|
HC SOM LYSO 86003
|
Facility
OP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914738
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$132.31 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
| Rate for Payer: Blue Shield of California Commercial |
$40.81
|
| Rate for Payer: Blue Shield of California EPN |
$31.90
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.86
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.62
|
| Rate for Payer: Heritage Provider Network Senior |
$4.62
|
| Rate for Payer: Humana Medicare |
$5.22
|
| Rate for Payer: IEHP Medi-Cal |
$7.24
|
| Rate for Payer: IEHP Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SOM MAGNESIUM RANDOM UR
|
Facility
IP
|
$7.41
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900913941
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$5.56 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.09
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.02
|
| Rate for Payer: Heritage Provider Network Senior |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.85
|
| Rate for Payer: Multiplan Commercial |
$5.56
|
|
|
HC SOM MAGNESIUM RANDOM UR
|
Facility
OP
|
$7.41
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900913941
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$55.73 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.73
|
| Rate for Payer: Blue Shield of California Commercial |
$52.32
|
| Rate for Payer: Blue Shield of California EPN |
$40.90
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.37
|
| Rate for Payer: Dignity Health Senior |
$6.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.59
|
| Rate for Payer: Heritage Provider Network Senior |
$4.59
|
| Rate for Payer: Humana Medicare |
$6.70
|
| Rate for Payer: IEHP Medi-Cal |
$9.30
|
| Rate for Payer: IEHP Medicare Advantage |
$6.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.44
|
| Rate for Payer: Multiplan Commercial |
$5.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.70
|
| Rate for Payer: TriValley Medical Group Senior |
$6.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Vantage Medical Group Senior |
$6.70
|
|
|
HC SOM MAGNESIUM, URINE
|
Facility
IP
|
$7.41
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900910757
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$5.56 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.09
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.02
|
| Rate for Payer: Heritage Provider Network Senior |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.85
|
| Rate for Payer: Multiplan Commercial |
$5.56
|
|
|
HC SOM MAGNESIUM, URINE
|
Facility
OP
|
$7.41
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900910757
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$55.73 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.73
|
| Rate for Payer: Blue Shield of California Commercial |
$52.32
|
| Rate for Payer: Blue Shield of California EPN |
$40.90
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.37
|
| Rate for Payer: Dignity Health Senior |
$6.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.59
|
| Rate for Payer: Heritage Provider Network Senior |
$4.59
|
| Rate for Payer: Humana Medicare |
$6.70
|
| Rate for Payer: IEHP Medi-Cal |
$9.30
|
| Rate for Payer: IEHP Medicare Advantage |
$6.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.44
|
| Rate for Payer: Multiplan Commercial |
$5.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.70
|
| Rate for Payer: TriValley Medical Group Senior |
$6.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Vantage Medical Group Senior |
$6.70
|
|
|
HC SOM MANGANESE
|
Facility
IP
|
$26.65
|
|
|
Service Code
|
CPT 83785
|
| Hospital Charge Code |
900911066
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$19.99 |
| Rate for Payer: Adventist Health Commercial |
$5.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.31
|
| Rate for Payer: Cash Price |
$11.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.04
|
| Rate for Payer: Heritage Provider Network Senior |
$18.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.66
|
| Rate for Payer: Multiplan Commercial |
$19.99
|
|
|
HC SOM MANGANESE
|
Facility
OP
|
$26.65
|
|
|
Service Code
|
CPT 83785
|
| Hospital Charge Code |
900911066
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$205.79 |
| Rate for Payer: Adventist Health Commercial |
$5.33
|
| Rate for Payer: Aetna of CA Gatekeeper |
$71.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$39.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$26.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.79
|
| Rate for Payer: Blue Shield of California Commercial |
$192.07
|
| Rate for Payer: Blue Shield of California EPN |
$150.15
|
| Rate for Payer: Cash Price |
$11.99
|
| Rate for Payer: Cash Price |
$11.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.32
|
| Rate for Payer: Dignity Health Senior |
$26.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.32
|
| Rate for Payer: EPIC Health Plan Medicare |
$26.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.50
