|
HC SOM VON WILLEBRAND FACTOR ACTIVITY
|
Facility
|
OP
|
$74.20
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
900912874
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.43 |
| Max. Negotiated Rate |
$208.85 |
| Rate for Payer: Adventist Health Commercial |
$14.84
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$208.85
|
| Rate for Payer: Blue Shield of California Commercial |
$193.02
|
| Rate for Payer: Blue Shield of California EPN |
$154.82
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.95
|
| Rate for Payer: Dignity Health Senior |
$30.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.23
|
| Rate for Payer: EPIC Health Plan Medicare |
$30.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.93
|
| Rate for Payer: Heritage Provider Network Senior |
$45.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38.88
|
| Rate for Payer: Multiplan Commercial |
$55.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$30.86
|
| Rate for Payer: TriValley Medical Group Senior |
$30.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$33.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$33.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.95
|
| Rate for Payer: Vantage Medical Group Senior |
$30.86
|
|
|
HC SOM VON WILLEBRAND FACTOR MULTIMER P
|
Facility
|
IP
|
$51.10
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
900910113
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.25 |
| Max. Negotiated Rate |
$38.33 |
| Rate for Payer: Adventist Health Commercial |
$10.22
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.59
|
| Rate for Payer: Heritage Provider Network Senior |
$34.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.78
|
| Rate for Payer: Multiplan Commercial |
$38.33
|
|
|
HC SOM VON WILLEBRAND FACTOR MULTIMER P
|
Facility
|
OP
|
$51.10
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
900910113
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.25 |
| Max. Negotiated Rate |
$209.47 |
| Rate for Payer: Adventist Health Commercial |
$10.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$209.47
|
| Rate for Payer: Blue Shield of California Commercial |
$184.67
|
| Rate for Payer: Blue Shield of California EPN |
$148.12
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.23
|
| Rate for Payer: Dignity Health Senior |
$22.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.63
|
| Rate for Payer: Heritage Provider Network Senior |
$31.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.90
|
| Rate for Payer: Multiplan Commercial |
$38.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.94
|
| Rate for Payer: TriValley Medical Group Senior |
$22.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: Vantage Medical Group Senior |
$22.94
|
|
|
HC SOM VORICONAZOLE LEVEL
|
Facility
|
OP
|
$27.11
|
|
|
Service Code
|
CPT 80285
|
| Hospital Charge Code |
900912707
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$156.15 |
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.71
|
| Rate for Payer: Blue Shield of California Commercial |
$156.15
|
| Rate for Payer: Blue Shield of California EPN |
$125.25
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.82
|
| Rate for Payer: Dignity Health Senior |
$27.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$27.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.78
|
| Rate for Payer: Heritage Provider Network Senior |
$16.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.16
|
| Rate for Payer: Multiplan Commercial |
$20.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.11
|
| Rate for Payer: TriValley Medical Group Senior |
$27.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Vantage Medical Group Senior |
$27.11
|
|
|
HC SOM VORICONAZOLE LEVEL
|
Facility
|
IP
|
$27.11
|
|
|
Service Code
|
CPT 80285
|
| Hospital Charge Code |
900912707
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$20.33 |
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.35
|
| Rate for Payer: Heritage Provider Network Senior |
$18.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.78
|
| Rate for Payer: Multiplan Commercial |
$20.33
|
|
|
HC SOM VPHIV 87900
|
Facility
|
OP
|
$174.30
|
|
|
Service Code
|
CPT 87900
|
| Hospital Charge Code |
900914741
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$31.55 |
| Max. Negotiated Rate |
$1,164.05 |
| Rate for Payer: Adventist Health Commercial |
$34.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$93.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$130.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,164.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1,048.95
|
| Rate for Payer: Blue Shield of California EPN |
$841.35
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$113.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.38
|
| Rate for Payer: Dignity Health Senior |
$130.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$130.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.89
|
| Rate for Payer: Heritage Provider Network Senior |
$107.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$187.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$130.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$83.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$164.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$164.24
|
| Rate for Payer: Multiplan Commercial |
$130.72
|
| Rate for Payer: TriValley Medical Group Commercial |
$130.35
|
| Rate for Payer: TriValley Medical Group Senior |
$130.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$140.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$140.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.38
|
| Rate for Payer: Vantage Medical Group Senior |
$130.35
|
|
|
HC SOM VPHIV 87900
|
Facility
|
IP
|
$174.30
|
|
|
Service Code
|
CPT 87900
|
| Hospital Charge Code |
900914741
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$31.55 |
| Max. Negotiated Rate |
$130.72 |
| Rate for Payer: Adventist Health Commercial |
$34.86
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.00
|
| Rate for Payer: Heritage Provider Network Senior |
$118.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.58
|
| Rate for Payer: Multiplan Commercial |
$130.72
|
|
|
HC SOM WESTERN EQUINE ENCEPH AB IGG
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
900911337
|
|
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 WESTERN EQUINE ENCEPH AB IGG
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
900911337
|
|
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 WESTERN EQUINE ENCEPH AB IGM
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
900912651
|
|
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 WESTERN EQUINE ENCEPH AB IGM
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
900912651
|
|
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 WEST NILE VIRUS AB
|
Facility
|
IP
|
$18.39
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
900912544
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$13.79 |
| Rate for Payer: Adventist Health Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$18.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.45
|
| Rate for Payer: Heritage Provider Network Senior |
$12.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$13.79
|
|
|
HC SOM WEST NILE VIRUS AB
|
Facility
|
OP
|
$18.39
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
900912544
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$150.46 |
| Rate for Payer: Adventist Health Commercial |
