|
HC SOM ORG REFER FOR ID, AEROBIC
|
Facility
|
OP
|
$17.20
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912887
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$73.69 |
| Rate for Payer: Adventist Health Commercial |
$3.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.69
|
| Rate for Payer: Blue Shield of California Commercial |
$65.03
|
| Rate for Payer: Blue Shield of California EPN |
$52.16
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.65
|
| Rate for Payer: Heritage Provider Network Senior |
$10.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$12.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC SOM ORG REFER FOR ID, ANAEROB
|
Facility
|
OP
|
$23.74
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
900912889
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Adventist Health Commercial |
$4.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.00
|
| Rate for Payer: Blue Shield of California Commercial |
$65.03
|
| Rate for Payer: Blue Shield of California EPN |
$52.16
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.43
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.70
|
| Rate for Payer: Heritage Provider Network Senior |
$14.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$17.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC SOM ORG REFER FOR ID, ANAEROB
|
Facility
|
IP
|
$23.74
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
900912889
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$17.80 |
| Rate for Payer: Adventist Health Commercial |
$4.75
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.07
|
| Rate for Payer: Heritage Provider Network Senior |
$16.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.93
|
| Rate for Payer: Multiplan Commercial |
$17.80
|
|
|
HC SOM OROT 83921
|
Facility
|
OP
|
$23.58
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900914729
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$150.22 |
| Rate for Payer: Adventist Health Commercial |
$4.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.20
|
| 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 |
$23.58
|
| Rate for Payer: Cash Price |
$23.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.33
|
| 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 |
$15.33
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.60
|
| Rate for Payer: Heritage Provider Network Senior |
$14.60
|
| 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 |
$11.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.89
|
| 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 |
$17.68
|
| 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 OROT 83921
|
Facility
|
IP
|
$23.58
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900914729
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$17.68 |
| Rate for Payer: Adventist Health Commercial |
$4.72
|
| Rate for Payer: Cash Price |
$23.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.96
|
| Rate for Payer: Heritage Provider Network Senior |
$15.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.89
|
| Rate for Payer: Multiplan Commercial |
$17.68
|
|
|
HC SOM ORTHOPOXVIRUS DNA - LABCORP
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
900915424
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$57.75 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.13
|
| Rate for Payer: Heritage Provider Network Senior |
$52.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
|
|
HC SOM ORTHOPOXVIRUS DNA - LABCORP
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
900915424
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$76.97 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Senior |
$51.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.66
|
| Rate for Payer: Heritage Provider Network Senior |
$47.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.65
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.31
|
| Rate for Payer: TriValley Medical Group Senior |
$51.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HC SOM OSTEOCALCIN
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 83937
|
| Hospital Charge Code |
900911399
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$106.88 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.88
|
| Rate for Payer: Blue Shield of California Commercial |
$101.84
|
| Rate for Payer: Blue Shield of California EPN |
$81.68
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.84
|
| Rate for Payer: Dignity Health Senior |
$29.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$29.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.38
|
| Rate for Payer: Heritage Provider Network Senior |
$25.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.61
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.85
|
| Rate for Payer: TriValley Medical Group Senior |
$29.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$32.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.84
|
| Rate for Payer: Vantage Medical Group Senior |
$29.85
|
|
|
HC SOM OSTEOCALCIN
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 83937
|
| Hospital Charge Code |
900911399
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.76
|
| Rate for Payer: Heritage Provider Network Senior |
$27.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
|
|
HC SOM OXALATE
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
900911124
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC SOM OXALATE
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
900911124
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$117.52 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.52
|
| Rate for Payer: Blue Shield of California Commercial |
$103.62
|
| Rate for Payer: Blue Shield of California EPN |
$83.11
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.89
|
| Rate for Payer: Dignity Health Senior |
$14.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.21
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.45
|
| Rate for Payer: TriValley Medical Group Senior |
$14.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.89
|
| Rate for Payer: Vantage Medical Group Senior |
$14.45
|
|
|
HC SOM OXALATE PLASMA
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
900910579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$117.52 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$36.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.52
|
| Rate for Payer: Blue Shield of California Commercial |
$103.62
|
| Rate for Payer: Blue Shield of California EPN |
$83.11
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.89
|
| Rate for Payer: Dignity Health Senior |
$14.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.09
|
| Rate for Payer: Heritage Provider Network Senior |
$42.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.21
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.45
|
| Rate for Payer: TriValley Medical Group Senior |
$14.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.89
|
| Rate for Payer: Vantage Medical Group Senior |
$14.45
|
|
|
HC SOM OXALATE PLASMA
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
900910579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.04
|
| Rate for Payer: Heritage Provider Network Senior |
