|
HC SOM SEROTONIN BLOOD
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
900911033
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| 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 SEX HORMN BINDNG GLOBU SER
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
900913804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.80
|
| Rate for Payer: Heritage Provider Network Senior |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
|
|
HC SOM SEX HORMN BINDNG GLOBU SER
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
900913804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$198.28 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$198.28
|
| Rate for Payer: Blue Shield of California Commercial |
$174.87
|
| Rate for Payer: Blue Shield of California EPN |
$140.26
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.90
|
| Rate for Payer: Dignity Health Senior |
$21.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.05
|
| Rate for Payer: Heritage Provider Network Senior |
$8.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.38
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.73
|
| Rate for Payer: TriValley Medical Group Senior |
$21.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.90
|
| Rate for Payer: Vantage Medical Group Senior |
$21.73
|
|
|
HC SOM SMA CARRIER BY DEL/DUP
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 81329
|
| Hospital Charge Code |
900915323
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$777.51 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$106.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$777.51
|
| Rate for Payer: Blue Shield of California Commercial |
$122.00
|
| Rate for Payer: Blue Shield of California EPN |
$97.60
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.70
|
| Rate for Payer: Dignity Health Senior |
$137.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.80
|
| Rate for Payer: Heritage Provider Network Senior |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$177.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$95.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$157.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$172.62
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.00
|
| Rate for Payer: TriValley Medical Group Senior |
$137.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$147.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$147.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.00
|
|
|
HC SOM SMA CARRIER BY DEL/DUP
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 81329
|
| Hospital Charge Code |
900915323
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.40
|
| Rate for Payer: Heritage Provider Network Senior |
$135.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
|
|
HC SOM SMOOTH MUSCLE AB TITER REFLEX
|
Facility
|
IP
|
$16.93
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
900915437
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$12.70 |
| Rate for Payer: Adventist Health Commercial |
$3.39
|
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.46
|
| Rate for Payer: Heritage Provider Network Senior |
$11.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.23
|
| Rate for Payer: Multiplan Commercial |
$12.70
|
|
|
HC SOM SMOOTH MUSCLE AB TITER REFLEX
|
Facility
|
OP
|
$16.93
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
900915437
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$66.41 |
| Rate for Payer: Adventist Health Commercial |
$3.39
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.56
|
| Rate for Payer: Blue Shield of California Commercial |
$66.41
|
| Rate for Payer: Blue Shield of California EPN |
$53.27
|
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.48
|
| Rate for Payer: Heritage Provider Network Senior |
$10.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.23
|
| 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 |
$12.70
|
| 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 |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM SOMATOSTATIN
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 84307
|
| Hospital Charge Code |
900911327
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$183.75 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.87
|
| Rate for Payer: Heritage Provider Network Senior |
$165.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.25
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
|
|
HC SOM SOMATOSTATIN
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 84307
|
| Hospital Charge Code |
900911327
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.28 |
| Max. Negotiated Rate |
$183.75 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$130.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$168.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.52
|
| Rate for Payer: Blue Shield of California Commercial |
$147.11
|
| Rate for Payer: Blue Shield of California EPN |
$117.99
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$159.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.11
|
| Rate for Payer: Dignity Health Senior |
$18.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$151.66
|
| Rate for Payer: Heritage Provider Network Senior |
$151.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$116.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.03
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.28
|
| Rate for Payer: TriValley Medical Group Senior |
$18.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.11
|
| Rate for Payer: Vantage Medical Group Senior |
$18.28
|
|
|
HC SOM SOTALOL
|
Facility
|
OP
|
$82.23
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910789
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$132.94 |
| Rate for Payer: Adventist Health Commercial |
$16.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.94
|
| Rate for Payer: Blue Shield of California Commercial |
$110.19
|
| Rate for Payer: Blue Shield of California EPN |
$88.38
|
| Rate for Payer: Cash Price |
$82.23
|
| Rate for Payer: Cash Price |
$82.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$53.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.90
|
| Rate for Payer: Heritage Provider Network Senior |
$50.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$39.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.49
|
| Rate for Payer: Multiplan Commercial |
$61.67
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.64
|
| Rate for Payer: TriValley Medical Group Senior |
$18.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM SOTALOL
|
Facility
|
IP
|
$82.23
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910789
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$61.67 |
| Rate for Payer: Adventist Health Commercial |
$16.45
|
| Rate for Payer: Cash Price |
$82.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.67
|
| Rate for Payer: Heritage Provider Network Senior |
$55.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.56
|
| Rate for Payer: Multiplan Commercial |
$61.67
|
|
|
HC SOM SPCL HC COAG INTERPRETATION
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900913972
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.37
|
| Rate for Payer: Heritage Provider Network Senior |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
|
|
HC SOM SPCL HC COAG INTERPRETATION
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900913972
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$47.08 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.08
|
| Rate for Payer: Blue Shield of California Commercial |
$41.59
|
| Rate for Payer: Blue Shield of California EPN |
$33.36
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.03
|
| Rate for Payer: Dignity Health Senior |
$15.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.28
|
| Rate for Payer: Heritage Provider Network Senior |
$22.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.48
|
| Rate for Payer: TriValley Medical Group Senior |
$15.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Vantage Medical Group Senior |
$15.48
|
|
|
HC SOM SPN 87206
|
Facility
|
IP
|
$48.68
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900914919
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$36.51 |
