
$83.14
|
|
|
HC SOM META LT 15
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
900915299
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.62
|
| Rate for Payer: Heritage Provider Network Senior |
$84.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
|
|
HC SOM META LT 15
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
900915299
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$1,641.19 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$66.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$282.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,641.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,446.74
|
| Rate for Payer: Blue Shield of California EPN |
$1,160.41
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$282.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.43
|
| Rate for Payer: Dignity Health Senior |
$188.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$188.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.38
|
| Rate for Payer: Heritage Provider Network Senior |
$77.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$258.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$188.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$59.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.60
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$188.57
|
| Rate for Payer: TriValley Medical Group Senior |
$188.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$203.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$203.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$282.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.43
|
| Rate for Payer: Vantage Medical Group Senior |
$188.57
|
|
|
HC SOM METANEPHRINES,FRACT,FREE,P
|
Facility
|
OP
|
$24.26
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912922
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: Adventist Health Commercial |
$4.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.70
|
| Rate for Payer: Blue Shield of California Commercial |
$136.34
|
| Rate for Payer: Blue Shield of California EPN |
$109.36
|
| Rate for Payer: Cash Price |
$24.26
|
| Rate for Payer: Cash Price |
$24.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: Dignity Health Senior |
$16.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.77
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.02
|
| Rate for Payer: Heritage Provider Network Senior |
$15.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.34
|
| Rate for Payer: Multiplan Commercial |
$18.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.94
|
| Rate for Payer: TriValley Medical Group Senior |
$16.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
|
|
HC SOM METANEPHRINES,FRACT,FREE,P
|
Facility
|
IP
|
$24.26
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912922
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Adventist Health Commercial |
$4.85
|
| Rate for Payer: Cash Price |
$24.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.42
|
| Rate for Payer: Heritage Provider Network Senior |
$16.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: Multiplan Commercial |
$18.20
|
|
|
HC SOM METHADONE CONFIRMATION, U
|
Facility
|
IP
|
$114.08
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
900912918
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.65 |
| Max. Negotiated Rate |
$85.56 |
| Rate for Payer: Adventist Health Commercial |
$22.82
|
| Rate for Payer: Cash Price |
$114.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.23
|
| Rate for Payer: Heritage Provider Network Senior |
$77.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.52
|
| Rate for Payer: Multiplan Commercial |
$85.56
|
|
|
HC SOM METHADONE CONFIRMATION, U
|
Facility
|
OP
|
$114.08
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
900912918
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.65 |
| Max. Negotiated Rate |
$143.02 |
| Rate for Payer: Adventist Health Commercial |
$22.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$60.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$78.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.02
|
| Rate for Payer: Cash Price |
$114.08
|
| Rate for Payer: Cash Price |
$114.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$74.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.97
|
| Rate for Payer: Dignity Health Senior |
$96.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.62
|
| Rate for Payer: Heritage Provider Network Senior |
$70.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$54.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.86
|
| Rate for Payer: Multiplan Commercial |
$85.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$57.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$57.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.97
|
| Rate for Payer: Vantage Medical Group Senior |
$96.97
|
|
|
HC SOM METHANPHETAMINE QUANT
|
Facility
|
OP
|
$16.18
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
900912822
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$136.14 |
| Rate for Payer: Adventist Health Commercial |
$3.24
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.14
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.75
|
| Rate for Payer: Dignity Health Senior |
$13.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.02
|
| Rate for Payer: Heritage Provider Network Senior |
$10.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.33
|
| Rate for Payer: Multiplan Commercial |
$12.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: Vantage Medical Group Senior |
$13.75
|
|
|
HC SOM METHANPHETAMINE QUANT
|
Facility
|
IP
|
$16.18
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
900912822
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$12.13 |
| Rate for Payer: Adventist Health Commercial |
$3.24
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.95
|
| Rate for Payer: Heritage Provider Network Senior |
$10.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.04
|
| Rate for Payer: Multiplan Commercial |
$12.13
|
|
|
HC SOM METHYLMALONIC ACID
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900911265
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.89
|
| Rate for Payer: Heritage Provider Network Senior |
$14.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
|
|
HC SOM METHYLMALONIC ACID
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900911265
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$150.22 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.22
|
| Rate for Payer: Blue Shield of California Commercial |
$132.48
|
| Rate for Payer: Blue Shield of California EPN |
$106.26
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.33
|
| Rate for Payer: Dignity Health Senior |
$21.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.62
|
| Rate for Payer: Heritage Provider Network Senior |
$13.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.72
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.21
|
| Rate for Payer: TriValley Medical Group Senior |
$21.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.33
|
| Rate for Payer: Vantage Medical Group Senior |
$21.21
|
|
|
HC SOM METHYLMALONIC ACID URINE
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900910587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.89
|
| Rate for Payer: Heritage Provider Network Senior |
$14.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
|
|
HC SOM METHYLMALONIC ACID URINE
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900910587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$150.22 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.22
|
| Rate for Payer: Blue Shield of California Commercial |
$132.48
|
| Rate for Payer: Blue Shield of California EPN |
$106.26
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.33
|
| Rate for Payer: Dignity Health Senior |
$21.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.62
|
| Rate for Payer: Heritage Provider Network Senior |
$13.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.72
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.21
|
| Rate for Payer: TriValley Medical Group Senior |
$21.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.33
|
| Rate for Payer: Vantage Medical Group Senior |
$21.21
|
|
|
HC SOM MEXILETINE PLASMA
|
Facility
|
IP
|
$289.80
