|
HC SOM FISH DIGEORGE VELO-CARDIO-FACL
|
Facility
|
OP
|
$203.22
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910684
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$29.95 |
| Max. Negotiated Rate |
$177.38 |
| Rate for Payer: Adventist Health Commercial |
$40.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$125.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$172.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$111.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$152.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.38
|
| Rate for Payer: Blue Shield of California Commercial |
$37.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.95
|
| Rate for Payer: Cash Price |
$203.22
|
| Rate for Payer: Cash Price |
$203.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$132.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$172.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$172.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$172.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.79
|
| Rate for Payer: Heritage Provider Network Senior |
$125.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$96.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$142.25
|
| Rate for Payer: Multiplan Commercial |
$152.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$172.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$172.74
|
| Rate for Payer: Vantage Medical Group Senior |
$172.74
|
|
|
HC SOM FISH FOR CLL
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910707
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$225.40
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.95
|
| Rate for Payer: Heritage Provider Network Senior |
$236.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
|
|
HC SOM FISH FOR CLL
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910707
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$29.95 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.38
|
| Rate for Payer: Blue Shield of California Commercial |
$37.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.95
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$227.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.65
|
| Rate for Payer: Heritage Provider Network Senior |
$216.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$166.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC SOM FISH MDS LOCUS ANOMALIES
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912610
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$177.38 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.38
|
| Rate for Payer: Blue Shield of California Commercial |
$37.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.95
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$97.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.85
|
| Rate for Payer: Heritage Provider Network Senior |
$92.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$71.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
|
HC SOM FISH MDS LOCUS ANOMALIES
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912610
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.60
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.55
|
| Rate for Payer: Heritage Provider Network Senior |
$101.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
|
|
HC SOM FISH NEWBORN ANEUPLOIDY DETECT
|
Facility
|
IP
|
$204.69
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910685
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$153.52 |
| Rate for Payer: Adventist Health Commercial |
$40.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.82
|
| Rate for Payer: Cash Price |
$204.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.58
|
| Rate for Payer: Heritage Provider Network Senior |
$138.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.17
|
| Rate for Payer: Multiplan Commercial |
$153.52
|
|
|
HC SOM FISH NEWBORN ANEUPLOIDY DETECT
|
Facility
|
OP
|
$204.69
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910685
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$29.95 |
| Max. Negotiated Rate |
$177.38 |
| Rate for Payer: Adventist Health Commercial |
$40.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$173.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$112.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$153.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.38
|
| Rate for Payer: Blue Shield of California Commercial |
$37.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.95
|
| Rate for Payer: Cash Price |
$204.69
|
| Rate for Payer: Cash Price |
$204.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$133.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$173.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$173.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$126.70
|
| Rate for Payer: Heritage Provider Network Senior |
$126.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$97.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$143.28
|
| Rate for Payer: Multiplan Commercial |
$153.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$173.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$173.99
|
| Rate for Payer: Vantage Medical Group Senior |
$173.99
|
|
|
HC SOM FISH PRENATAL ANEUPLOIDY DETEC
|
Facility
|
OP
|
$217.35
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910689
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$29.95 |
| Max. Negotiated Rate |
$184.75 |
| Rate for Payer: Adventist Health Commercial |
$43.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$134.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$184.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.38
|
| Rate for Payer: Blue Shield of California Commercial |
$37.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.95
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$141.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$184.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$184.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$184.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.54
|
| Rate for Payer: Heritage Provider Network Senior |
$134.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$103.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$152.15
|
| Rate for Payer: Multiplan Commercial |