| Rate for Payer: Adventist Health Commercial |
$9.74
|
| Rate for Payer: Cash Price |
$48.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.96
|
| Rate for Payer: Heritage Provider Network Senior |
$32.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.17
|
| Rate for Payer: Multiplan Commercial |
$36.51
|
|
|
HC SOM SPN 87206
|
Facility
|
OP
|
$48.68
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900914919
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$49.05 |
| Rate for Payer: Adventist Health Commercial |
$9.74
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.05
|
| Rate for Payer: Blue Shield of California Commercial |
$43.20
|
| Rate for Payer: Blue Shield of California EPN |
$34.65
|
| Rate for Payer: Cash Price |
$48.68
|
| Rate for Payer: Cash Price |
$48.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: Dignity Health Senior |
$5.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.64
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.13
|
| Rate for Payer: Heritage Provider Network Senior |
$30.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.79
|
| Rate for Payer: Multiplan Commercial |
$36.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.39
|
| Rate for Payer: TriValley Medical Group Senior |
$5.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
HC SOM SSDNA 86226
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 86226
|
| Hospital Charge Code |
900914817
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$110.57 |
| 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 |
$18.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.57
|
| Rate for Payer: Blue Shield of California Commercial |
$97.46
|
| Rate for Payer: Blue Shield of California EPN |
$78.17
|
| 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 |
$18.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.32
|
| Rate for Payer: Dignity Health Senior |
$12.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.11
|
| 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 |
$17.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.11
|
| 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 |
$13.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.26
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.11
|
| Rate for Payer: TriValley Medical Group Senior |
$12.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Vantage Medical Group Senior |
$12.11
|
|
|
HC SOM SSDNA 86226
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 86226
|
| Hospital Charge Code |
900914817
|
|
Hospital Revenue Code
|
302
|
| 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 ST2
|
Facility
|
OP
|
$145.73
|
|
|
Service Code
|
CPT 83006
|
| Hospital Charge Code |
900915314
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.38 |
| Max. Negotiated Rate |
$172.40 |
| Rate for Payer: Adventist Health Commercial |
$29.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$77.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$100.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.71
|
| 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 |
$145.73
|
| Rate for Payer: Cash Price |
$145.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$94.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.16
|
| Rate for Payer: Dignity Health Senior |
$75.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.72
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.21
|
| Rate for Payer: Heritage Provider Network Senior |
$90.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$69.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.26
|
| Rate for Payer: Multiplan Commercial |
$109.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$75.60
|
| Rate for Payer: TriValley Medical Group Senior |
$75.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$81.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$81.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.16
|
| Rate for Payer: Vantage Medical Group Senior |
$75.60
|
|
|
HC SOM ST2
|
Facility
|
IP
|
$145.73
|
|
|
Service Code
|
CPT 83006
|
| Hospital Charge Code |
900915314
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.38 |
| Max. Negotiated Rate |
$109.30 |
| Rate for Payer: Adventist Health Commercial |
$29.15
|
| Rate for Payer: Cash Price |
$145.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$98.66
|
| Rate for Payer: Heritage Provider Network Senior |
$98.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.43
|
| Rate for Payer: Multiplan Commercial |
$109.30
|
|
|
HC SOM ST LOUIS ENCEPH AB IGM
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
900912812
|
|
Hospital Revenue Code
|
302
|
| 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 ST LOUIS ENCEPH AB IGM
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
900912812
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$120.41 |
| 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 |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.41
|
| Rate for Payer: Blue Shield of California Commercial |
$106.16
|
| Rate for Payer: Blue Shield of California EPN |
$85.15
|
| 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 |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Senior |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.19
|
| 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 |
$18.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| 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 |
$15.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.62
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.19
|
| Rate for Payer: TriValley Medical Group Senior |
$13.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC SOM ST LOUIS ENCEPHALITIS AB IGG
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
900911336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$120.41 |
| 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 |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.41
|
| Rate for Payer: Blue Shield of California Commercial |
$106.16
|
| Rate for Payer: Blue Shield of California EPN |
$85.15
|
| 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 |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Senior |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.19
|
| 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 |
$18.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| 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 |
$15.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.62
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.19
|
| Rate for Payer: TriValley Medical Group Senior |
$13.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC SOM ST LOUIS ENCEPHALITIS AB IGG
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
900911336
|
|
Hospital Revenue Code
|
302
|
| 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 STONE ANALYSIS
|
Facility
|
OP
|
$16.63
|
|
|
Service Code
|
CPT 82365
|
| Hospital Charge Code |
900911025
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$117.76 |
| Rate for Payer: Adventist Health Commercial |
$3.33
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.76
|
| Rate for Payer: Blue Shield of California Commercial |
$103.74
|
| Rate for Payer: Blue Shield of California EPN |
$83.21
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.19
|
| Rate for Payer: Dignity Health Senior |
$12.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.29
|
| Rate for Payer: Heritage Provider Network Senior |
$10.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.25
|
| Rate for Payer: Multiplan Commercial |
$12.47
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.90
|
| Rate for Payer: TriValley Medical Group Senior |
$12.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Vantage Medical Group Senior |
$12.90
|
|
|
HC SOM STONE ANALYSIS
|
Facility
|
IP
|
$16.63
|
|
|
Service Code
|
CPT 82365
|
| Hospital Charge Code |
900911025
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$12.47 |
| Rate for Payer: Adventist Health Commercial |
$3.33
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.26
|
| Rate for Payer: Heritage Provider Network Senior |
$11.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.16
|
| Rate for Payer: Multiplan Commercial |
$12.47
|
|
