|
HC SOM MECONIUM AMPHETAMINE CONFIRM
|
Facility
IP
|
$35.08
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
900912830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$26.31 |
| Rate for Payer: Adventist Health Commercial |
$7.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.10
|
| Rate for Payer: Cash Price |
$15.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.75
|
| Rate for Payer: Heritage Provider Network Senior |
$23.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.77
|
| Rate for Payer: Multiplan Commercial |
$26.31
|
|
|
HC SOM MECONIUM AMPHETAMINE CONFIRM
|
Facility
OP
|
$35.08
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
900912830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$124.82 |
| Rate for Payer: Adventist Health Commercial |
$7.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$26.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.82
|
| Rate for Payer: Cash Price |
$15.79
|
| Rate for Payer: Cash Price |
$15.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.82
|
| Rate for Payer: Dignity Health Senior |
$29.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.71
|
| Rate for Payer: Heritage Provider Network Senior |
$21.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.77
|
| Rate for Payer: Multiplan Commercial |
$26.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Vantage Medical Group Senior |
$29.82
|
|
|
HC SOM MECONIUM COCAINE CONFIRM
|
Facility
OP
|
$96.01
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
900912832
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$121.72 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$81.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$52.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$72.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.72
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$62.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.61
|
| Rate for Payer: Dignity Health Senior |
$81.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.43
|
| Rate for Payer: Heritage Provider Network Senior |
$59.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$72.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.61
|
| Rate for Payer: Vantage Medical Group Senior |
$81.61
|
|
|
HC SOM MECONIUM COCAINE CONFIRM
|
Facility
IP
|
$96.01
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
900912832
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$72.01 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.96
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.00
|
| Rate for Payer: Heritage Provider Network Senior |
$65.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$72.01
|
|
|
HC SOM MECONIUM METHAMPHETAMINE CONF
|
Facility
IP
|
$23.42
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
900912831
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$17.56 |
| Rate for Payer: Adventist Health Commercial |
$4.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.09
|
| Rate for Payer: Cash Price |
$10.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.86
|
| Rate for Payer: Heritage Provider Network Senior |
$15.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.86
|
| Rate for Payer: Multiplan Commercial |
$17.56
|
|
|
HC SOM MECONIUM METHAMPHETAMINE CONF
|
Facility
OP
|
$23.42
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
900912831
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$124.82 |
| Rate for Payer: Adventist Health Commercial |
$4.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.91
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.82
|
| Rate for Payer: Cash Price |
$10.54
|
| Rate for Payer: Cash Price |
$10.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.91
|
| Rate for Payer: Dignity Health Senior |
$19.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.50
|
| Rate for Payer: Heritage Provider Network Senior |
$14.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.86
|
| Rate for Payer: Multiplan Commercial |
$17.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.91
|
| Rate for Payer: Vantage Medical Group Senior |
$19.91
|
|
|
HC SOM MECONIUM OPIATE CONFIRM
|
Facility
IP
|
$49.07
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
900912833
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$36.80 |
| Rate for Payer: Adventist Health Commercial |
$9.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.71
|
| Rate for Payer: Cash Price |
$22.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.22
|
| Rate for Payer: Heritage Provider Network Senior |
$33.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.27
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
|
|
HC SOM MECONIUM OPIATE CONFIRM
|
Facility
OP
|
$49.07
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
900912833
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$156.20 |
| Rate for Payer: Adventist Health Commercial |
$9.81
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$41.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.99
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$36.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.20
|
| Rate for Payer: Cash Price |
$22.08
|
| Rate for Payer: Cash Price |
$22.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.71
|
| Rate for Payer: Dignity Health Senior |
$41.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.37
|
| Rate for Payer: Heritage Provider Network Senior |
$30.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.27
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.71
|
| Rate for Payer: Vantage Medical Group Senior |
$41.71
|
|
|
HC SOM MECONIUM PCP CONFIRM
|
Facility
IP
|
$180.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900912835
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.58 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.66
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.86
|
| Rate for Payer: Heritage Provider Network Senior |
$121.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
|
|
HC SOM MECONIUM PCP CONFIRM
|
Facility
OP
|
$180.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900912835
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$99.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$135.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.02
|
| Rate for Payer: Blue Shield of California Commercial |
$108.95
|
| Rate for Payer: Blue Shield of California EPN |
$85.17
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$117.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.00
