|
HC SOM DCP 83951
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 83951
|
| Hospital Charge Code |
900914920
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$57.96
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.93
|
| Rate for Payer: Heritage Provider Network Senior |
$60.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
|
|
HC SOM DENGUE FEVER AB IGG
|
Facility
|
OP
|
$89.10
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900911637
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$122.35 |
| Rate for Payer: Adventist Health Commercial |
$17.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.35
|
| Rate for Payer: Blue Shield of California Commercial |
$103.68
|
| Rate for Payer: Blue Shield of California EPN |
$83.16
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.57
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.15
|
| Rate for Payer: Heritage Provider Network Senior |
$55.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$42.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$66.83
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.88
|
| Rate for Payer: TriValley Medical Group Senior |
$12.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM DENGUE FEVER AB IGG
|
Facility
|
IP
|
$89.10
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900911637
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.13 |
| Max. Negotiated Rate |
$66.83 |
| Rate for Payer: Adventist Health Commercial |
$17.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$57.38
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.32
|
| Rate for Payer: Heritage Provider Network Senior |
$60.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.27
|
| Rate for Payer: Multiplan Commercial |
$66.83
|
|
|
HC SOM DENGUE FEVER AB IGM
|
Facility
|
IP
|
$89.10
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900912614
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.13 |
| Max. Negotiated Rate |
$66.83 |
| Rate for Payer: Adventist Health Commercial |
$17.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$57.38
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.32
|
| Rate for Payer: Heritage Provider Network Senior |
$60.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.27
|
| Rate for Payer: Multiplan Commercial |
$66.83
|
|
|
HC SOM DENGUE FEVER AB IGM
|
Facility
|
OP
|
$89.10
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900912614
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$122.35 |
| Rate for Payer: Adventist Health Commercial |
$17.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.35
|
| Rate for Payer: Blue Shield of California Commercial |
$103.68
|
| Rate for Payer: Blue Shield of California EPN |
$83.16
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.57
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.15
|
| Rate for Payer: Heritage Provider Network Senior |
$55.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$42.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$66.83
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.88
|
| Rate for Payer: TriValley Medical Group Senior |
$12.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM DESMOGLEIN 1
|
Facility
|
IP
|
$62.50
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900914423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$46.88 |
| Rate for Payer: Adventist Health Commercial |
$12.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.25
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.31
|
| Rate for Payer: Heritage Provider Network Senior |
$42.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.62
|
| Rate for Payer: Multiplan Commercial |
$46.88
|
|
|
HC SOM DESMOGLEIN 1
|
Facility
|
OP
|
$62.50
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900914423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$222.13 |
| Rate for Payer: Adventist Health Commercial |
$12.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.13
|
| 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 |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.69
|
| Rate for Payer: Heritage Provider Network Senior |
$38.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$29.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$46.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM DESMOGLEIN 3
|
Facility
|
IP
|
$62.50
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900914662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$46.88 |
| Rate for Payer: Adventist Health Commercial |
$12.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.25
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.31
|
| Rate for Payer: Heritage Provider Network Senior |
$42.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.62
|
| Rate for Payer: Multiplan Commercial |
$46.88
|
|
|
HC SOM DESMOGLEIN 3
|
Facility
|
OP
|
$62.50
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900914662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$222.13 |
| Rate for Payer: Adventist Health Commercial |
$12.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.13
|
| 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 |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.69
|
| Rate for Payer: Heritage Provider Network Senior |
$38.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$29.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$46.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM DESYREL (TRAZODONE)
|
Facility
|
OP
|
$70.25
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
900911223
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$163.00 |
| Rate for Payer: Adventist Health Commercial |
$14.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.00
|
| Rate for Payer: Cash Price |
$70.25
|
| Rate for Payer: Cash Price |
$70.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$45.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.48
|
| Rate for Payer: Heritage Provider Network Senior |
$43.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$33.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.17
|
| Rate for Payer: Multiplan Commercial |
$52.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$35.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$35.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.71
|
| Rate for Payer: Vantage Medical Group Senior |
$59.71
|
|
|
HC SOM DESYREL (TRAZODONE)
|
Facility
|
IP
|
$70.25
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
900911223
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$52.69 |
| Rate for Payer: Adventist Health Commercial |
$14.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.24
|
| Rate for Payer: Cash Price |
$70.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.56
|
| Rate for Payer: Heritage Provider Network Senior |
$47.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.56
|
| Rate for Payer: Multiplan Commercial |
$52.69
|
|
|
HC SOM DHEA
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
900911115
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.52
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.22
|
| Rate for Payer: Heritage Provider Network Senior |
$14.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
|
|
HC SOM DHEA
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
900911115
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$239.96 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.96
|
| Rate for Payer: Blue Shield of California Commercial |
$203.39
|
| Rate for Payer: Blue Shield of California EPN |
$163.13
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.00
|
| Rate for Payer: Heritage Provider Network Senior |
$13.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33.86
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.27
|
| Rate for Payer: TriValley Medical Group Senior |
$25.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.80
|
| Rate for Payer: Vantage Medical Group Senior |
$25.27
|
|
|