$46.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
|
|
HC SOM OXCARBAZEPINE LEVEL
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
900912537
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$104.20 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.77
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.57
|
| Rate for Payer: Dignity Health Senior |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.70
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.25
|
| Rate for Payer: TriValley Medical Group Senior |
$13.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
|
HC SOM OXCARBAZEPINE LEVEL
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
900912537
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC SOM PANCREATIC ELASTASE/STOOL
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 82653
|
| Hospital Charge Code |
900912993
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$132.31 |
| Rate for Payer: Adventist Health Commercial |
$16.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.00
|
| Rate for Payer: Blue Shield of California Commercial |
$132.31
|
| Rate for Payer: Blue Shield of California EPN |
$106.12
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$52.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.27
|
| Rate for Payer: Dignity Health Senior |
$22.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.52
|
| Rate for Payer: Heritage Provider Network Senior |
$49.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.94
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.97
|
| Rate for Payer: TriValley Medical Group Senior |
$22.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.27
|
| Rate for Payer: Vantage Medical Group Senior |
$22.97
|
|
|
HC SOM PANCREATIC ELASTASE/STOOL
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 82653
|
| Hospital Charge Code |
900912993
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Adventist Health Commercial |
$16.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.16
|
| Rate for Payer: Heritage Provider Network Senior |
$54.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
|
|
HC SOM PANCREATIC POLYPEPTIDE
|
Facility
|
IP
|
$555.29
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911326
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.51 |
| Max. Negotiated Rate |
$416.47 |
| Rate for Payer: Adventist Health Commercial |
$111.06
|
| Rate for Payer: Cash Price |
$555.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$375.93
|
| Rate for Payer: Heritage Provider Network Senior |
$375.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.82
|
| Rate for Payer: Multiplan Commercial |
$416.47
|
|
|
HC SOM PANCREATIC POLYPEPTIDE
|
Facility
|
OP
|
$555.29
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911326
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$416.47 |
| Rate for Payer: Adventist Health Commercial |
$111.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$296.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$381.48
|
| 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 |
$555.29
|
| Rate for Payer: Cash Price |
$555.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$360.94
|
| 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 |
$360.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$343.72
|
| Rate for Payer: Heritage Provider Network Senior |
$343.72
|
| 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 |
$264.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.82
|
| 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 |
$416.47
|
| 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 PARANEOPL EVAL ACHR AB
|
Facility
|
OP
|
$39.35
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914660
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$123.36 |
| Rate for Payer: Adventist Health Commercial |
$7.87
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.03
|
| 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 |
$39.35
|
| Rate for Payer: Cash Price |
$39.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.58
|
| 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 |
$25.58
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.36
|
| Rate for Payer: Heritage Provider Network Senior |
$24.36
|
| 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 |
$18.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| 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 |
$29.51
|
| 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 PARANEOPL EVAL ACHR AB
|
Facility
|
IP
|
$39.35
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914660
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$29.51 |
| Rate for Payer: Adventist Health Commercial |
$7.87
|
| Rate for Payer: Cash Price |
$39.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.64
|
| Rate for Payer: Heritage Provider Network Senior |
$26.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Multiplan Commercial |
$29.51
|
|
|
HC SOM PARANEOPL EVAL AGNA1
|
Facility
|
OP
|
$30.36
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914652
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$110.08 |
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.86
|
| 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 |
$110.08
|
| 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 |
$30.36
|
| Rate for Payer: Cash Price |
$30.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.73
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.79
|
| Rate for Payer: Heritage Provider Network Senior |
$18.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$22.77
|
| 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 PARANEOPL EVAL AGNA1
|
Facility
|
IP
|
$30.36
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914652
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$22.77 |
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| Rate for Payer: Cash Price |
$30.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.55
|
| Rate for Payer: Heritage Provider Network Senior |
$20.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.59
|
| Rate for Payer: Multiplan Commercial |
$22.77
|
|
|
HC SOM PARANEOPL EVAL AMPH AB
|
Facility
|
OP
|
$30.37
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914656
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$110.08 |
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.86
|
| 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 |
$110.08
|
| 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 |
$30.37
|
| Rate for Payer: Cash Price |
$30.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.80
|
| Rate for Payer: Heritage Provider Network Senior |
$18.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$22.78
|
| 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 PARANEOPL EVAL AMPH AB
|
Facility
|
IP
|
$30.37
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914656
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$22.78 |
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| Rate for Payer: Cash Price |
$30.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.56
|
| Rate for Payer: Heritage Provider Network Senior |
$20.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.59
|
| Rate for Payer: Multiplan Commercial |
$22.78
|
|
