|
HC SOM COMPLEMENT C-5
|
Facility
|
IP
|
$45.83
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900911042
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$34.37 |
| Rate for Payer: Adventist Health Commercial |
$9.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.51
|
| Rate for Payer: Cash Price |
$45.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.03
|
| Rate for Payer: Heritage Provider Network Senior |
$31.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.46
|
| Rate for Payer: Multiplan Commercial |
$34.37
|
|
|
HC SOM COMPLEMENT C-5
|
Facility
|
OP
|
$45.83
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900911042
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$113.97 |
| Rate for Payer: Adventist Health Commercial |
$9.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.97
|
| Rate for Payer: Blue Shield of California Commercial |
$96.65
|
| Rate for Payer: Blue Shield of California EPN |
$77.52
|
| Rate for Payer: Cash Price |
$45.83
|
| Rate for Payer: Cash Price |
$45.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.37
|
| Rate for Payer: Heritage Provider Network Senior |
$28.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$34.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
|
|
HC SOM COMPLEMENT TOTAL
|
Facility
|
OP
|
$13.83
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
900915322
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Adventist Health Commercial |
$2.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.85
|
| Rate for Payer: Blue Shield of California Commercial |
$163.53
|
| Rate for Payer: Blue Shield of California EPN |
$131.16
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.56
|
| Rate for Payer: Heritage Provider Network Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.23
|
| Rate for Payer: Multiplan Commercial |
$10.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.32
|
| Rate for Payer: TriValley Medical Group Senior |
$20.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.35
|
| Rate for Payer: Vantage Medical Group Senior |
$20.32
|
|
|
HC SOM COMPLEMENT TOTAL
|
Facility
|
IP
|
$13.83
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
900915322
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$10.37 |
| Rate for Payer: Adventist Health Commercial |
$2.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.91
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.36
|
| Rate for Payer: Heritage Provider Network Senior |
$9.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.46
|
| Rate for Payer: Multiplan Commercial |
$10.37
|
|
|
HC SOM CONF HC DRUG ABUSE SUR 12, U
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912913
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$585.08 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$585.08
|
| Rate for Payer: Blue Shield of California Commercial |
$459.71
|
| Rate for Payer: Blue Shield of California EPN |
$368.72
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$97.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$62.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.85
|
| Rate for Payer: Heritage Provider Network Senior |
$92.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$71.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.14
|
| Rate for Payer: TriValley Medical Group Senior |
$62.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$67.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC SOM CONF HC DRUG ABUSE SUR 12, U
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912913
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.60
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.55
|
| Rate for Payer: Heritage Provider Network Senior |
$101.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
|
|
HC SOM CONTROLLED SUB MON 1
|
Facility
|
IP
|
$64.75
|
|
|
Service Code
|
CPT G0482
|
| Hospital Charge Code |
900915354
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$48.56 |
| Rate for Payer: Adventist Health Commercial |
$12.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.70
|
| Rate for Payer: Cash Price |
$64.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.84
|
| Rate for Payer: Heritage Provider Network Senior |
$43.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.19
|
| Rate for Payer: Multiplan Commercial |
$48.56
|
|
|
HC SOM CONTROLLED SUB MON 1
|
Facility
|
OP
|
$64.75
|
|
|
Service Code
|
CPT G0482
|
| Hospital Charge Code |
900915354
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$1,564.11 |
| Rate for Payer: Adventist Health Commercial |
$12.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,564.11
|
| Rate for Payer: Blue Shield of California Commercial |
$956.33
|
| Rate for Payer: Blue Shield of California EPN |
$767.06
|
| Rate for Payer: Cash Price |
$64.75
|
| Rate for Payer: Cash Price |
$64.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$198.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.08
|
| Rate for Payer: Heritage Provider Network Senior |
$40.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$30.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$228.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$266.31
|
| Rate for Payer: Multiplan Commercial |
$48.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$198.74
|
| Rate for Payer: TriValley Medical Group Senior |