|
| Rate for Payer: Heritage Provider Network Senior |
$16.50
|
| Rate for Payer: Humana Medicare |
$26.65
|
| Rate for Payer: IEHP Medi-Cal |
$34.10
|
| Rate for Payer: IEHP Medicare Advantage |
$26.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$50.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.58
|
| Rate for Payer: Multiplan Commercial |
$19.99
|
| Rate for Payer: TriValley Medical Group Commercial |
$26.65
|
| Rate for Payer: TriValley Medical Group Senior |
$26.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.32
|
| Rate for Payer: Vantage Medical Group Senior |
$26.65
|
|
|
HC SOM MATERNAL CELL CONTAM
|
Facility
IP
|
$460.00
|
|
|
Service Code
|
CPT 81265
|
| Hospital Charge Code |
900915281
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$345.00 |
| Rate for Payer: Adventist Health Commercial |
$92.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$316.02
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$311.42
|
| Rate for Payer: Heritage Provider Network Senior |
$311.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.00
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
|
|
HC SOM MATERNAL CELL CONTAM
|
Facility
OP
|
$460.00
|
|
|
Service Code
|
CPT 81265
|
| Hospital Charge Code |
900915281
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$1,996.52 |
| Rate for Payer: Adventist Health Commercial |
$92.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$656.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$316.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$349.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$256.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$233.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,996.52
|
| Rate for Payer: Blue Shield of California Commercial |
$285.66
|
| Rate for Payer: Blue Shield of California EPN |
$270.02
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$299.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$349.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$256.38
|
| Rate for Payer: Dignity Health Senior |
$233.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$299.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$233.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$284.74
|
| Rate for Payer: Heritage Provider Network Senior |
$284.74
|
| Rate for Payer: Humana Medicare |
$233.07
|
| Rate for Payer: IEHP Medi-Cal |
$298.19
|
| Rate for Payer: IEHP Medicare Advantage |
$233.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$442.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$275.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$293.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$293.67
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$233.07
|
| Rate for Payer: TriValley Medical Group Senior |
$233.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$251.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$251.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$349.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$256.38
|
| Rate for Payer: Vantage Medical Group Senior |
$233.07
|
|
|
HC SOM MBCR 88271 SOM
|
Facility
OP
|
$51.34
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914721
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$1,420.05 |
| Rate for Payer: Adventist Health Commercial |
$10.27
|
| Rate for Payer: Aetna of CA Gatekeeper |
$62.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,420.05
|
| Rate for Payer: Blue Shield of California Commercial |
$167.31
|
| Rate for Payer: Blue Shield of California EPN |
$130.79
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Senior |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.37
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.78
|
| Rate for Payer: Heritage Provider Network Senior |
$31.78
|
| Rate for Payer: Humana Medicare |
$21.42
|
| Rate for Payer: IEHP Medi-Cal |
$26.21
|
| Rate for Payer: IEHP Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$40.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.99
|
| Rate for Payer: Multiplan Commercial |
$38.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.42
|
| Rate for Payer: TriValley Medical Group Senior |
$21.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC SOM MBCR 88271 SOM
|
Facility
IP
|
$51.34
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914721
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$38.50 |
| Rate for Payer: Adventist Health Commercial |
$10.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.27
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.76
|
| Rate for Payer: Heritage Provider Network Senior |
$34.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.84
|
| Rate for Payer: Multiplan Commercial |
$38.50
|
|
|
HC SOM MBCR 88275 SOM
|
Facility
IP
|
$62.47
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914722
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$46.85 |
| Rate for Payer: Adventist Health Commercial |
$12.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.92
|
| Rate for Payer: Cash Price |