$163.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$184.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$184.75
|
| Rate for Payer: Vantage Medical Group Senior |
$184.75
|
|
|
HC SOM FISH PRENATAL ANEUPLOIDY DETEC
|
Facility
|
IP
|
$217.35
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910689
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$39.34 |
| Max. Negotiated Rate |
$163.01 |
| Rate for Payer: Adventist Health Commercial |
$43.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$139.97
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.15
|
| Rate for Payer: Heritage Provider Network Senior |
$147.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.34
|
| Rate for Payer: Multiplan Commercial |
$163.01
|
|
|
HC SOM FISH UROTHELIAL CANCER
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
CPT 88120
|
| Hospital Charge Code |
900910694
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$79.64 |
| Max. Negotiated Rate |
$2,752.35 |
| Rate for Payer: Adventist Health Commercial |
$88.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$271.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,752.35
|
| Rate for Payer: Blue Shield of California Commercial |
$2,399.95
|
| Rate for Payer: Blue Shield of California EPN |
$1,929.96
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$286.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$219.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$272.36
|
| Rate for Payer: Heritage Provider Network Senior |
$272.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$209.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$330.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$219.12
|
| Rate for Payer: TriValley Medical Group Senior |
$219.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC SOM FISH UROTHELIAL CANCER
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
CPT 88120
|
| Hospital Charge Code |
900910694
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$79.64 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Adventist Health Commercial |
$88.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$283.36
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$297.88
|
| Rate for Payer: Heritage Provider Network Senior |
$297.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.00
|
| Rate for Payer: Multiplan Commercial |
$330.00
|
|
|
HC SOM FLECAINIDE ACETATE
|
Facility
|
IP
|
$44.23
|
|
|
Service Code
|
CPT 80181
|
| Hospital Charge Code |
900910551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.01 |
| Max. Negotiated Rate |
$33.17 |
| Rate for Payer: Adventist Health Commercial |
$8.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.48
|
| Rate for Payer: Cash Price |
$44.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.94
|
| Rate for Payer: Heritage Provider Network Senior |
$29.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.06
|
| Rate for Payer: Multiplan Commercial |
$33.17
|
|
|
HC SOM FLECAINIDE ACETATE
|
Facility
|
OP
|
$44.23
|
|
|
Service Code
|
CPT 80181
|
| Hospital Charge Code |
900910551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.01 |
| Max. Negotiated Rate |
$107.37 |
| Rate for Payer: Adventist Health Commercial |
$8.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.33
|
| 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 |
$62.64
|
| Rate for Payer: Blue Shield of California Commercial |
$107.37
|
| Rate for Payer: Blue Shield of California EPN |
$86.12
|
| Rate for Payer: Cash Price |
$44.23
|
| Rate for Payer: Cash Price |
$44.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.38
|
| Rate for Payer: Heritage Provider Network Senior |
$27.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$33.17
|
| 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 FLEXERIL
|
Facility
|
OP
|
$69.57
|
|
|
Service Code
|
CPT 80369
|
| Hospital Charge Code |
900911448
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$160.51 |
| Rate for Payer: Adventist Health Commercial |
$13.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.51
|
| Rate for Payer: Cash Price |
$69.57
|
| Rate for Payer: Cash Price |
$69.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$45.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.06
|
| Rate for Payer: Heritage Provider Network Senior |
$43.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$33.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$48.70
|
| Rate for Payer: Multiplan Commercial |
$52.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$34.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$34.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.13
|
| Rate for Payer: Vantage Medical Group Senior |
$59.13
|
|
|
HC SOM FLEXERIL
|
Facility
|
IP
|
$69.57
|
|
|
Service Code
|
CPT 80369
|
| Hospital Charge Code |
900911448
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$52.18 |
| Rate for Payer: Adventist Health Commercial |
$13.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.80
|
| Rate for Payer: Cash Price |
$69.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.10
|
| Rate for Payer: Heritage Provider Network Senior |
$47.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.39
|
| Rate for Payer: Multiplan Commercial |
$52.18
|
|
|
HC SOM FLT3 D835 INTERP
|
Facility
|
OP
|
$162.50
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900914513
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$121.88 |
| Rate for Payer: Adventist Health Commercial |
$32.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$100.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.64
|
| Rate for Payer: Blue Shield of California Commercial |
$65.03
|
| Rate for Payer: Blue Shield of California EPN |
$52.16
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$105.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.59
|
| Rate for Payer: Heritage Provider Network Senior |
$100.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$77.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$121.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC SOM FLT3 D835 INTERP
|
Facility
|
IP
|
$162.50
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900914513
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$29.41 |
| Max. Negotiated Rate |
$121.88 |
| Rate for Payer: Adventist Health Commercial |
$32.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$104.65