$3.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.46
|
| Rate for Payer: Blue Shield of California Commercial |
$135.59
|
| Rate for Payer: Blue Shield of California EPN |
$108.75
|
| Rate for Payer: Cash Price |
$18.39
|
| Rate for Payer: Cash Price |
$18.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.54
|
| Rate for Payer: Dignity Health Senior |
$16.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.38
|
| Rate for Payer: Heritage Provider Network Senior |
$11.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.23
|
| Rate for Payer: Multiplan Commercial |
$13.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.85
|
| Rate for Payer: TriValley Medical Group Senior |
$16.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Vantage Medical Group Senior |
$16.85
|
|
|
HC SOM WEST NILE VIRUS AB IGG CSF
|
Facility
|
IP
|
$15.66
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
900912603
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$11.74 |
| Rate for Payer: Adventist Health Commercial |
$3.13
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.60
|
| Rate for Payer: Heritage Provider Network Senior |
$10.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.92
|
| Rate for Payer: Multiplan Commercial |
$11.74
|
|
|
HC SOM WEST NILE VIRUS AB IGG CSF
|
Facility
|
OP
|
$15.66
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
900912603
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$128.52 |
| Rate for Payer: Adventist Health Commercial |
$3.13
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.52
|
| Rate for Payer: Blue Shield of California Commercial |
$115.83
|
| Rate for Payer: Blue Shield of California EPN |
$92.91
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Senior |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.69
|
| Rate for Payer: Heritage Provider Network Senior |
$9.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.13
|
| Rate for Payer: Multiplan Commercial |
$11.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.39
|
| Rate for Payer: TriValley Medical Group Senior |
$14.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC SOM WEST NILE VIRUS AB IGM
|
Facility
|
OP
|
$15.71
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
900912602
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$128.52 |
| Rate for Payer: Adventist Health Commercial |
$3.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.52
|
| Rate for Payer: Blue Shield of California Commercial |
$115.83
|
| Rate for Payer: Blue Shield of California EPN |
$92.91
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Senior |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.21
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.72
|
| Rate for Payer: Heritage Provider Network Senior |
$9.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.13
|
| Rate for Payer: Multiplan Commercial |
$11.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.39
|
| Rate for Payer: TriValley Medical Group Senior |
$14.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC SOM WEST NILE VIRUS AB IGM
|
Facility
|
IP
|
$15.71
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
900912602
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$11.78 |
| Rate for Payer: Adventist Health Commercial |
$3.14
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.64
|
| Rate for Payer: Heritage Provider Network Senior |
$10.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.93
|
| Rate for Payer: Multiplan Commercial |
$11.78
|
|
|
HC SOM WEST NILE VIRUS AB IGM CSF
|
Facility
|
IP
|
$18.34
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
900912164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$13.76 |
| Rate for Payer: Adventist Health Commercial |
$3.67
|
| Rate for Payer: Cash Price |
$18.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.42
|
| Rate for Payer: Heritage Provider Network Senior |
$12.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.58
|
| Rate for Payer: Multiplan Commercial |
$13.76
|
|
|
HC SOM WEST NILE VIRUS AB IGM CSF
|
Facility
|
OP
|
$18.34
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
900912164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$150.46 |
| Rate for Payer: Adventist Health Commercial |
$3.67
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.46
|
| Rate for Payer: Blue Shield of California Commercial |
$135.59
|
| Rate for Payer: Blue Shield of California EPN |
$108.75
|
| Rate for Payer: Cash Price |
$18.34
|
| Rate for Payer: Cash Price |
$18.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.54
|
| Rate for Payer: Dignity Health Senior |
$16.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.92
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.35
|
| Rate for Payer: Heritage Provider Network Senior |
$11.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.23
|
| Rate for Payer: Multiplan Commercial |
$13.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.85
|
| Rate for Payer: TriValley Medical Group Senior |
$16.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Vantage Medical Group Senior |
$16.85
|
|
|
HC SOM WEST NILE VIRUS PCR
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912543
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$310.02 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$44.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$57.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.02
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$54.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.00
|
| Rate for Payer: Heritage Provider Network Senior |
$52.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$40.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM WEST NILE VIRUS PCR
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912543
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$56.87
|
| Rate for Payer: Heritage Provider Network Senior |
$56.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
|
|
HC SOM WEST NILE VIRUS PCR (CSF)
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912764
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$310.02 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$44.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$57.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.02
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$54.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.00
|
| Rate for Payer: Heritage Provider Network Senior |
$52.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$40.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM WEST NILE VIRUS PCR (CSF)
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912764
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$56.87
|
| Rate for Payer: Heritage Provider Network Senior |
$56.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
|
|
HC SOM WHEY IGE
|
Facility
|
OP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914677
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$144.32 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.32
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.86
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.62
|
| Rate for Payer: Heritage Provider Network Senior |
$4.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SOM WHEY IGE
|
Facility
|
IP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914677
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.06
|
| Rate for Payer: Heritage Provider Network Senior |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
|
