|
HC SOM CHRTI CULTURE 02
|
Facility
|
IP
|
$173.04
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915283
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.32 |
| Max. Negotiated Rate |
$129.78 |
| Rate for Payer: Adventist Health Commercial |
$34.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.44
|
| Rate for Payer: Cash Price |
$173.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$117.15
|
| Rate for Payer: Heritage Provider Network Senior |
$117.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.26
|
| Rate for Payer: Multiplan Commercial |
$129.78
|
|
|
HC SOM CHRTI CULTURE 02
|
Facility
|
OP
|
$173.04
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915283
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.32 |
| Max. Negotiated Rate |
$1,134.30 |
| Rate for Payer: Adventist Health Commercial |
$34.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,134.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,132.59
|
| Rate for Payer: Blue Shield of California EPN |
$908.43
|
| Rate for Payer: Cash Price |
$173.04
|
| Rate for Payer: Cash Price |
$173.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$140.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$140.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.11
|
| Rate for Payer: Heritage Provider Network Senior |
$107.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$140.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$82.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$188.58
|
| Rate for Payer: Multiplan Commercial |
$129.78
|
| 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 |
$211.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
|
|
HC SOM CIF IMMUNOFLUOR ANTB 1ST STAIN
|
Facility
|
OP
|
$61.76
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
900915525
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$328.68 |
| Rate for Payer: Adventist Health Commercial |
$12.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.66
|
| Rate for Payer: Blue Shield of California Commercial |
$219.02
|
| Rate for Payer: Blue Shield of California EPN |
$176.13
|
| Rate for Payer: Cash Price |
$61.76
|
| Rate for Payer: Cash Price |
$61.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$219.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.23
|
| Rate for Payer: Heritage Provider Network Senior |
$38.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$29.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$46.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$219.12
|
| Rate for Payer: TriValley Medical Group Senior |
$219.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$321.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$321.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC SOM CIF IMMUNOFLUOR ANTB 1ST STAIN
|
Facility
|
IP
|
$61.76
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
900915525
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$46.32 |
| Rate for Payer: Adventist Health Commercial |
$12.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.77
|
| Rate for Payer: Cash Price |
$61.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.81
|
| Rate for Payer: Heritage Provider Network Senior |
$41.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.44
|
| Rate for Payer: Multiplan Commercial |
$46.32
|
|
|
HC SOM CIF IMMUNOFLUOR ANTB ADDL STAIN
|
Facility
|
IP
|
$47.24
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
900915526
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$35.43 |
| Rate for Payer: Adventist Health Commercial |
$9.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.42
|
| Rate for Payer: Cash Price |
$47.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.98
|
| Rate for Payer: Heritage Provider Network Senior |
$31.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.81
|
| Rate for Payer: Multiplan Commercial |
$35.43
|
|
|
HC SOM CIF IMMUNOFLUOR ANTB ADDL STAIN
|
Facility
|
OP
|
$47.24
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
900915526
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$526.91 |
| Rate for Payer: Adventist Health Commercial |
$9.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$526.91
|
| Rate for Payer: Blue Shield of California Commercial |
$247.87
|
| Rate for Payer: Blue Shield of California EPN |
$199.33
|
| Rate for Payer: Cash Price |
$47.24
|
| Rate for Payer: Cash Price |
$47.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$30.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.24
|
| Rate for Payer: Heritage Provider Network Senior |
$29.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$22.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33.07
|
| Rate for Payer: Multiplan Commercial |
$35.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$98.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$98.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.15
|
| Rate for Payer: Vantage Medical Group Senior |
$40.15
|
|
|
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 |
$809.89 |
| Rate for Payer: Adventist Health Commercial |
$65.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$201.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$376.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$809.89
|
| Rate for Payer: Blue Shield of California Commercial |
$198.40
|
| Rate for Payer: Blue Shield of California EPN |
$158.72
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cash Price |
$325.24
|
| 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 Medicare Advantage |
$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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$155.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$288.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$336.05
|
| 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 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 |
$209.45
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$220.19
|
| Rate for Payer: Heritage Provider Network Senior |
$220.19
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$276.45 |
| Rate for Payer: Adventist Health Commercial |
$65.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$201.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$276.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$178.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$243.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$201.93
|
| Rate for Payer: Blue Shield of California Commercial |
$198.40
|
| Rate for Payer: Blue Shield of California EPN |
$158.72
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cash Price |
$325.24
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$155.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$227.67
|
| Rate for Payer: Multiplan Commercial |
$243.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$162.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$162.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$276.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$276.45
|
| Rate for Payer: Vantage Medical Group Senior |
$276.45
|
|
|
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 |
$209.45
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$220.19
|
| Rate for Payer: Heritage Provider Network Senior |
$220.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.31
|
| Rate for Payer: Multiplan Commercial |
$243.93
|
|
|
HC SOM CITRIC ACID URINE
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
900911053
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.10
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.93
|
| Rate for Payer: Heritage Provider Network Senior |