|
| Rate for Payer: Dignity Health Senior |
$153.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.42
|
| Rate for Payer: Heritage Provider Network Senior |
$111.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$86.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$40.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$40.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.00
|
| Rate for Payer: Vantage Medical Group Senior |
$153.00
|
|
|
HC SOM MECONIUM THC LAB REF CONFIRM
|
Facility
OP
|
$76.10
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
900912834
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$190.18 |
| Rate for Payer: Adventist Health Commercial |
$15.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$64.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$41.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$57.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$190.18
|
| Rate for Payer: Cash Price |
$34.25
|
| Rate for Payer: Cash Price |
$34.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$49.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.68
|
| Rate for Payer: Dignity Health Senior |
$64.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.11
|
| Rate for Payer: Heritage Provider Network Senior |
$47.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.02
|
| Rate for Payer: Multiplan Commercial |
$57.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.68
|
| Rate for Payer: Vantage Medical Group Senior |
$64.68
|
|
|
HC SOM MECONIUM THC LAB REF CONFIRM
|
Facility
IP
|
$76.10
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
900912834
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$57.08 |
| Rate for Payer: Adventist Health Commercial |
$15.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.28
|
| Rate for Payer: Cash Price |
$34.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.52
|
| Rate for Payer: Heritage Provider Network Senior |
$51.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.02
|
| Rate for Payer: Multiplan Commercial |
$57.08
|
|
|
HC SOM MENMS 81405
|
Facility
OP
|
$556.35
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914742
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$100.70 |
| Max. Negotiated Rate |
$1,972.62 |
| Rate for Payer: Adventist Health Commercial |
$111.27
|
| Rate for Payer: Aetna of CA Gatekeeper |
$255.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$382.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$331.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$301.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,972.62
|
| Rate for Payer: Blue Shield of California Commercial |
$345.49
|
| Rate for Payer: Blue Shield of California EPN |
$326.58
|
| Rate for Payer: Cash Price |
$250.36
|
| Rate for Payer: Cash Price |
$250.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$361.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$452.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$331.48
|
| Rate for Payer: Dignity Health Senior |
$301.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$301.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$344.38
|
| Rate for Payer: Heritage Provider Network Senior |
$344.38
|
| Rate for Payer: Humana Medicare |
$301.35
|
| Rate for Payer: IEHP Medi-Cal |
$470.11
|
| Rate for Payer: IEHP Medicare Advantage |
$301.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$572.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$379.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$379.70
|
| Rate for Payer: Multiplan Commercial |
$417.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$301.35
|
| Rate for Payer: TriValley Medical Group Senior |
$301.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$325.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$325.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$331.48
|
| Rate for Payer: Vantage Medical Group Senior |
$301.35
|
|
|
HC SOM MENMS 81405
|
Facility
IP
|
$556.35
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914742
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$100.70 |
| Max. Negotiated Rate |
$417.26 |
| Rate for Payer: Adventist Health Commercial |
$111.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$382.21
|
| Rate for Payer: Cash Price |
$250.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.65
|
| Rate for Payer: Heritage Provider Network Senior |
$376.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.09
|
| Rate for Payer: Multiplan Commercial |
$417.26
|
|
|
HC SOM MEPERIDINE
|
Facility
OP
|
$98.28
|
|
|
Service Code
|
CPT 80362
|
| Hospital Charge Code |
900910758
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$156.20 |
| Rate for Payer: Adventist Health Commercial |
$19.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$83.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$54.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$73.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.20
|
| Rate for Payer: Cash Price |
$44.23
|
| Rate for Payer: Cash Price |
$44.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.54
|
| Rate for Payer: Dignity Health Senior |
$83.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.84
|
| Rate for Payer: Heritage Provider Network Senior |
$60.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.57
|
| Rate for Payer: Multiplan Commercial |
$73.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.54
|
| Rate for Payer: Vantage Medical Group Senior |
$83.54
|
|
|
HC SOM MEPERIDINE
|
Facility
IP
|
$98.28
|
|
|
Service Code
|
CPT 80362
|
| Hospital Charge Code |
900910758
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.79 |
| Max. Negotiated Rate |
$73.71 |
| Rate for Payer: Adventist Health Commercial |
$19.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.52
|
| Rate for Payer: Cash Price |
$44.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.54
|
| Rate for Payer: Heritage Provider Network Senior |
$66.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.57
|
| Rate for Payer: Multiplan Commercial |
$73.71
|
|
|
HC SOM MERCURY BLOOD
|
Facility
IP
|
$22.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
900910759
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.11
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.89
|
| Rate for Payer: Heritage Provider Network Senior |
$14.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
|
|
HC SOM MERCURY BLOOD
|
Facility
OP
|
$22.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
