|
HC SOMN NC08 CSF A-AMIN 82017
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
900914733
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$153.75 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Cash Price |
$112.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.78
|
| Rate for Payer: Heritage Provider Network Senior |
$138.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.25
|
| Rate for Payer: Multiplan Commercial |
$153.75
|
|
|
HC SOMN NC08 CSF A-AMIN 82017
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
900914733
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$153.75 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$109.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$140.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.29
|
| Rate for Payer: Blue Shield of California Commercial |
$135.76
|
| Rate for Payer: Blue Shield of California EPN |
$108.89
|
| Rate for Payer: Cash Price |
$112.75
|
| Rate for Payer: Cash Price |
$112.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$133.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.56
|
| Rate for Payer: Dignity Health Senior |
$16.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$126.89
|
| Rate for Payer: Heritage Provider Network Senior |
$126.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$97.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.26
|
| Rate for Payer: Multiplan Commercial |
$153.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.87
|
| Rate for Payer: TriValley Medical Group Senior |
$16.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Vantage Medical Group Senior |
$16.87
|
|
|
HC SOM NORCLOZAPINE LEVEL
|
Facility
|
OP
|
$15.80
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
900912685
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$145.32 |
| Rate for Payer: Adventist Health Commercial |
$3.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.85
|
| 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 |
$101.60
|
| 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 |
$15.80
|
| Rate for Payer: Cash Price |
$15.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.16
|
| Rate for Payer: Dignity Health Senior |
$20.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.27
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.78
|
| Rate for Payer: Heritage Provider Network Senior |
$9.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.39
|
| Rate for Payer: Multiplan Commercial |
$11.85
|
| 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 NORCLOZAPINE LEVEL
|
Facility
|
IP
|
$15.80
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
900912685
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$11.85 |
| Rate for Payer: Adventist Health Commercial |
$3.16
|
| Rate for Payer: Cash Price |
$15.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.70
|
| Rate for Payer: Heritage Provider Network Senior |
$10.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.95
|
| Rate for Payer: Multiplan Commercial |
$11.85
|
|
|
HC SOM NORDOXEPIN LEVEL
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900912562
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$156.73 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.73
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.75
|
| Rate for Payer: Dignity Health Senior |
$29.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.66
|
| Rate for Payer: Heritage Provider Network Senior |
$21.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.75
|
| Rate for Payer: Vantage Medical Group Senior |
$29.75
|
|
|
HC SOM NORDOXEPIN LEVEL
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900912562
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.70
|
| Rate for Payer: Heritage Provider Network Senior |
$23.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
|
|
HC SOM NOROVIRUS AG
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
900914127
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.81 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.30
|
| Rate for Payer: Heritage Provider Network Senior |
$85.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
|
|
HC SOM NOROVIRUS AG
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
900914127
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.05
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.99
|
| Rate for Payer: Heritage Provider Network Senior |
$77.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$60.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.09
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC SOM NOROVIRUS RNA
|
Facility
|
OP
|
$245.52
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913809
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$310.02 |
| Rate for Payer: Adventist Health Commercial |
$49.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$131.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$168.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.02
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$245.52
|
| Rate for Payer: Cash Price |
$245.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$159.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$151.98
|
| Rate for Payer: Heritage Provider Network Senior |
$151.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$117.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$184.14
|
| 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 NOROVIRUS RNA
|
Facility
|
IP
|
$245.52
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913809
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$44.44 |
| Max. Negotiated Rate |
$184.14 |