$16.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SOM CITRIC ACID URINE
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
900911053
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$263.93 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$263.93
|
| Rate for Payer: Blue Shield of California Commercial |
$223.78
|
| Rate for Payer: Blue Shield of California EPN |
$179.49
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$27.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.47
|
| Rate for Payer: Heritage Provider Network Senior |
$15.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| 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 CLONAZEPAM (CLONOPIN)
|
Facility
|
OP
|
$29.78
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$138.26 |
| Rate for Payer: Adventist Health Commercial |
$5.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.40
|
| 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 |
$138.26
|
| 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 |
$29.78
|
| Rate for Payer: Cash Price |
$29.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.57
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.43
|
| Rate for Payer: Heritage Provider Network Senior |
$18.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$22.34
|
| 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 CLONAZEPAM (CLONOPIN)
|
Facility
|
IP
|
$29.78
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$22.34 |
| Rate for Payer: Adventist Health Commercial |
$5.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.18
|
| Rate for Payer: Cash Price |
$29.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.16
|
| Rate for Payer: Heritage Provider Network Senior |
$20.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.45
|
| Rate for Payer: Multiplan Commercial |
$22.34
|
|
|
HC SOM CLOZAPINE LEVEL
|
Facility
|
IP
|
$27.01
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
900911438
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$20.26 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.39
|
| Rate for Payer: Cash Price |
$27.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.29
|
| Rate for Payer: Heritage Provider Network Senior |
$18.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: Multiplan Commercial |
$20.26
|
|
|
HC SOM CLOZAPINE LEVEL
|
Facility
|
OP
|
$27.01
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
900911438
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$145.32 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.66
|
| Rate for Payer: Blue Shield of California Commercial |
$145.32
|
| Rate for Payer: Blue Shield of California EPN |
$116.56
|
| Rate for Payer: Cash Price |
$27.01
|
| Rate for Payer: Cash Price |
$27.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.72
|
| Rate for Payer: Heritage Provider Network Senior |
$16.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$20.26
|
| 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 |
$30.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.16
|
| Rate for Payer: Vantage Medical Group Senior |
$20.15
|
|
|
HC SOM CMV PCR NON-BLOOD
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
900912519
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.98
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.46
|
| Rate for Payer: Heritage Provider Network Senior |
$30.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
|
|
HC SOM CMV PCR NON-BLOOD
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
900912519
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.42
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.86
|
| Rate for Payer: Heritage Provider Network Senior |
$27.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM 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 |
$344.74 |
| Rate for Payer: Adventist Health Commercial |
$66.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$206.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.65
|
| Rate for Payer: Blue Shield of California Commercial |
$344.74
|
| Rate for Payer: Blue Shield of California EPN |
$276.51
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$217.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.00
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$159.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$250.43
|
| 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 |
$250.43 |
| Rate for Payer: Adventist Health Commercial |
$66.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$215.03
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$226.05
|
| Rate for Payer: Heritage Provider Network Senior |
$226.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.47
|
| Rate for Payer: Multiplan Commercial |
$250.43
|
|
|
HC SOM CNS DEMYELINATING MOG FACS
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915331
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$50.68 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$180.32
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$189.56
|
| Rate for Payer: Heritage Provider Network Senior |
$189.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
|
|
HC SOM CNS DEMYELINATING MOG FACS
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915331
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$173.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.48
|
| Rate for Payer: Blue Shield of California Commercial |
$97.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.80
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$182.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$173.32
|
| Rate for Payer: Heritage Provider Network Senior |
$173.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$133.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| 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 |
$18.07
|
| 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
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915330
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$50.68 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$180.32
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$189.56
|
| Rate for Payer: Heritage Provider Network Senior |
$189.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
|
|
HC SOM CNS DEMYELINATING NMO/AQP4 FACS
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915330
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$173.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.22
|
| Rate for Payer: Blue Shield of California Commercial |
$69.41
|
| Rate for Payer: Blue Shield of California EPN |
$55.67
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$182.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$173.32
|
| Rate for Payer: Heritage Provider Network Senior |
$173.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$133.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.73
|
| Rate for Payer: TriValley Medical Group Senior |
$37.73
|
| 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 |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC SOM COAG FACTOR VIII ASSAY
|
Facility
|
IP
|
$75.32
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
900913969
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$56.49 |
| Rate for Payer: Adventist Health Commercial |
$15.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.51
|
| Rate for Payer: Cash Price |
$75.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.99
|
| Rate for Payer: Heritage Provider Network Senior |
$50.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.83
|
| Rate for Payer: Multiplan Commercial |
$56.49
|
|
