|
HC SOM PROTEIN ELECT URINE
|
Facility
|
IP
|
$24.88
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912721
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$18.66 |
| Rate for Payer: Adventist Health Commercial |
$4.98
|
| Rate for Payer: Cash Price |
$24.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.84
|
| Rate for Payer: Heritage Provider Network Senior |
$16.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.22
|
| Rate for Payer: Multiplan Commercial |
$18.66
|
|
|
HC SOM PROTEIN ELECT URINE
|
Facility
|
OP
|
$24.88
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912721
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$159.50 |
| Rate for Payer: Adventist Health Commercial |
$4.98
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.50
|
| Rate for Payer: Blue Shield of California Commercial |
$143.54
|
| Rate for Payer: Blue Shield of California EPN |
$115.13
|
| Rate for Payer: Cash Price |
$24.88
|
| Rate for Payer: Cash Price |
$24.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.61
|
| Rate for Payer: Dignity Health Senior |
$17.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.40
|
| Rate for Payer: Heritage Provider Network Senior |
$15.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.22
|
| 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 |
$18.66
|
| 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 |
$26.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Vantage Medical Group Senior |
$17.83
|
|
|
HC SOM PROTEIN S AG
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900913807
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.85
|
| Rate for Payer: Heritage Provider Network Senior |
$33.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
|
|
HC SOM PROTEIN S AG
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900913807
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$139.95 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.95
|
| Rate for Payer: Blue Shield of California Commercial |
$123.32
|
| Rate for Payer: Blue Shield of California EPN |
$98.91
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.85
|
| Rate for Payer: Dignity Health Senior |
$15.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.30
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.32
|
| Rate for Payer: TriValley Medical Group Senior |
$15.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Vantage Medical Group Senior |
$15.32
|
|
|
HC SOM PROTEIN S PLASMA
|
Facility
|
IP
|
$28.63
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900911277
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$21.47 |
| Rate for Payer: Adventist Health Commercial |
$5.73
|
| Rate for Payer: Cash Price |
$28.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.38
|
| Rate for Payer: Heritage Provider Network Senior |
$19.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.16
|
| Rate for Payer: Multiplan Commercial |
$21.47
|
|
|
HC SOM PROTEIN S PLASMA
|
Facility
|
OP
|
$28.63
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900911277
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$139.95 |
| Rate for Payer: Adventist Health Commercial |
$5.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.95
|
| Rate for Payer: Blue Shield of California Commercial |
$123.32
|
| Rate for Payer: Blue Shield of California EPN |
$98.91
|
| Rate for Payer: Cash Price |
$28.63
|
| Rate for Payer: Cash Price |
$28.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.85
|
| Rate for Payer: Dignity Health Senior |
$15.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.61
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.72
|
| Rate for Payer: Heritage Provider Network Senior |
$17.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.30
|
| Rate for Payer: Multiplan Commercial |
$21.47
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.32
|
| Rate for Payer: TriValley Medical Group Senior |
$15.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Vantage Medical Group Senior |
$15.32
|
|
|
HC SOM PROTEIN, TOTAL, RANDOM, U
|
Facility
|
IP
|
$4.13
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912892
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Adventist Health Commercial |
$0.83
|
| Rate for Payer: Cash Price |
$4.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.80
|
| Rate for Payer: Heritage Provider Network Senior |
$2.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$3.10
|
|
|
HC SOM PROTEIN, TOTAL, RANDOM, U
|
Facility
|
OP
|
$4.13
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912892
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$33.56 |
| Rate for Payer: Adventist Health Commercial |
$0.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.56
|
| Rate for Payer: Blue Shield of California Commercial |
$29.49
|
| Rate for Payer: Blue Shield of California EPN |
$23.65
|
| Rate for Payer: Cash Price |
$4.13
|
| Rate for Payer: Cash Price |
$4.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.68
|
| 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 |
$2.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.56
|
| Rate for Payer: Heritage Provider Network Senior |
$2.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| 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 |
$3.10
|
| 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 PROTEIN TOTAL URINE
|
Facility
|
OP
|
$5.12
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$33.56 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.56
|
| Rate for Payer: Blue Shield of California Commercial |
$29.49
|
| Rate for Payer: Blue Shield of California EPN |
$23.65
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.33
|
