|
HC SOM NEOPTERIN
|
Facility
IP
|
$179.25
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900913946
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.44 |
| Max. Negotiated Rate |
$134.44 |
| Rate for Payer: Adventist Health Commercial |
$35.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.14
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.35
|
| Rate for Payer: Heritage Provider Network Senior |
$121.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.81
|
| Rate for Payer: Multiplan Commercial |
$134.44
|
|
|
HC SOM NEUROCONDRIN IFA
|
Facility
OP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915453
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$100.92 |
| Rate for Payer: Adventist Health Commercial |
$10.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.92
|
| Rate for Payer: Blue Shield of California Commercial |
$94.14
|
| Rate for Payer: Blue Shield of California EPN |
$73.59
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.13
|
| Rate for Payer: Heritage Provider Network Senior |
$33.13
|
| Rate for Payer: Humana Medicare |
$12.05
|
| Rate for Payer: IEHP Medi-Cal |
$13.46
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$40.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM NEUROCONDRIN IFA
|
Facility
IP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915453
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$40.14 |
| Rate for Payer: Adventist Health Commercial |
$10.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.77
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.23
|
| Rate for Payer: Heritage Provider Network Senior |
$36.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| Rate for Payer: Multiplan Commercial |
$40.14
|
|
|
HC SOM NEURON SPECIFIC ENOLASE CSF
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910766
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$108.36 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.36
|
| Rate for Payer: Blue Shield of California Commercial |
$101.12
|
| Rate for Payer: Blue Shield of California EPN |
$79.05
|
| 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 |
$25.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.57
|
| Rate for Payer: Heritage Provider Network Senior |
$18.57
|
| Rate for Payer: Humana Medicare |
$17.27
|
| Rate for Payer: IEHP Medi-Cal |
$15.97
|
| Rate for Payer: IEHP Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.76
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.27
|
| Rate for Payer: TriValley Medical Group Senior |
$17.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM NEURON SPECIFIC ENOLASE CSF
|
Facility
IP
|
$30.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910766
|
|
Hospital Revenue Code
|
302
|
| 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 NEURON SPECIFIC ENOLASE SERUM
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.92
|
| Rate for Payer: Heritage Provider Network Senior |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SOM NEURON SPECIFIC ENOLASE SERUM
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$108.36 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.36
|
| Rate for Payer: Blue Shield of California Commercial |
$101.12
|
| Rate for Payer: Blue Shield of California EPN |
$79.05
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.48
|
| Rate for Payer: Heritage Provider Network Senior |
$15.48
|
| Rate for Payer: Humana Medicare |
$17.27
|
| Rate for Payer: IEHP Medi-Cal |
$15.97
|
| Rate for Payer: IEHP Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.76
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.27
|
| Rate for Payer: TriValley Medical Group Senior |
$17.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM NEUROTENSIN
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900910768
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Adventist Health Commercial |
$52.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$178.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.10
|
| Rate for Payer: Blue Shield of California Commercial |
$105.54
|
| Rate for Payer: Blue Shield of California EPN |
$82.51
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$169.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Senior |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$160.94
|
| Rate for Payer: Heritage Provider Network Senior |
$160.94
|
| Rate for Payer: Humana Medicare |
$18.40
|
| Rate for Payer: IEHP Medi-Cal |
$19.14
|
| Rate for Payer: IEHP Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.18
|
| Rate for Payer: Multiplan Commercial |
$195.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.40
|
| Rate for Payer: TriValley Medical Group Senior |
$18.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM NEUROTENSIN
|
Facility
IP
|
$260.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900910768
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.06 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Adventist Health Commercial |
$52.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$178.62
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$176.02
|
| Rate for Payer: Heritage Provider Network Senior |
$176.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Multiplan Commercial |
$195.00
|
|
|
HC SOM NEUROTRANSMITTER METAB
|
Facility
IP
|
$195.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914688
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.30 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.96
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.02
|
| Rate for Payer: Heritage Provider Network Senior |
$132.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.75
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
|
|
HC SOM NEUROTRANSMITTER METAB
|
Facility
OP
|
$195.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914688
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.95 |
| Max. Negotiated Rate |
$150.51 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.51
|