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911280
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.45 |
| Max. Negotiated Rate |
$217.35 |
| Rate for Payer: Adventist Health Commercial |
$57.96
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$196.19
|
| Rate for Payer: Heritage Provider Network Senior |
$196.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.45
|
| Rate for Payer: Multiplan Commercial |
$217.35
|
|
|
HC SOM MEXILETINE PLASMA
|
Facility
|
OP
|
$289.80
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911280
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$217.35 |
| Rate for Payer: Adventist Health Commercial |
$57.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$154.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$199.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.94
|
| Rate for Payer: Blue Shield of California Commercial |
$110.19
|
| Rate for Payer: Blue Shield of California EPN |
$88.38
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$188.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.37
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$179.39
|
| Rate for Payer: Heritage Provider Network Senior |
$179.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$138.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.49
|
| Rate for Payer: Multiplan Commercial |
$217.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.64
|
| Rate for Payer: TriValley Medical Group Senior |
$18.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM MGLE ACH RECEPTOR BINDING AB
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.69 |
| Max. Negotiated Rate |
$201.75 |
| Rate for Payer: Adventist Health Commercial |
$53.80
|
| Rate for Payer: Cash Price |
$269.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.11
|
| Rate for Payer: Heritage Provider Network Senior |
$182.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.25
|
| Rate for Payer: Multiplan Commercial |
$201.75
|
|
|
HC SOM MGLE ACH RECEPTOR BINDING AB
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$201.75 |
| Rate for Payer: Adventist Health Commercial |
$53.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$143.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$184.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.36
|
| Rate for Payer: Blue Shield of California Commercial |
$108.75
|
| Rate for Payer: Blue Shield of California EPN |
$87.23
|
| Rate for Payer: Cash Price |
$269.00
|
| Rate for Payer: Cash Price |
$269.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$174.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Senior |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$166.51
|
| Rate for Payer: Heritage Provider Network Senior |
$166.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$128.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.18
|
| Rate for Payer: Multiplan Commercial |
$201.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.40
|
| Rate for Payer: TriValley Medical Group Senior |
$18.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM MGLES 83519A
|
Facility
|
OP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914809
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$123.36 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.36
|
| Rate for Payer: Blue Shield of California Commercial |
$108.75
|
| Rate for Payer: Blue Shield of California EPN |
$87.23
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$82.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Senior |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.24
|
| Rate for Payer: Heritage Provider Network Senior |
$78.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$60.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.18
|
| Rate for Payer: Multiplan Commercial |
$94.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.40
|
| Rate for Payer: TriValley Medical Group Senior |
$18.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM MGLES 83519A
|
Facility
|
IP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914809
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$94.80 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.57
|
| Rate for Payer: Heritage Provider Network Senior |
$85.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: Multiplan Commercial |
$94.80
|
|
|
HC SOM MGLES 83519B
|
Facility
|
OP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914811
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$123.36 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.36
|
| Rate for Payer: Blue Shield of California Commercial |
$108.75
|
| Rate for Payer: Blue Shield of California EPN |
$87.23
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$82.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Senior |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.24
|
| Rate for Payer: Heritage Provider Network Senior |
$78.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$60.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.18
|
| Rate for Payer: Multiplan Commercial |
$94.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.40
|
| Rate for Payer: TriValley Medical Group Senior |
$18.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM MGLES 83519B
|
Facility
|
IP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914811
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$94.80 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.57
|
| Rate for Payer: Heritage Provider Network Senior |
$85.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: Multiplan Commercial |
$94.80
|
|
|
HC SOM MGLES 83519C
|
Facility
|
OP
|
$126.41
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914812
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$123.36 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.36
|
| Rate for Payer: Blue Shield of California Commercial |
$108.75
|
| Rate for Payer: Blue Shield of California EPN |
$87.23
|
| Rate for Payer: Cash Price |
$126.41
|
| Rate for Payer: Cash Price |
$126.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$82.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Senior |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.17
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.25
|
| Rate for Payer: Heritage Provider Network Senior |
$78.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$60.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.18
|
| Rate for Payer: Multiplan Commercial |
$94.81
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.40
|
| Rate for Payer: TriValley Medical Group Senior |
$18.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM MGLES 83519C
|
Facility
|
IP
|
$126.41
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914812
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$94.81 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Cash Price |
$126.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.58
|
| Rate for Payer: Heritage Provider Network Senior |
$85.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: Multiplan Commercial |
$94.81
|
|
|
HC SOM MGLES 83519D
|
Facility
|
IP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914813
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$94.80 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.57
|
| Rate for Payer: Heritage Provider Network Senior |
$85.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: Multiplan Commercial |
$94.80
|
|
|
HC SOM MGLES 83519D
|
Facility
|
OP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914813
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$123.36 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.36
|
| Rate for Payer: Blue Shield of California Commercial |
$108.75
|
| Rate for Payer: Blue Shield of California EPN |
$87.23
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$82.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Senior |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.24
|
| Rate for Payer: Heritage Provider Network Senior |
$78.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$60.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.18
|
| Rate for Payer: Multiplan Commercial |
$94.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.40
|
| Rate for Payer: TriValley Medical Group Senior |
$18.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
