|
HC SOM PORPHYRINS QN RND U
|
Facility
|
OP
|
$12.09
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
900914686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Adventist Health Commercial |
$2.42
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.14
|
| Rate for Payer: Blue Shield of California Commercial |
$67.97
|
| Rate for Payer: Blue Shield of California EPN |
$54.52
|
| Rate for Payer: Cash Price |
$12.09
|
| Rate for Payer: Cash Price |
$12.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.28
|
| Rate for Payer: Dignity Health Senior |
$8.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.86
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.48
|
| Rate for Payer: Heritage Provider Network Senior |
$7.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.63
|
| Rate for Payer: Multiplan Commercial |
$9.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.44
|
| Rate for Payer: TriValley Medical Group Senior |
$8.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.28
|
| Rate for Payer: Vantage Medical Group Senior |
$8.44
|
|
|
HC SOM PORPHYRINS TOTAL PLAS
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900914689
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.23
|
| Rate for Payer: Heritage Provider Network Senior |
$37.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
|
|
HC SOM PORPHYRINS TOTAL PLAS
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900914689
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$63.86 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.86
|
| Rate for Payer: Blue Shield of California Commercial |
$56.28
|
| Rate for Payer: Blue Shield of California EPN |
$45.14
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.91
|
| Rate for Payer: Dignity Health Senior |
$8.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.05
|
| Rate for Payer: Heritage Provider Network Senior |
$34.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.21
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.10
|
| Rate for Payer: TriValley Medical Group Senior |
$8.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Vantage Medical Group Senior |
$8.10
|
|
|
HC SOM PORPHYRINS URINE FRACTIONATED
|
Facility
|
IP
|
$28.59
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
900911511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$21.44 |
| Rate for Payer: Adventist Health Commercial |
$5.72
|
| Rate for Payer: Cash Price |
$28.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.36
|
| Rate for Payer: Heritage Provider Network Senior |
$19.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$21.44
|
|
|
HC SOM PORPHYRINS URINE FRACTIONATED
|
Facility
|
OP
|
$28.59
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
900911511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$134.30 |
| Rate for Payer: Adventist Health Commercial |
$5.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.30
|
| Rate for Payer: Blue Shield of California Commercial |
$118.37
|
| Rate for Payer: Blue Shield of California EPN |
$94.94
|
| Rate for Payer: Cash Price |
$28.59
|
| Rate for Payer: Cash Price |
$28.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.18
|
| Rate for Payer: Dignity Health Senior |
$14.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.58
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.70
|
| Rate for Payer: Heritage Provider Network Senior |
$17.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.53
|
| Rate for Payer: Multiplan Commercial |
$21.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.71
|
| Rate for Payer: TriValley Medical Group Senior |
$14.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.18
|
| Rate for Payer: Vantage Medical Group Senior |
$14.71
|
|
|
HC SOM PORPHYR UR FRAC PORPHOBIL
|
Facility
|
OP
|
$16.41
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
900912814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Adventist Health Commercial |
$3.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.14
|
| Rate for Payer: Blue Shield of California Commercial |
$67.97
|
| Rate for Payer: Blue Shield of California EPN |
$54.52
|
| Rate for Payer: Cash Price |
$16.41
|
| Rate for Payer: Cash Price |
$16.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.28
|
| Rate for Payer: Dignity Health Senior |
$8.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.16
|
| Rate for Payer: Heritage Provider Network Senior |
$10.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.63
|
| Rate for Payer: Multiplan Commercial |
$12.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.44
|
| Rate for Payer: TriValley Medical Group Senior |
$8.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.28
|
| Rate for Payer: Vantage Medical Group Senior |
$8.44
|
|
|
HC SOM PORPHYR UR FRAC PORPHOBIL
|
Facility
|
IP
|
$16.41
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
900912814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$12.31 |
| Rate for Payer: Adventist Health Commercial |
$3.28
|
| Rate for Payer: Cash Price |
$16.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.11
|
| Rate for Payer: Heritage Provider Network Senior |
$11.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.10
|
| Rate for Payer: Multiplan Commercial |
$12.31
|
|
|
HC SOM POSACONAZOLE LEVEL
|
Facility
|
OP
|
$27.11
|
|
|
Service Code
|
CPT 80187
|
| Hospital Charge Code |
900912708
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$156.15 |
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.71
|
| Rate for Payer: Blue Shield of California Commercial |
$156.15
|
| Rate for Payer: Blue Shield of California EPN |
$125.25
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.82
|
| Rate for Payer: Dignity Health Senior |
$27.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$27.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.78
|