| Rate for Payer: Adventist Health Commercial |
$49.10
|
| Rate for Payer: Cash Price |
$245.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$166.22
|
| Rate for Payer: Heritage Provider Network Senior |
$166.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.38
|
| Rate for Payer: Multiplan Commercial |
$184.14
|
|
|
HC SOM N-TELOPEPTIDE URINE
|
Facility
|
OP
|
$19.23
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
900911412
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$251.57 |
| Rate for Payer: Adventist Health Commercial |
$3.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$251.57
|
| Rate for Payer: Blue Shield of California Commercial |
$149.24
|
| Rate for Payer: Blue Shield of California EPN |
$119.70
|
| Rate for Payer: Cash Price |
$19.23
|
| Rate for Payer: Cash Price |
$19.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.55
|
| Rate for Payer: Dignity Health Senior |
$18.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.90
|
| Rate for Payer: Heritage Provider Network Senior |
$11.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.54
|
| Rate for Payer: Multiplan Commercial |
$14.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.68
|
| Rate for Payer: TriValley Medical Group Senior |
$18.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.55
|
| Rate for Payer: Vantage Medical Group Senior |
$18.68
|
|
|
HC SOM N-TELOPEPTIDE URINE
|
Facility
|
IP
|
$19.23
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
900911412
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$14.42 |
| Rate for Payer: Adventist Health Commercial |
$3.85
|
| Rate for Payer: Cash Price |
$19.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.02
|
| Rate for Payer: Heritage Provider Network Senior |
$13.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.81
|
| Rate for Payer: Multiplan Commercial |
$14.42
|
|
|
HC SOM NUCLEOPHOSMIN MUTAT ANAL
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 81310
|
| Hospital Charge Code |
900914001
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.95
|
| Rate for Payer: Heritage Provider Network Senior |
$236.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
|
|
HC SOM NUCLEOPHOSMIN MUTAT ANAL
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 81310
|
| Hospital Charge Code |
900914001
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$369.78 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$187.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$369.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$271.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.09
|
| Rate for Payer: Blue Shield of California Commercial |
$213.50
|
| Rate for Payer: Blue Shield of California EPN |
$170.80
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$227.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$369.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$271.17
|
| Rate for Payer: Dignity Health Senior |
$246.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$246.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.65
|
| Rate for Payer: Heritage Provider Network Senior |
$216.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$319.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$246.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$166.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$283.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$310.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$310.62
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$246.52
|
| Rate for Payer: TriValley Medical Group Senior |
$246.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$266.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$266.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$369.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$271.17
|
| Rate for Payer: Vantage Medical Group Senior |
$246.52
|
|
|
HC SOM OLANZAPINE
|
Facility
|
IP
|
$93.80
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910772
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.98 |
| Max. Negotiated Rate |
$70.35 |
| Rate for Payer: Adventist Health Commercial |
$18.76
|
| Rate for Payer: Cash Price |
$93.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.50
|
| Rate for Payer: Heritage Provider Network Senior |
$63.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.45
|
| Rate for Payer: Multiplan Commercial |
$70.35
|
|
|
HC SOM OLANZAPINE
|
Facility
|
OP
|
$93.80
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910772
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.98 |
| Max. Negotiated Rate |
$132.94 |
| Rate for Payer: Adventist Health Commercial |
$18.76
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64.44
|
| 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 |
$93.80
|
| Rate for Payer: Cash Price |
$93.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.97
|
| 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 |
$60.97
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.06
|
| Rate for Payer: Heritage Provider Network Senior |
$58.06
|
| 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 |
$44.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.45
|
| 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 |
$70.35
|
| 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 OLIGOCLONAL BANDS CSF
|
Facility
|
OP
|
$22.86
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
900911235
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$183.53 |
| Rate for Payer: Adventist Health Commercial |
$4.57
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.53
|
| Rate for Payer: Blue Shield of California Commercial |