| Rate for Payer: Blue Shield of California Commercial |
$141.04
|
| Rate for Payer: Blue Shield of California EPN |
$110.26
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$126.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Senior |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.70
|
| Rate for Payer: Heritage Provider Network Senior |
$120.70
|
| Rate for Payer: Humana Medicare |
$24.09
|
| Rate for Payer: IEHP Medi-Cal |
$23.95
|
| Rate for Payer: IEHP Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.75
|
| 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 |
$146.25
|
| 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 |
$36.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM N.GONORRHOEAE AMP DNA FEMALE U
|
Facility
OP
|
$39.71
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912876
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$284.23 |
| Rate for Payer: Adventist Health Commercial |
$7.94
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.23
|
| Rate for Payer: Blue Shield of California Commercial |
$274.13
|
| Rate for Payer: Blue Shield of California EPN |
$214.30
|
| Rate for Payer: Cash Price |
$17.87
|
| Rate for Payer: Cash Price |
$17.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.58
|
| Rate for Payer: Heritage Provider Network Senior |
$24.58
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: IEHP Medi-Cal |
$39.56
|
| Rate for Payer: IEHP Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$29.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM N.GONORRHOEAE AMP DNA FEMALE U
|
Facility
IP
|
$39.71
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912876
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$29.78 |
| Rate for Payer: Adventist Health Commercial |
$7.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.28
|
| Rate for Payer: Cash Price |
$17.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.88
|
| Rate for Payer: Heritage Provider Network Senior |
$26.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.93
|
| Rate for Payer: Multiplan Commercial |
$29.78
|
|
|
HC SOM NICOTINE
|
Facility
OP
|
$20.35
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
900910769
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$241.01 |
| Rate for Payer: Adventist Health Commercial |
$4.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.01
|
| Rate for Payer: Cash Price |
$9.16
|
| Rate for Payer: Cash Price |
$9.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.30
|
| Rate for Payer: Dignity Health Senior |
$17.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.60
|
| Rate for Payer: Heritage Provider Network Senior |
$12.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.09
|
| Rate for Payer: Multiplan Commercial |
$15.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.30
|
| Rate for Payer: Vantage Medical Group Senior |
$17.30
|
|
|
HC SOM NICOTINE
|
Facility
IP
|
$20.35
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
900910769
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$15.26 |
| Rate for Payer: Adventist Health Commercial |
$4.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.98
|
| Rate for Payer: Cash Price |
$9.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.78
|
| Rate for Payer: Heritage Provider Network Senior |
$13.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.09
|
| Rate for Payer: Multiplan Commercial |
$15.26
|
|
|
HC SOM NITROGEN STOOL
|
Facility
OP
|
$388.30
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900911229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.28 |
| Max. Negotiated Rate |
$330.06 |
| Rate for Payer: Adventist Health Commercial |
$77.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$207.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$266.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$330.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$213.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$291.22
|
| Rate for Payer: Blue Shield of California Commercial |
$241.13
|
| Rate for Payer: Blue Shield of California EPN |
$227.93
|
| Rate for Payer: Cash Price |
$174.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$252.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$330.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$330.06
|
| Rate for Payer: Dignity Health Senior |
$330.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$240.36
|
| Rate for Payer: Heritage Provider Network Senior |
$240.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$187.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.08
|
| Rate for Payer: Multiplan Commercial |
$291.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$330.06
|
| Rate for Payer: Vantage Medical Group Senior |
$330.06
|
|
|
HC SOM NITROGEN STOOL
|
Facility
IP
|
$388.30
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900911229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.28 |
| Max. Negotiated Rate |
$291.22 |
| Rate for Payer: Adventist Health Commercial |
$77.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$266.76
|
| Rate for Payer: Cash Price |
$174.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$262.88
|
| Rate for Payer: Heritage Provider Network Senior |
$262.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.08
|
| Rate for Payer: Multiplan Commercial |
$291.22
|
|
|
HC SOM NMDCS 86255
|
Facility
IP
|
$344.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914769
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.32 |
| Max. Negotiated Rate |
$258.25 |
| Rate for Payer: Adventist Health Commercial |
$68.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$236.55
|
| Rate for Payer: Cash Price |
$154.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$233.11
|
| Rate for Payer: Heritage Provider Network Senior |
$233.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.08
|
| Rate for Payer: Multiplan Commercial |
$258.25
|
|
|
HC SOM NMDCS 86255
|
Facility
OP
|