900910759
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$135.47 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.47
|
| Rate for Payer: Blue Shield of California Commercial |
$127.00
|
| Rate for Payer: Blue Shield of California EPN |
$99.29
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.89
|
| Rate for Payer: Dignity Health Senior |
$16.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.62
|
| Rate for Payer: Heritage Provider Network Senior |
$13.62
|
| Rate for Payer: Humana Medicare |
$16.26
|
| Rate for Payer: IEHP Medi-Cal |
$22.03
|
| Rate for Payer: IEHP Medicare Advantage |
$16.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.49
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.26
|
| Rate for Payer: TriValley Medical Group Senior |
$16.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.89
|
| Rate for Payer: Vantage Medical Group Senior |
$16.26
|
|
|
HC SOM META 1-10
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900915301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$1,590.45 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$93.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$34.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,590.45
|
| Rate for Payer: Blue Shield of California Commercial |
$250.94
|
| Rate for Payer: Blue Shield of California EPN |
$196.17
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.29
|
| Rate for Payer: Dignity Health Senior |
$34.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$34.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.57
|
| Rate for Payer: Heritage Provider Network Senior |
$18.57
|
| Rate for Payer: Humana Medicare |
$34.81
|
| Rate for Payer: IEHP Medi-Cal |
$44.55
|
| Rate for Payer: IEHP Medicare Advantage |
$34.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43.86
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$34.81
|
| Rate for Payer: TriValley Medical Group Senior |
$34.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Vantage Medical Group Senior |
$34.81
|
|
|
HC SOM META 1-10
|
Facility
IP
|
$30.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900915301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.31
|
| Rate for Payer: Heritage Provider Network Senior |
$20.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
|
|
HC SOM META 1-19
|
Facility
OP
|
$125.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900915297
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$1,038.61 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$362.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$216.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$144.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,038.61
|
| Rate for Payer: Blue Shield of California Commercial |
$973.44
|
| Rate for Payer: Blue Shield of California EPN |
$760.99
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.07
|
| Rate for Payer: Dignity Health Senior |
$144.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$144.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.38
|
| Rate for Payer: Heritage Provider Network Senior |
$77.38
|
| Rate for Payer: Humana Medicare |
$144.61
|
| Rate for Payer: IEHP Medi-Cal |
$180.46
|
| Rate for Payer: IEHP Medicare Advantage |
$144.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$274.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$170.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$182.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$182.21
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$144.61
|
| Rate for Payer: TriValley Medical Group Senior |
$144.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$156.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$156.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: Vantage Medical Group Senior |
$144.61
|
|
|
HC SOM META 1-19
|
Facility
IP
|
$125.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900915297
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.62
|
| Rate for Payer: Heritage Provider Network Senior |
$84.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
|
|
HC SOM META 1-20
|
Facility
IP
|
$175.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900915293
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$131.25 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.22
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.48
|
| Rate for Payer: Heritage Provider Network Senior |
$118.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.75
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
|
|
HC SOM META 1-20
|
Facility
OP
|
$175.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900915293
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$1,043.23 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$362.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$188.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$125.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,043.23
|
| Rate for Payer: Blue Shield of California Commercial |
$973.44
|
| Rate for Payer: Blue Shield of California EPN |
$760.99
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$113.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$188.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.04
|
| Rate for Payer: Dignity Health Senior |
$125.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$125.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.32
|
| Rate for Payer: Heritage Provider Network Senior |
$108.32
|
| Rate for Payer: Humana Medicare |
$125.49
|
| Rate for Payer: IEHP Medi-Cal |
$168.18
|
| Rate for Payer: IEHP Medicare Advantage |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$238.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$148.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$158.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$158.12
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.49
|
| Rate for Payer: TriValley Medical Group Senior |
$125.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$135.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$135.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$188.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: Vantage Medical Group Senior |
$125.49
|
|
|
HC SOM META 1-25
|
Facility
IP
|
$125.00
|
|
|
Service Code
|
CPT 88245
|
| Hospital Charge Code |
900915291
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.62
|
| Rate for Payer: Heritage Provider Network Senior |
$84.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
|