$161.80
|
| Rate for Payer: Blue Shield of California EPN |
$129.78
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.13
|
| Rate for Payer: Dignity Health Senior |
$27.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.86
|
| Rate for Payer: EPIC Health Plan Medicare |
$27.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.15
|
| Rate for Payer: Heritage Provider Network Senior |
$14.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.51
|
| Rate for Payer: Multiplan Commercial |
$17.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.39
|
| Rate for Payer: TriValley Medical Group Senior |
$27.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.13
|
| Rate for Payer: Vantage Medical Group Senior |
$27.39
|
|
|
HC SOM OLIGOCLONAL BANDS CSF
|
Facility
|
IP
|
$22.86
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
900911235
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$17.14 |
| Rate for Payer: Adventist Health Commercial |
$4.57
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.48
|
| Rate for Payer: Heritage Provider Network Senior |
$15.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.71
|
| Rate for Payer: Multiplan Commercial |
$17.14
|
|
|
HC SOM OLIGOCLONAL BANDS SERUM
|
Facility
|
IP
|
$22.86
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
900912657
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$17.14 |
| Rate for Payer: Adventist Health Commercial |
$4.57
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.48
|
| Rate for Payer: Heritage Provider Network Senior |
$15.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.71
|
| Rate for Payer: Multiplan Commercial |
$17.14
|
|
|
HC SOM OLIGOCLONAL BANDS SERUM
|
Facility
|
OP
|
$22.86
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
900912657
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$183.53 |
| Rate for Payer: Adventist Health Commercial |
$4.57
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.53
|
| Rate for Payer: Blue Shield of California Commercial |
$161.80
|
| Rate for Payer: Blue Shield of California EPN |
$129.78
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.13
|
| Rate for Payer: Dignity Health Senior |
$27.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.86
|
| Rate for Payer: EPIC Health Plan Medicare |
$27.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.15
|
| Rate for Payer: Heritage Provider Network Senior |
$14.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.51
|
| Rate for Payer: Multiplan Commercial |
$17.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.39
|
| Rate for Payer: TriValley Medical Group Senior |
$27.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.13
|
| Rate for Payer: Vantage Medical Group Senior |
$27.39
|
|
|
HC SOM OPATU DRUG SCRN OXYCDN
|
Facility
|
OP
|
$13.93
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
900915279
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$170.38 |
| Rate for Payer: Adventist Health Commercial |
$2.79
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.38
|
| Rate for Payer: Cash Price |
$13.93
|
| Rate for Payer: Cash Price |
$13.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.84
|
| Rate for Payer: Dignity Health Senior |
$11.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.62
|
| Rate for Payer: Heritage Provider Network Senior |
$8.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.75
|
| Rate for Payer: Multiplan Commercial |
$10.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.84
|
| Rate for Payer: Vantage Medical Group Senior |
$11.84
|
|
|
HC SOM OPATU DRUG SCRN OXYCDN
|
Facility
|
IP
|
$13.93
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
900915279
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Adventist Health Commercial |
$2.79
|
| Rate for Payer: Cash Price |
$13.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.43
|
| Rate for Payer: Heritage Provider Network Senior |
$9.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.48
|
| Rate for Payer: Multiplan Commercial |
$10.45
|
|
|
HC SOM ORGANIC ACID SCREEN
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 83919
|
| Hospital Charge Code |
900911179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$149.60 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$149.60
|
| 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 |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.09
|
| Rate for Payer: Dignity Health Senior |
$16.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.76
|
| Rate for Payer: Heritage Provider Network Senior |
$24.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.73
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.45
|
| Rate for Payer: TriValley Medical Group Senior |
$16.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.09
|
| Rate for Payer: Vantage Medical Group Senior |
$16.45
|
|
|
HC SOM ORGANIC ACID SCREEN
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 83919
|
| Hospital Charge Code |
900911179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.08
|
| Rate for Payer: Heritage Provider Network Senior |
$27.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
|
|
HC SOM ORG REFER FOR ID, AEROBIC
|
Facility
|
IP
|
$17.20
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912887
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$12.90 |
| Rate for Payer: Adventist Health Commercial |
$3.44
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.64
|
| Rate for Payer: Heritage Provider Network Senior |
$11.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.30
|
| Rate for Payer: Multiplan Commercial |
$12.90
|
|
