|
HC SOM FRAGILE X FU ANALYSIS
|
Facility
|
OP
|
$216.50
|
|
|
Service Code
|
CPT 81244
|
| Hospital Charge Code |
900915280
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$39.19 |
| Max. Negotiated Rate |
$186.65 |
| Rate for Payer: Adventist Health Commercial |
$43.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$186.65
|
| Rate for Payer: Blue Shield of California Commercial |
$132.06
|
| Rate for Payer: Blue Shield of California EPN |
$105.65
|
| Rate for Payer: Cash Price |
$216.50
|
| Rate for Payer: Cash Price |
$216.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$140.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.72
|
| Rate for Payer: EPIC Health Plan Medicare |
$44.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.01
|
| Rate for Payer: Heritage Provider Network Senior |
$134.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$44.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$103.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$60.15
|
| Rate for Payer: Multiplan Commercial |
$162.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$44.89
|
| Rate for Payer: TriValley Medical Group Senior |
$44.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$48.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$48.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.38
|
| Rate for Payer: Vantage Medical Group Senior |
$44.89
|
|
|
HC SOM FRAGILE X MOLECULAR ANALYSIS
|
Facility
|
OP
|
$299.72
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
900912503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.25 |
| Max. Negotiated Rate |
$464.65 |
| Rate for Payer: Adventist Health Commercial |
$59.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$185.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$464.65
|
| Rate for Payer: Blue Shield of California Commercial |
$182.83
|
| Rate for Payer: Blue Shield of California EPN |
$146.26
|
| Rate for Payer: Cash Price |
$299.72
|
| Rate for Payer: Cash Price |
$299.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$194.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$57.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.83
|
| Rate for Payer: EPIC Health Plan Medicare |
$57.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$185.53
|
| Rate for Payer: Heritage Provider Network Senior |
$185.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$57.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$142.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$76.43
|
| Rate for Payer: Multiplan Commercial |
$224.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$57.04
|
| Rate for Payer: TriValley Medical Group Senior |
$57.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$61.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$61.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.74
|
| Rate for Payer: Vantage Medical Group Senior |
$57.04
|
|
|
HC SOM FRAGILE X MOLECULAR ANALYSIS
|
Facility
|
IP
|
$299.72
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
900912503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.25 |
| Max. Negotiated Rate |
$224.79 |
| Rate for Payer: Adventist Health Commercial |
$59.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$193.02
|
| Rate for Payer: Cash Price |
$299.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$202.91
|
| Rate for Payer: Heritage Provider Network Senior |
$202.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.93
|
| Rate for Payer: Multiplan Commercial |
$224.79
|
|
|
HC SOM FRANSICELLA AB
|
Facility
|
IP
|
$52.25
|
|
|
Service Code
|
CPT 86000
|
| Hospital Charge Code |
900911647
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$39.19 |
| Rate for Payer: Adventist Health Commercial |
$10.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.65
|
| Rate for Payer: Cash Price |
$52.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.37
|
| Rate for Payer: Heritage Provider Network Senior |
$35.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.06
|
| Rate for Payer: Multiplan Commercial |
$39.19
|
|
|
HC SOM FRANSICELLA AB
|
Facility
|
OP
|
$52.25
|
|
|
Service Code
|
CPT 86000
|
| Hospital Charge Code |
900911647
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$59.83 |
| Rate for Payer: Adventist Health Commercial |
$10.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.83
|
| Rate for Payer: Blue Shield of California Commercial |
$56.16
|
| Rate for Payer: Blue Shield of California EPN |
$45.05
|
| Rate for Payer: Cash Price |
$52.25
|
| Rate for Payer: Cash Price |
$52.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.83
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.34
|
| Rate for Payer: Heritage Provider Network Senior |
$32.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$24.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.35
|
| Rate for Payer: Multiplan Commercial |
$39.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.98
|
| Rate for Payer: TriValley Medical Group Senior |
$6.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6.98
|
|
|
HC SOM FREE FATTY ACIDS
|
Facility
|
OP
|
$39.05
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
900914522
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$126.44 |
| Rate for Payer: Adventist Health Commercial |
$7.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.44
|
| Rate for Payer: Blue Shield of California Commercial |
$107.14
|
| Rate for Payer: Blue Shield of California EPN |
$85.93
|
| Rate for Payer: Cash Price |
$39.05
|
| Rate for Payer: Cash Price |
$39.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.17
|
| Rate for Payer: Heritage Provider Network Senior |
$24.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.15
|
| Rate for Payer: Multiplan Commercial |
$29.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.77
|