$28.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.29
|
| Rate for Payer: Heritage Provider Network Senior |
$42.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.62
|
| Rate for Payer: Multiplan Commercial |
$46.85
|
|
|
HC SOM MBCR 88275 SOM
|
Facility
OP
|
$62.47
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914722
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$2,190.93 |
| Rate for Payer: Adventist Health Commercial |
$12.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$116.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,190.93
|
| Rate for Payer: Blue Shield of California Commercial |
$313.65
|
| Rate for Payer: Blue Shield of California EPN |
$245.20
|
| Rate for Payer: Cash Price |
$28.11
|
| Rate for Payer: Cash Price |
$28.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Senior |
$51.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.61
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.67
|
| Rate for Payer: Heritage Provider Network Senior |
$38.67
|
| Rate for Payer: Humana Medicare |
$51.19
|
| Rate for Payer: IEHP Medi-Cal |
$49.42
|
| Rate for Payer: IEHP Medicare Advantage |
$51.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$97.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.50
|
| Rate for Payer: Multiplan Commercial |
$46.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.19
|
| Rate for Payer: TriValley Medical Group Senior |
$51.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC SOM MBCR 88291 SOM
|
Facility
OP
|
$26.19
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914723
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$156.37 |
| Rate for Payer: Adventist Health Commercial |
$5.24
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.37
|
| Rate for Payer: Blue Shield of California Commercial |
$16.26
|
| Rate for Payer: Blue Shield of California EPN |
$15.37
|
| Rate for Payer: Cash Price |
$11.79
|
| Rate for Payer: Cash Price |
$11.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.26
|
| Rate for Payer: Dignity Health Senior |
$22.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.21
|
| Rate for Payer: Heritage Provider Network Senior |
$16.21
|
| Rate for Payer: IEHP Medi-Cal |
$21.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.55
|
| Rate for Payer: Multiplan Commercial |
$19.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.26
|
| Rate for Payer: Vantage Medical Group Senior |
$22.26
|
|
|
HC SOM MBCR 88291 SOM
|
Facility
IP
|
$26.19
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914723
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$19.64 |
| Rate for Payer: Adventist Health Commercial |
$5.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.99
|
| Rate for Payer: Cash Price |
$11.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.73
|
| Rate for Payer: Heritage Provider Network Senior |
$17.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.55
|
| Rate for Payer: Multiplan Commercial |
$19.64
|
|
|
HC SOM MCLON IFE U
|
Facility
IP
|
$28.86
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
900912768
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Adventist Health Commercial |
$5.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.83
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.54
|
| Rate for Payer: Heritage Provider Network Senior |
$19.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.22
|
| Rate for Payer: Multiplan Commercial |
$21.64
|
|
|
HC SOM MCLON IFE U
|
Facility
OP
|
$28.86
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
900912768
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$229.19 |
| Rate for Payer: Adventist Health Commercial |
$5.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$85.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$44.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.48
|
| Rate for Payer: Blue Shield of California Commercial |
$229.19
|
| Rate for Payer: Blue Shield of California EPN |
$179.17
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.28
|
| Rate for Payer: Dignity Health Senior |
$29.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$29.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.86
|
| Rate for Payer: Heritage Provider Network Senior |
$17.86
|
| Rate for Payer: Humana Medicare |
$29.35
|
| Rate for Payer: IEHP Medi-Cal |
$40.70
|
| Rate for Payer: IEHP Medicare Advantage |
$29.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$55.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.98
|
| Rate for Payer: Multiplan Commercial |
$21.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.35
|
| Rate for Payer: TriValley Medical Group Senior |
$29.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.28
|
| Rate for Payer: Vantage Medical Group Senior |
$29.35
|
|
|
HC SOM MCLON PROT ELEC. U
|
Facility
IP
|
$17.53
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$13.15 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.04
|
| Rate for Payer: Cash Price |
$7.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.87
|