| Rate for Payer: Heritage Provider Network Senior |
$16.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.16
|
| Rate for Payer: Multiplan Commercial |
$20.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.11
|
| Rate for Payer: TriValley Medical Group Senior |
$27.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Vantage Medical Group Senior |
$27.11
|
|
|
HC SOM POSACONAZOLE LEVEL
|
Facility
|
IP
|
$27.11
|
|
|
Service Code
|
CPT 80187
|
| Hospital Charge Code |
900912708
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$20.33 |
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.35
|
| Rate for Payer: Heritage Provider Network Senior |
$18.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.78
|
| Rate for Payer: Multiplan Commercial |
$20.33
|
|
|
HC SOM PRADER WILLI SYNDROME ANALYSIS
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
900910668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.95
|
| Rate for Payer: Heritage Provider Network Senior |
$236.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
|
|
HC SOM PRADER WILLI SYNDROME ANALYSIS
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
900910668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.07 |
| Max. Negotiated Rate |
$367.86 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$187.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$367.86
|
| Rate for Payer: Blue Shield of California Commercial |
$213.50
|
| Rate for Payer: Blue Shield of California EPN |
$170.80
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$227.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.18
|
| Rate for Payer: Dignity Health Senior |
$51.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.65
|
| Rate for Payer: Heritage Provider Network Senior |
$216.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$66.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$166.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.35
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.07
|
| Rate for Payer: TriValley Medical Group Senior |
$51.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.18
|
| Rate for Payer: Vantage Medical Group Senior |
$51.07
|
|
|
HC SOM PREGNENOLONE, SERUM
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 84140
|
| Hospital Charge Code |
900915512
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.93
|
| Rate for Payer: Heritage Provider Network Senior |
$16.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SOM PREGNENOLONE, SERUM
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 84140
|
| Hospital Charge Code |
900915512
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$184.70 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.70
|
| Rate for Payer: Blue Shield of California Commercial |
$166.41
|
| Rate for Payer: Blue Shield of California EPN |
$133.47
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.74
|
| Rate for Payer: Dignity Health Senior |
$20.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.47
|
| Rate for Payer: Heritage Provider Network Senior |
$15.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.04
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.67
|
| Rate for Payer: TriValley Medical Group Senior |
$20.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.74
|
| Rate for Payer: Vantage Medical Group Senior |
$20.67
|
|
|
HC SOM PRIMIDONE LEVEL
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
900911489
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$19.51 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Cash Price |
$26.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.61
|
| Rate for Payer: Heritage Provider Network Senior |
$17.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.50
|
| Rate for Payer: Multiplan Commercial |
$19.51
|
|
|
HC SOM PRIMIDONE LEVEL
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
900911489
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$151.57 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.57
|
| Rate for Payer: Blue Shield of California Commercial |
$133.52
|
| Rate for Payer: Blue Shield of California EPN |
$107.09
|
| Rate for Payer: Cash Price |
$26.01
|
| Rate for Payer: Cash Price |
$26.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.25
|
| Rate for Payer: Dignity Health Senior |
$16.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.91
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.10
|
| Rate for Payer: Heritage Provider Network Senior |
$16.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.90
|
| Rate for Payer: Multiplan Commercial |
$19.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.59
|
| Rate for Payer: TriValley Medical Group Senior |
$16.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.25
|
| Rate for Payer: Vantage Medical Group Senior |
$16.59
|
|
|
HC SOM PROBE SET COUNT
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900915278
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$1,548.87 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,548.87
|
| Rate for Payer: Blue Shield of California Commercial |
$172.40
|
| Rate for Payer: Blue Shield of California EPN |
$138.28
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.00
|
| 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 |
$26.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.76
|
| Rate for Payer: Heritage Provider Network Senior |
$24.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| 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 |
$30.00
|
| 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 PROBE SET COUNT
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900915278
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.08
|
| Rate for Payer: Heritage Provider Network Senior |
$27.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
|
|
HC SOM PROINSULIN
|
Facility
|
IP
|
$26.69
|
|
|
Service Code
|