| Rate for Payer: TriValley Medical Group Senior |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.65
|
| Rate for Payer: Vantage Medical Group Senior |
$18.77
|
|
|
HC SOM FREE FATTY ACIDS
|
Facility
|
IP
|
$39.05
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
900914522
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$29.29 |
| Rate for Payer: Adventist Health Commercial |
$7.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.15
|
| Rate for Payer: Cash Price |
$39.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.44
|
| Rate for Payer: Heritage Provider Network Senior |
$26.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.76
|
| Rate for Payer: Multiplan Commercial |
$29.29
|
|
|
HC SOM FR TYR IDX BIND CAP
|
Facility
|
IP
|
$9.27
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
900912805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$6.95 |
| Rate for Payer: Adventist Health Commercial |
$1.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.97
|
| Rate for Payer: Cash Price |
$9.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.28
|
| Rate for Payer: Heritage Provider Network Senior |
$6.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.32
|
| Rate for Payer: Multiplan Commercial |
$6.95
|
|
|
HC SOM FR TYR IDX BIND CAP
|
Facility
|
OP
|
$9.27
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
900912805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$61.43 |
| Rate for Payer: Adventist Health Commercial |
$1.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.43
|
| Rate for Payer: Blue Shield of California Commercial |
$52.07
|
| Rate for Payer: Blue Shield of California EPN |
$41.76
|
| Rate for Payer: Cash Price |
$9.27
|
| Rate for Payer: Cash Price |
$9.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.74
|
| Rate for Payer: Heritage Provider Network Senior |
$5.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$6.95
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC SOM FRUCTOSAMINE
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 82985
|
| Hospital Charge Code |
900913929
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$143.12 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.12
|
| Rate for Payer: Blue Shield of California Commercial |
$121.31
|
| Rate for Payer: Blue Shield of California EPN |
$97.30
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.46
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.76
|
| Rate for Payer: TriValley Medical Group Senior |
$16.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.44
|
| Rate for Payer: Vantage Medical Group Senior |
$16.76
|
|
|
HC SOM FRUCTOSAMINE
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 82985
|
| Hospital Charge Code |
900913929
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.88
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC SOM FSUCC 82491
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914734
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.14
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.25
|
| Rate for Payer: Heritage Provider Network Senior |
$125.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
|
|
HC SOM FSUCC 82491
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914734
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$170.74 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.74
|
| Rate for Payer: Blue Shield of California Commercial |
$145.32
|
| Rate for Payer: Blue Shield of California EPN |
$116.56
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.52
|
| Rate for Payer: Heritage Provider Network Senior |
$114.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$88.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.09
|
| Rate for Payer: TriValley Medical Group Senior |
$24.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM FUNGITELL
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
900915351
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$85.34 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Adventist Health Commercial |
$29.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.34
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$94.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.57
|
| Rate for Payer: Heritage Provider Network Senior |
$90.37
|
| Rate for Payer: Heritage Provider Network Senior |
$44.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$69.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$34.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$109.50
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC SOM FUNGITELL
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
900915351
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.37
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.74
|
| Rate for Payer: Heritage Provider Network Senior |
$48.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
|
|
HC SOM FUNGITELL ASSAY
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
900912985
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$97.50 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$80.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.34
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$80.47
|
| Rate for Payer: Heritage Provider Network Senior |
$80.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$62.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC SOM FUNGITELL ASSAY
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
900912985
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$97.50 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.72
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$88.01
|
| Rate for Payer: Heritage Provider Network Senior |
$88.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.50
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
|
|
HC SOM GABAPENTIN (NEURONTIN)
|
Facility
|
OP
|
$22.35
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