| Rate for Payer: Heritage Provider Network Senior |
$11.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.38
|
| Rate for Payer: Multiplan Commercial |
$13.15
|
|
|
HC SOM MCLON PROT ELEC. U
|
Facility
OP
|
$17.53
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$146.23 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.23
|
| Rate for Payer: Blue Shield of California Commercial |
$139.30
|
| Rate for Payer: Blue Shield of California EPN |
$108.90
|
| Rate for Payer: Cash Price |
$7.89
|
| Rate for Payer: Cash Price |
$7.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.61
|
| Rate for Payer: Dignity Health Senior |
$17.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.85
|
| Rate for Payer: Heritage Provider Network Senior |
$10.85
|
| Rate for Payer: Humana Medicare |
$17.83
|
| Rate for Payer: IEHP Medi-Cal |
$24.73
|
| Rate for Payer: IEHP Medicare Advantage |
$17.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$33.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.47
|
| Rate for Payer: Multiplan Commercial |
$13.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.83
|
| Rate for Payer: TriValley Medical Group Senior |
$17.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Vantage Medical Group Senior |
$17.83
|
|
|
HC SOM MCLON T. PROT U
|
Facility
IP
|
$3.61
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.71 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.48
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.44
|
| Rate for Payer: Heritage Provider Network Senior |
$2.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$2.71
|
|
|
HC SOM MCLON T. PROT U
|
Facility
OP
|
$3.61
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$30.77 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.77
|
| Rate for Payer: Blue Shield of California Commercial |
$28.62
|
| Rate for Payer: Blue Shield of California EPN |
$22.37
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: Dignity Health Senior |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2.23
|
| Rate for Payer: Humana Medicare |
$3.67
|
| Rate for Payer: IEHP Medi-Cal |
$5.09
|
| Rate for Payer: IEHP Medicare Advantage |
$3.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$2.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.67
|
| Rate for Payer: TriValley Medical Group Senior |
$3.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
HC SOM MEASLES AB CSF IGG
|
Facility
OP
|
$22.50
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900911355
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Adventist Health Commercial |
$4.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.86
|
| Rate for Payer: Blue Shield of California Commercial |
$100.62
|
| Rate for Payer: Blue Shield of California EPN |
$78.66
|
| Rate for Payer: Cash Price |
$10.13
|
| Rate for Payer: Cash Price |
$10.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.93
|
| Rate for Payer: Heritage Provider Network Senior |
$13.93
|
| Rate for Payer: Humana Medicare |
$12.88
|
| Rate for Payer: IEHP Medi-Cal |
$17.86
|
| Rate for Payer: IEHP Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$16.88
|
| 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 MEASLES AB CSF IGG
|
Facility
IP
|
$22.50
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900911355
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$16.88 |
| Rate for Payer: Adventist Health Commercial |
$4.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.46
|
| Rate for Payer: Cash Price |
$10.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.23
|
| Rate for Payer: Heritage Provider Network Senior |
$15.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.62
|
| Rate for Payer: Multiplan Commercial |
$16.88
|
|
|
HC SOM MEASLES AB IGM CSF
|
Facility
OP
|
$22.50
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900912655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Adventist Health Commercial |
$4.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.86
|
| Rate for Payer: Blue Shield of California Commercial |
$100.62
|
| Rate for Payer: Blue Shield of California EPN |
$78.66
|
| Rate for Payer: Cash Price |
$10.13
|
| Rate for Payer: Cash Price |
$10.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.93
|
| Rate for Payer: Heritage Provider Network Senior |
$13.93
|
| Rate for Payer: Humana Medicare |
$12.88
|
| Rate for Payer: IEHP Medi-Cal |
$17.86
|
| Rate for Payer: IEHP Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$16.88
|
| 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 MEASLES AB IGM CSF
|
Facility
IP
|
$22.50
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900912655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$16.88 |
| Rate for Payer: Adventist Health Commercial |
$4.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.46
|
| Rate for Payer: Cash Price |
$10.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.23
|
| Rate for Payer: Heritage Provider Network Senior |
$15.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.62
|
| Rate for Payer: Multiplan Commercial |
$16.88
|
|