CPT 84206
|
| Hospital Charge Code |
900911398
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$20.02 |
| Rate for Payer: Adventist Health Commercial |
$5.34
|
| Rate for Payer: Cash Price |
$26.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.07
|
| Rate for Payer: Heritage Provider Network Senior |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.67
|
| Rate for Payer: Multiplan Commercial |
$20.02
|
|
|
HC SOM PROINSULIN
|
Facility
|
OP
|
$26.69
|
|
|
Service Code
|
CPT 84206
|
| Hospital Charge Code |
900911398
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$157.35 |
| Rate for Payer: Adventist Health Commercial |
$5.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.35
|
| Rate for Payer: Blue Shield of California Commercial |
$143.37
|
| Rate for Payer: Blue Shield of California EPN |
$114.99
|
| Rate for Payer: Cash Price |
$26.69
|
| Rate for Payer: Cash Price |
$26.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.36
|
| Rate for Payer: Dignity Health Senior |
$26.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$26.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.52
|
| Rate for Payer: Heritage Provider Network Senior |
$16.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.63
|
| Rate for Payer: Multiplan Commercial |
$20.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$26.69
|
| Rate for Payer: TriValley Medical Group Senior |
$26.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.36
|
| Rate for Payer: Vantage Medical Group Senior |
$26.69
|
|
|
HC SOM PROSTATE HEALTH INDEX
|
Facility
|
IP
|
$13.28
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900915518
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$9.96 |
| Rate for Payer: Adventist Health Commercial |
$2.66
|
| Rate for Payer: Cash Price |
$13.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.99
|
| Rate for Payer: Heritage Provider Network Senior |
$8.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.32
|
| Rate for Payer: Multiplan Commercial |
$9.96
|
|
|
HC SOM PROSTATE HEALTH INDEX
|
Facility
|
OP
|
$13.28
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900915518
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$167.92 |
| Rate for Payer: Adventist Health Commercial |
$2.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.92
|
| Rate for Payer: Blue Shield of California Commercial |
$148.03
|
| Rate for Payer: Blue Shield of California EPN |
$118.73
|
| Rate for Payer: Cash Price |
$13.28
|
| Rate for Payer: Cash Price |
$13.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: Dignity Health Senior |
$18.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.22
|
| Rate for Payer: Heritage Provider Network Senior |
$8.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.17
|
| Rate for Payer: Multiplan Commercial |
$9.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.39
|
| Rate for Payer: TriValley Medical Group Senior |
$18.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
|
|
HC SOM PROTEINASE 3 AB
|
Facility
|
IP
|
$19.01
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$14.26 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$19.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.87
|
| Rate for Payer: Heritage Provider Network Senior |
$12.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.75
|
| Rate for Payer: Multiplan Commercial |
$14.26
|
|
|
HC SOM PROTEINASE 3 AB
|
Facility
|
OP
|
$19.01
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$213.58 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.06
|
| 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 |
$213.58
|
| 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 |
$19.01
|
| Rate for Payer: Cash Price |
$19.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.36
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.77
|
| Rate for Payer: Heritage Provider Network Senior |
$11.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$14.26
|
| 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 PROTEIN C AG
|
Facility
|
OP
|
$223.58
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
900913801
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$167.69 |
| Rate for Payer: Adventist Health Commercial |
$44.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$119.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$153.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.08
|
| Rate for Payer: Blue Shield of California Commercial |
$96.77
|
| Rate for Payer: Blue Shield of California EPN |
$77.62
|
| Rate for Payer: Cash Price |
$223.58
|
| Rate for Payer: Cash Price |
$223.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$145.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.21
|
| Rate for Payer: Dignity Health Senior |
$12.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.33
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.40
|
| Rate for Payer: Heritage Provider Network Senior |
$138.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$106.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.13
|
| Rate for Payer: Multiplan Commercial |
$167.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.01
|
| Rate for Payer: TriValley Medical Group Senior |
$12.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.21
|
| Rate for Payer: Vantage Medical Group Senior |
$12.01
|
|
|
HC SOM PROTEIN C AG
|
Facility
|
IP
|
$223.58
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
900913801
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$40.47 |
| Max. Negotiated Rate |
$167.69 |
| Rate for Payer: Adventist Health Commercial |
$44.72
|
| Rate for Payer: Cash Price |
$223.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$151.36
|
| Rate for Payer: Heritage Provider Network Senior |
$151.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.90
|
| Rate for Payer: Multiplan Commercial |
$167.69
|
|