$198.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$214.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$214.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.61
|
| Rate for Payer: Vantage Medical Group Senior |
$198.74
|
|
|
HC SOM CONTROLLED SUB MON 2
|
Facility
|
OP
|
$20.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900915355
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$585.08 |
| Rate for Payer: Adventist Health Commercial |
$4.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$585.08
|
| Rate for Payer: Blue Shield of California Commercial |
$459.71
|
| Rate for Payer: Blue Shield of California EPN |
$368.72
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$62.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.53
|
| Rate for Payer: Heritage Provider Network Senior |
$12.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$15.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.14
|
| Rate for Payer: TriValley Medical Group Senior |
$62.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$67.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC SOM CONTROLLED SUB MON 2
|
Facility
|
IP
|
$20.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900915355
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$15.19 |
| Rate for Payer: Adventist Health Commercial |
$4.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.04
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.71
|
| Rate for Payer: Heritage Provider Network Senior |
$13.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.06
|
| Rate for Payer: Multiplan Commercial |
$15.19
|
|
|
HC SOM CONTROLLED SUB MON 3
|
Facility
|
IP
|
$24.01
|
|
|
Service Code
|
CPT 80347
|
| Hospital Charge Code |
900915356
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$18.01 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.46
|
| Rate for Payer: Cash Price |
$24.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.25
|
| Rate for Payer: Heritage Provider Network Senior |
$16.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$18.01
|
|
|
HC SOM CONTROLLED SUB MON 3
|
Facility
|
OP
|
$24.01
|
|
|
Service Code
|
CPT 80347
|
| Hospital Charge Code |
900915356
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$185.25 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.25
|
| Rate for Payer: Cash Price |
$24.01
|
| Rate for Payer: Cash Price |
$24.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.86
|
| Rate for Payer: Heritage Provider Network Senior |
$14.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.81
|
| Rate for Payer: Multiplan Commercial |
$18.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.41
|
| Rate for Payer: Vantage Medical Group Senior |
$20.41
|
|
|
HC SOM CONTROLLED SUB MON 4
|
Facility
|
OP
|
$9.62
|
|
|
Service Code
|
CPT 80326
|
| Hospital Charge Code |
900915357
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$169.84 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.84
|
| Rate for Payer: Cash Price |
$9.62
|
| Rate for Payer: Cash Price |
$9.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.95
|
| Rate for Payer: Heritage Provider Network Senior |
$5.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$7.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.18
|
| Rate for Payer: Vantage Medical Group Senior |
$8.18
|
|
|
HC SOM CONTROLLED SUB MON 4
|
Facility
|
IP
|
$9.62
|
|
|
Service Code
|
CPT 80326
|
| Hospital Charge Code |
900915357
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.21 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.20
|
| Rate for Payer: Cash Price |
$9.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.51
|
| Rate for Payer: Heritage Provider Network Senior |
$6.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$7.21
|
|
|
HC SOM COPPER SERUM
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911099
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$118.13 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.13
|
| Rate for Payer: Blue Shield of California Commercial |
$99.88
|
| Rate for Payer: Blue Shield of California EPN |
$80.11
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.29
|
| Rate for Payer: Heritage Provider Network Senior |
$9.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.63
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.41
|
| Rate for Payer: TriValley Medical Group Senior |
$12.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Vantage Medical Group Senior |
$12.41
|
|
|
HC SOM COPPER SERUM
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911099
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.66
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.15
|
| Rate for Payer: Heritage Provider Network Senior |
$10.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
|
|
HC SOM COPPER URINE
|
Facility
|
IP
|
$39.97
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$29.98 |
| Rate for Payer: Adventist Health Commercial |
$7.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.74
|
| Rate for Payer: Cash Price |
$39.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.06
|
| Rate for Payer: Heritage Provider Network Senior |
$27.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.99
|
| Rate for Payer: Multiplan Commercial |
$29.98
|
|
|
HC SOM COPPER URINE
|
Facility
|
OP
|
$39.97
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$118.13 |
| Rate for Payer: Adventist Health Commercial |