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.01
|
| Rate for Payer: Heritage Provider Network Senior |
$110.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.62
|
| Rate for Payer: Multiplan Commercial |
$121.88
|
|
|
HC SOM FLT 3 & D835 VARIANT DET
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 81245
|
| Hospital Charge Code |
900912984
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$29.86 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.26
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.70
|
| Rate for Payer: Heritage Provider Network Senior |
$111.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.25
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
|
|
HC SOM FLT 3 & D835 VARIANT DET
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 81245
|
| Hospital Charge Code |
900912984
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$29.86 |
| Max. Negotiated Rate |
$594.92 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$101.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$594.92
|
| Rate for Payer: Blue Shield of California Commercial |
$100.65
|
| Rate for Payer: Blue Shield of California EPN |
$80.52
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$107.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$165.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.14
|
| Rate for Payer: Heritage Provider Network Senior |
$102.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$78.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$190.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.78
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$165.51
|
| Rate for Payer: TriValley Medical Group Senior |
$165.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$178.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$178.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.06
|
| Rate for Payer: Vantage Medical Group Senior |
$165.51
|
|
|
HC SOM FLUORIDE BLOOD
|
Facility
|
OP
|
$120.20
|
|
|
Service Code
|
CPT 82735
|
| Hospital Charge Code |
900911276
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.54 |
| Max. Negotiated Rate |
$176.04 |
| Rate for Payer: Adventist Health Commercial |
$24.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.04
|
| Rate for Payer: Blue Shield of California Commercial |
$149.24
|
| Rate for Payer: Blue Shield of California EPN |
$119.70
|
| Rate for Payer: Cash Price |
$120.20
|
| Rate for Payer: Cash Price |
$120.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.92
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.40
|
| Rate for Payer: Heritage Provider Network Senior |
$74.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$57.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.84
|
| Rate for Payer: Multiplan Commercial |
$90.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.54
|
| Rate for Payer: TriValley Medical Group Senior |
$18.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Vantage Medical Group Senior |
$18.54
|
|
|
HC SOM FLUORIDE BLOOD
|
Facility
|
IP
|
$120.20
|
|
|
Service Code
|
CPT 82735
|
| Hospital Charge Code |
900911276
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$90.15 |
| Rate for Payer: Adventist Health Commercial |
$24.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.41
|
| Rate for Payer: Cash Price |
$120.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.38
|
| Rate for Payer: Heritage Provider Network Senior |
$81.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.05
|
| Rate for Payer: Multiplan Commercial |
$90.15
|
|
|
HC SOM FLUOXETINE
|
Facility
|
IP
|
$54.29
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911433
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$40.72 |
| Rate for Payer: Adventist Health Commercial |
$10.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.96
|
| Rate for Payer: Cash Price |
$54.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.75
|
| Rate for Payer: Heritage Provider Network Senior |
$36.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.57
|
| Rate for Payer: Multiplan Commercial |
$40.72
|
|
|
HC SOM FLUOXETINE
|
Facility
|
OP
|
$54.29
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911433
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$138.26 |
| Rate for Payer: Adventist Health Commercial |
$10.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.55
|
| 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 |
$138.26
|
| 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 |
$54.29
|
| Rate for Payer: Cash Price |
$54.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.03
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.61
|
| Rate for Payer: Heritage Provider Network Senior |
$33.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$25.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$40.72
|
| 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 FLUPHENAZINE
|
Facility
|
IP
|
$85.63
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
900911432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$64.22 |
| Rate for Payer: Adventist Health Commercial |
$17.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.15
|
| Rate for Payer: Cash Price |
$85.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.97
|
| Rate for Payer: Heritage Provider Network Senior |
$57.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.41
|
| Rate for Payer: Multiplan Commercial |
$64.22
|
|
|
HC SOM FLUPHENAZINE
|
Facility
|
OP
|
$85.63
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
900911432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$141.84 |
| Rate for Payer: Adventist Health Commercial |
$17.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.84
|
| Rate for Payer: Cash Price |
$85.63
|
| Rate for Payer: Cash Price |
$85.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$72.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.00
|
| Rate for Payer: Heritage Provider Network Senior |
$53.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$40.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$59.94
|
| Rate for Payer: Multiplan Commercial |
$64.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$42.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$42.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.79
|
| Rate for Payer: Vantage Medical Group Senior |
$72.79
|
|