| 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 |
$3.33
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.17
|
| Rate for Payer: Heritage Provider Network Senior |
$3.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| 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 |
$3.84
|
| 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 PROTEIN TOTAL URINE
|
Facility
|
IP
|
$5.12
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.47
|
| Rate for Payer: Heritage Provider Network Senior |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
|
|
HC SOM PROTOPORPH FR RBC
|
Facility
|
OP
|
$355.71
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900911168
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$266.78 |
| Rate for Payer: Adventist Health Commercial |
$71.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$190.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$244.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.17
|
| Rate for Payer: Blue Shield of California Commercial |
$145.32
|
| Rate for Payer: Blue Shield of California EPN |
$116.56
|
| Rate for Payer: Cash Price |
$355.71
|
| Rate for Payer: Cash Price |
$355.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$231.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Senior |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$231.21
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$220.18
|
| Rate for Payer: Heritage Provider Network Senior |
$220.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$169.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.35
|
| Rate for Payer: Multiplan Commercial |
$266.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.09
|
| Rate for Payer: TriValley Medical Group Senior |
$24.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM PROTOPORPH FR RBC
|
Facility
|
IP
|
$355.71
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900911168
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.38 |
| Max. Negotiated Rate |
$266.78 |
| Rate for Payer: Adventist Health Commercial |
$71.14
|
| Rate for Payer: Cash Price |
$355.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$240.82
|
| Rate for Payer: Heritage Provider Network Senior |
$240.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.93
|
| Rate for Payer: Multiplan Commercial |
$266.78
|
|
|
HC SOM PROTRIPTYLINE (VIVACTYL)
|
Facility
|
OP
|
$62.99
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900911246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$156.73 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$33.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.73
|
| Rate for Payer: Cash Price |
$62.99
|
| Rate for Payer: Cash Price |
$62.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.54
|
| Rate for Payer: Dignity Health Senior |
$53.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.99
|
| Rate for Payer: Heritage Provider Network Senior |
$38.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.09
|
| Rate for Payer: Multiplan Commercial |
$47.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.54
|
| Rate for Payer: Vantage Medical Group Senior |
$53.54
|
|
|
HC SOM PROTRIPTYLINE (VIVACTYL)
|
Facility
|
IP
|
$62.99
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900911246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$47.24 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Cash Price |
$62.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.64
|
| Rate for Payer: Heritage Provider Network Senior |
$42.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.75
|
| Rate for Payer: Multiplan Commercial |
$47.24
|
|
|
HC SOM PSA ULTRASENSITIVE
|
Facility
|
IP
|
$123.40
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900913953
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.34 |
| Max. Negotiated Rate |
$92.55 |
| Rate for Payer: Adventist Health Commercial |
$24.68
|
| Rate for Payer: Cash Price |
$123.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.54
|
| Rate for Payer: Heritage Provider Network Senior |
$83.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.85
|
| Rate for Payer: Multiplan Commercial |
$92.55
|
|
|
HC SOM PSA ULTRASENSITIVE
|
Facility
|
OP
|
$123.40
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900913953
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$167.92 |
| Rate for Payer: Adventist Health Commercial |
$24.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$65.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$84.78
|
| 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 |
$123.40
|
| Rate for Payer: Cash Price |
$123.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$80.21
|
| 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 |
$80.21
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.38
|
| Rate for Payer: Heritage Provider Network Senior |
$76.38
|
| 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 |
$58.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.85
|
| 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 |
$92.55
|
| 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 PST
|
Facility
|
OP
|
$103.35
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900914755
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$139.95 |
| Rate for Payer: Adventist Health Commercial |
$20.67
|
| Rate for Payer: Aetna of CA Gatekeeper |
$55.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$71.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.95
|
| Rate for Payer: Blue Shield of California Commercial |
$123.32
|
| Rate for Payer: Blue Shield of California EPN |
$98.91
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$67.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.85