$7.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.13
|
| Rate for Payer: Blue Shield of California Commercial |
$99.88
|
| Rate for Payer: Blue Shield of California EPN |
$80.11
|
| Rate for Payer: Cash Price |
$39.97
|
| Rate for Payer: Cash Price |
$39.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.58
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.74
|
| Rate for Payer: Heritage Provider Network Senior |
$24.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.63
|
| Rate for Payer: Multiplan Commercial |
$29.98
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.41
|
| Rate for Payer: TriValley Medical Group Senior |
$12.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Vantage Medical Group Senior |
$12.41
|
|
|
HC SOM CORT FREE QUANTITATION
|
Facility
|
IP
|
$19.97
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$14.98 |
| Rate for Payer: Adventist Health Commercial |
$3.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.86
|
| Rate for Payer: Cash Price |
$19.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.52
|
| Rate for Payer: Heritage Provider Network Senior |
$13.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.99
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
|
|
HC SOM CORT FREE QUANTITATION
|
Facility
|
OP
|
$19.97
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$170.74 |
| Rate for Payer: Adventist Health Commercial |
$3.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.74
|
| 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 |
$19.97
|
| Rate for Payer: Cash Price |
$19.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.36
|
| Rate for Payer: Heritage Provider Network Senior |
$12.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.31
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.11
|
| Rate for Payer: TriValley Medical Group Senior |
$24.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Vantage Medical Group Senior |
$24.11
|
|
|
HC SOM CORTISOL FREE RANDOM UR
|
Facility
|
IP
|
$31.01
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900912608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$23.26 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.97
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.99
|
| Rate for Payer: Heritage Provider Network Senior |
$20.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$23.26
|
|
|
HC SOM CORTISOL FREE RANDOM UR
|
Facility
|
OP
|
$31.01
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900912608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$161.02 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.02
|
| Rate for Payer: Blue Shield of California Commercial |
$134.50
|
| Rate for Payer: Blue Shield of California EPN |
$107.88
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.20
|
| Rate for Payer: Heritage Provider Network Senior |
$19.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.39
|
| Rate for Payer: Multiplan Commercial |
$23.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.71
|
| Rate for Payer: TriValley Medical Group Senior |
$16.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Vantage Medical Group Senior |
$16.71
|
|
|
HC SOM CORTISOL FREE SERUM
|
Facility
|
OP
|
$40.60
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900910672
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$161.02 |
| Rate for Payer: Adventist Health Commercial |
$8.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.02
|
| Rate for Payer: Blue Shield of California Commercial |
$134.50
|
| Rate for Payer: Blue Shield of California EPN |
$107.88
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.13
|
| Rate for Payer: Heritage Provider Network Senior |
$25.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.39
|
| Rate for Payer: Multiplan Commercial |
$30.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.71
|
| Rate for Payer: TriValley Medical Group Senior |
$16.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Vantage Medical Group Senior |
$16.71
|
|
|
HC SOM CORTISOL FREE SERUM
|
Facility
|
IP
|
$40.60
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900910672
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$30.45 |
| Rate for Payer: Adventist Health Commercial |
$8.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.15
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.49
|
| Rate for Payer: Heritage Provider Network Senior |
$27.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.15
|
| Rate for Payer: Multiplan Commercial |
$30.45
|
|
|
HC SOM CORTISOL FREE UR
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900914673
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$161.02 |
| 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 |
$25.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.02
|
| Rate for Payer: Blue Shield of California Commercial |
$134.50
|
| Rate for Payer: Blue Shield of California EPN |
$107.88
|
| 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 |
$25.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.71
|
| 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 |
$16.71
|
| 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 |
$19.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.39
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.71
|
| Rate for Payer: TriValley Medical Group Senior |
$16.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Vantage Medical Group Senior |
$16.71
|
|