HC SOM DIABETES MELLITUS TYPE1 EV
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
900912904
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.83
|
| Rate for Payer: Heritage Provider Network Senior |
$10.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
|
|
HC SOM DIABETES MELLITUS TYPE1 EV
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
900912904
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$172.59 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$172.59
|
| Rate for Payer: Blue Shield of California Commercial |
$172.34
|
| Rate for Payer: Blue Shield of California EPN |
$138.23
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.44
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Senior |
$9.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.69
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.41
|
| Rate for Payer: TriValley Medical Group Senior |
$21.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.55
|
| Rate for Payer: Vantage Medical Group Senior |
$21.41
|
|
|
HC SOM DIAB EVAL IA-2 AB
|
Facility
|
IP
|
$43.69
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Adventist Health Commercial |
$8.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.14
|
| Rate for Payer: Cash Price |
$43.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.58
|
| Rate for Payer: Heritage Provider Network Senior |
$29.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.92
|
| Rate for Payer: Multiplan Commercial |
$32.77
|
|
|
HC SOM DIAB EVAL IA-2 AB
|
Facility
|
OP
|
$43.69
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$146.00 |
| Rate for Payer: Adventist Health Commercial |
$8.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.00
|
| Rate for Payer: Blue Shield of California Commercial |
$133.75
|
| Rate for Payer: Blue Shield of California EPN |
$107.28
|
| Rate for Payer: Cash Price |
$43.69
|
| Rate for Payer: Cash Price |
$43.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$23.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.04
|
| Rate for Payer: Heritage Provider Network Senior |
$27.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31.58
|
| Rate for Payer: Multiplan Commercial |
$32.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.57
|
| Rate for Payer: TriValley Medical Group Senior |
$23.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM DIAB EVAL ZN T8 AB
|
Facility
|
OP
|
$43.69
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$146.00 |
| Rate for Payer: Adventist Health Commercial |
$8.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.00
|
| Rate for Payer: Blue Shield of California Commercial |
$133.75
|
| Rate for Payer: Blue Shield of California EPN |
$107.28
|
| Rate for Payer: Cash Price |
$43.69
|
| Rate for Payer: Cash Price |
$43.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$23.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.04
|
| Rate for Payer: Heritage Provider Network Senior |
$27.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31.58
|
| Rate for Payer: Multiplan Commercial |
$32.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.57
|
| Rate for Payer: TriValley Medical Group Senior |
$23.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM DIAB EVAL ZN T8 AB
|
Facility
|
IP
|
$43.69
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Adventist Health Commercial |
$8.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.14
|
| Rate for Payer: Cash Price |
$43.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.58
|
| Rate for Payer: Heritage Provider Network Senior |
$29.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.92
|
| Rate for Payer: Multiplan Commercial |
$32.77
|
|
|
HC SOM DIAZEPAM (VALIUM)
|
Facility
|
OP
|
$43.73
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911088
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$138.26 |
| Rate for Payer: Adventist Health Commercial |
$8.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.26
|
| Rate for Payer: Blue Shield of California Commercial |
$110.19
|
| Rate for Payer: Blue Shield of California EPN |
$88.38
|
| Rate for Payer: Cash Price |
$43.73
|
| Rate for Payer: Cash Price |
$43.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.07
|
| Rate for Payer: Heritage Provider Network Senior |
$27.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| 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 DIAZEPAM (VALIUM)
|
Facility
|
IP
|
$43.73
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911088
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$32.80 |
| Rate for Payer: Adventist Health Commercial |
$8.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.16
|
| Rate for Payer: Cash Price |
$43.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.61
|
| Rate for Payer: Heritage Provider Network Senior |
$29.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.93
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
|
|
HC SOM DIHYDROTESTERONE
|
Facility
|
OP
|
$43.87
|
|
|
Service Code
|
CPT 82642
|
| Hospital Charge Code |
900911013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.94 |
| Max. Negotiated Rate |
$192.02 |
| Rate for Payer: EPIC Health Plan Commercial |
$25.88
|
| Rate for Payer: Adventist Health Commercial |
$8.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.02
|
| Rate for Payer: Blue Shield of California Commercial |
$187.37
|
| Rate for Payer: Blue Shield of California EPN |
$150.29
|
| Rate for Payer: Cash Price |
$43.87
|
| Rate for Payer: Cash Price |
$43.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$29.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.16
|
| Rate for Payer: Heritage Provider Network Senior |
$27.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39.24
|
| Rate for Payer: Multiplan Commercial |
$32.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.28
|
| Rate for Payer: TriValley Medical Group Senior |
$29.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Vantage Medical Group Senior |
$29.28
|
|
|
HC SOM DIHYDROTESTERONE
|
Facility
|
IP
|
$43.87
|
|
|
Service Code
|
CPT 82642
|
| Hospital Charge Code |
900911013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.94 |
| Max. Negotiated Rate |
$32.90 |
| Rate for Payer: Adventist Health Commercial |
$8.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.25
|
| Rate for Payer: Cash Price |
$43.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.70
|
| Rate for Payer: Heritage Provider Network Senior |
$29.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.97
|
| Rate for Payer: Multiplan Commercial |
$32.90
|
|
|
HC SOM DILANTIN FREE
|
Facility
|
IP
|
$14.36
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
900911414
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$10.77 |
| Rate for Payer: Adventist Health Commercial |
$2.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.25
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.72
|
| Rate for Payer: Heritage Provider Network Senior |
$9.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.59
|
| Rate for Payer: Multiplan Commercial |
$10.77
|
|
|
HC SOM DILANTIN FREE
|
Facility
|
OP
|
$14.36
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
900911414
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$133.09 |
| Rate for Payer: Adventist Health Commercial |
$2.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.09
|
| Rate for Payer: Blue Shield of California Commercial |
$110.76
|
| Rate for Payer: Blue Shield of California EPN |
$88.84
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.89
|
| Rate for Payer: Heritage Provider Network Senior |
$8.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.44
|
| Rate for Payer: Multiplan Commercial |
$10.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.76
|
| Rate for Payer: TriValley Medical Group Senior |
$13.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.14
|
| Rate for Payer: Vantage Medical Group Senior |
$13.76
|
|