900910415
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$104.20 |
| Rate for Payer: Adventist Health Commercial |
$4.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.68
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Cash Price |
$22.35
|
| Rate for Payer: Cash Price |
$22.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.83
|
| Rate for Payer: Heritage Provider Network Senior |
$13.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.04
|
| Rate for Payer: Multiplan Commercial |
$16.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.67
|
| Rate for Payer: TriValley Medical Group Senior |
$21.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.84
|
| Rate for Payer: Vantage Medical Group Senior |
$21.67
|
|
|
HC SOM GABAPENTIN (NEURONTIN)
|
Facility
|
IP
|
$22.35
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
900910415
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$16.76 |
| Rate for Payer: Adventist Health Commercial |
$4.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.39
|
| Rate for Payer: Cash Price |
$22.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.13
|
| Rate for Payer: Heritage Provider Network Senior |
$15.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.59
|
| Rate for Payer: Multiplan Commercial |
$16.76
|
|
|
HC SOM GAD 65 ANTIBODIES
|
Facility
|
OP
|
$43.69
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900912683
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$146.00 |
| Rate for Payer: Adventist Health Commercial |
$8.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.00
|
| Rate for Payer: Blue Shield of California Commercial |
$133.75
|
| Rate for Payer: Blue Shield of California EPN |
$107.28
|
| Rate for Payer: Cash Price |
$43.69
|
| Rate for Payer: Cash Price |
$43.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$23.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.04
|
| Rate for Payer: Heritage Provider Network Senior |
$27.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31.58
|
| Rate for Payer: Multiplan Commercial |
$32.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.57
|
| Rate for Payer: TriValley Medical Group Senior |
$23.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM GAD 65 ANTIBODIES
|
Facility
|
IP
|
$43.69
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900912683
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Adventist Health Commercial |
$8.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.14
|
| Rate for Payer: Cash Price |
$43.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.58
|
| Rate for Payer: Heritage Provider Network Senior |
$29.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.92
|
| Rate for Payer: Multiplan Commercial |
$32.77
|
|
|
HC SOM GAL-1-PO4 URIDYL TR
|
Facility
|
IP
|
$61.34
|
|
|
Service Code
|
CPT 82775
|
| Hospital Charge Code |
900911057
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.10 |
| Max. Negotiated Rate |
$46.01 |
| Rate for Payer: Adventist Health Commercial |
$12.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.50
|
| Rate for Payer: Cash Price |
$61.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.53
|
| Rate for Payer: Heritage Provider Network Senior |
$41.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.34
|
| Rate for Payer: Multiplan Commercial |
$46.01
|
|
|
HC SOM GAL-1-PO4 URIDYL TR
|
Facility
|
OP
|
$61.34
|
|
|
Service Code
|
CPT 82775
|
| Hospital Charge Code |
900911057
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.10 |
| Max. Negotiated Rate |
$200.08 |
| Rate for Payer: Adventist Health Commercial |
$12.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$200.08
|
| Rate for Payer: Blue Shield of California Commercial |
$169.52
|
| Rate for Payer: Blue Shield of California EPN |
$135.97
|
| Rate for Payer: Cash Price |
$61.34
|
| Rate for Payer: Cash Price |
$61.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.97
|
| Rate for Payer: Heritage Provider Network Senior |
$37.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$29.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.23
|
| Rate for Payer: Multiplan Commercial |
$46.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.07
|
| Rate for Payer: TriValley Medical Group Senior |
$21.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.18
|
| Rate for Payer: Vantage Medical Group Senior |
$21.07
|
|
|
HC SOM GALACTOSE 1 PHOSPHATE ERYTHRO
|
Facility
|
OP
|
$122.76
|
|
|
Service Code
|
CPT 84378
|
| Hospital Charge Code |
900910746
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$108.86 |
| Rate for Payer: Adventist Health Commercial |
$24.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.86
|
| Rate for Payer: Blue Shield of California Commercial |
$92.74
|
| Rate for Payer: Blue Shield of California EPN |
$74.38
|
| Rate for Payer: Cash Price |
$122.76
|
| Rate for Payer: Cash Price |
$122.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$79.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.43
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$75.99
|
| Rate for Payer: Heritage Provider Network Senior |
$75.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$58.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$92.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM GALACTOSE 1 PHOSPHATE ERYTHRO
|
Facility
|
IP
|
$122.76
|
|
|
Service Code
|
CPT 84378
|
| Hospital Charge Code |
900910746
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.22 |
| Max. Negotiated Rate |
$92.07 |
| Rate for Payer: Adventist Health Commercial |
$24.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.06
|
| Rate for Payer: Cash Price |
$122.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.11
|
| Rate for Payer: Heritage Provider Network Senior |
$83.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.69
|
| Rate for Payer: Multiplan Commercial |
$92.07
|
|