$344.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914769
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$258.25 |
| Rate for Payer: Adventist Health Commercial |
$68.87
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$236.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.92
|
| Rate for Payer: Blue Shield of California Commercial |
$94.14
|
| Rate for Payer: Blue Shield of California EPN |
$73.59
|
| Rate for Payer: Cash Price |
$154.95
|
| Rate for Payer: Cash Price |
$154.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$223.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.14
|
| Rate for Payer: Heritage Provider Network Senior |
$213.14
|
| Rate for Payer: Humana Medicare |
$12.05
|
| Rate for Payer: IEHP Medi-Cal |
$13.46
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$258.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM NMHIN 83789
|
Facility
IP
|
$162.45
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914806
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$121.84 |
| Rate for Payer: Adventist Health Commercial |
$32.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.60
|
| Rate for Payer: Cash Price |
$73.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.98
|
| Rate for Payer: Heritage Provider Network Senior |
$109.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.61
|
| Rate for Payer: Multiplan Commercial |
$121.84
|
|
|
HC SOM NMHIN 83789
|
Facility
OP
|
$162.45
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914806
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$150.51 |
| Rate for Payer: Adventist Health Commercial |
$32.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.51
|
| Rate for Payer: Blue Shield of California Commercial |
$141.04
|
| Rate for Payer: Blue Shield of California EPN |
$110.26
|
| Rate for Payer: Cash Price |
$73.10
|
| Rate for Payer: Cash Price |
$73.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$105.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.52
|
| Rate for Payer: Dignity Health Senior |
$24.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.56
|
| Rate for Payer: Heritage Provider Network Senior |
$100.56
|
| Rate for Payer: Humana Medicare |
$24.11
|
| Rate for Payer: IEHP Medi-Cal |
$25.49
|
| Rate for Payer: IEHP Medicare Advantage |
$24.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.38
|
| Rate for Payer: Multiplan Commercial |
$121.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.11
|
| Rate for Payer: TriValley Medical Group Senior |
$24.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Vantage Medical Group Senior |
$24.11
|
|
|
HC SOM NMO EVAL W/REFLEX, SERUM
|
Facility
OP
|
$467.90
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912998
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.97 |
| Max. Negotiated Rate |
$350.92 |
| Rate for Payer: Adventist Health Commercial |
$93.58
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$321.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.36
|
| Rate for Payer: Blue Shield of California Commercial |
$101.12
|
| Rate for Payer: Blue Shield of California EPN |
$79.05
|
| Rate for Payer: Cash Price |
$210.56
|
| Rate for Payer: Cash Price |
$210.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$304.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$304.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$289.63
|
| Rate for Payer: Heritage Provider Network Senior |
$289.63
|
| Rate for Payer: Humana Medicare |
$17.27
|
| Rate for Payer: IEHP Medi-Cal |
$15.97
|
| Rate for Payer: IEHP Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.76
|
| Rate for Payer: Multiplan Commercial |
$350.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.27
|
| Rate for Payer: TriValley Medical Group Senior |
$17.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM NMO EVAL W/REFLEX, SERUM
|
Facility
IP
|
$467.90
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912998
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$84.69 |
| Max. Negotiated Rate |
$350.92 |
| Rate for Payer: Adventist Health Commercial |
$93.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$321.45
|
| Rate for Payer: Cash Price |
$210.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$316.77
|
| Rate for Payer: Heritage Provider Network Senior |
$316.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.98
|
| Rate for Payer: Multiplan Commercial |
$350.92
|
|
|
HC SOM NMO-IGG
|
Facility
IP
|
$467.90
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914664
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$84.69 |
| Max. Negotiated Rate |
$350.92 |
| Rate for Payer: Adventist Health Commercial |
$93.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$321.45
|
| Rate for Payer: Cash Price |
$210.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$316.77
|
| Rate for Payer: Heritage Provider Network Senior |
$316.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.98
|
| Rate for Payer: Multiplan Commercial |
$350.92
|
|
|
HC SOM NMO-IGG
|
Facility
OP
|
$467.90
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914664
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$350.92 |
| Rate for Payer: Adventist Health Commercial |
$93.58
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$321.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.92
|
| Rate for Payer: Blue Shield of California Commercial |
$94.14
|
| Rate for Payer: Blue Shield of California EPN |
$73.59
|
| Rate for Payer: Cash Price |
$210.56
|
| Rate for Payer: Cash Price |
$210.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$304.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$304.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$289.63
|
| Rate for Payer: Heritage Provider Network Senior |
$289.63
|
| Rate for Payer: Humana Medicare |
$12.05
|
| Rate for Payer: IEHP Medi-Cal |
$13.46
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$350.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