|
| Rate for Payer: Dignity Health Senior |
$15.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.97
|
| Rate for Payer: Heritage Provider Network Senior |
$63.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$49.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.30
|
| Rate for Payer: Multiplan Commercial |
$77.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.32
|
| Rate for Payer: TriValley Medical Group Senior |
$15.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Vantage Medical Group Senior |
$15.32
|
|
|
HC SOM PST
|
Facility
|
IP
|
$103.35
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900914755
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.71 |
| Max. Negotiated Rate |
$77.51 |
| Rate for Payer: Adventist Health Commercial |
$20.67
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.97
|
| Rate for Payer: Heritage Provider Network Senior |
$69.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.84
|
| Rate for Payer: Multiplan Commercial |
$77.51
|
|
|
HC SOM PTH RELATED PROTEIN
|
Facility
|
OP
|
$15.62
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900911417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.01
|
| Rate for Payer: Blue Shield of California Commercial |
$113.70
|
| Rate for Payer: Blue Shield of California EPN |
$91.20
|
| Rate for Payer: Cash Price |
$15.62
|
| Rate for Payer: Cash Price |
$15.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.53
|
| Rate for Payer: Dignity Health Senior |
$14.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.67
|
| Rate for Payer: Heritage Provider Network Senior |
$9.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.79
|
| Rate for Payer: Multiplan Commercial |
$11.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.12
|
| Rate for Payer: TriValley Medical Group Senior |
$14.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Vantage Medical Group Senior |
$14.12
|
|
|
HC SOM PTH RELATED PROTEIN
|
Facility
|
IP
|
$15.62
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900911417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$11.71 |
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Cash Price |
$15.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.57
|
| Rate for Payer: Heritage Provider Network Senior |
$10.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: Multiplan Commercial |
$11.71
|
|
|
HC SOM PWDNA 81331
|
Facility
|
IP
|
$561.17
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
900914888
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$101.57 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Adventist Health Commercial |
$112.23
|
| Rate for Payer: Cash Price |
$561.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$379.91
|
| Rate for Payer: Heritage Provider Network Senior |
$379.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.29
|
| Rate for Payer: Multiplan Commercial |
$420.88
|
|
|
HC SOM PWDNA 81331
|
Facility
|
OP
|
$561.17
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
900914888
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$51.07 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Adventist Health Commercial |
$112.23
|
| Rate for Payer: Aetna of CA Gatekeeper |
$299.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$385.52
|
| 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 |
$342.31
|
| Rate for Payer: Blue Shield of California EPN |
$273.85
|
| Rate for Payer: Cash Price |
$561.17
|
| Rate for Payer: Cash Price |
$561.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$364.76
|
| 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 |
$364.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$347.36
|
| Rate for Payer: Heritage Provider Network Senior |
$347.36
|
| 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 |
$267.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.29
|
| 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 |
$420.88
|
| 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 PYRUVATE KINASE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
900911491
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.01
|
| Rate for Payer: Heritage Provider Network Senior |
$44.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.25
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
|
|
HC SOM PYRUVATE KINASE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
900911491
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$86.11 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$34.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.11
|
| Rate for Payer: Blue Shield of California Commercial |
$75.92
|
| Rate for Payer: Blue Shield of California EPN |
$60.89
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.38
|
| Rate for Payer: Dignity Health Senior |
$9.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.23
|
| Rate for Payer: Heritage Provider Network Senior |
$40.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.89
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.44
|
| Rate for Payer: TriValley Medical Group Senior |
$9.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.38
|
| Rate for Payer: Vantage Medical Group Senior |
$9.44
|
|
|
HC SOM Q FEVER AB SCREEN
|
Facility
|
IP
|
$40.10
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900915440
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$30.07 |
| Rate for Payer: Adventist Health Commercial |
$8.02
|
| Rate for Payer: Cash Price |
$40.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.15
|
| Rate for Payer: Heritage Provider Network Senior |
$27.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.03
|
| Rate for Payer: Multiplan Commercial |
$30.07
|
|
