|
HC SOM HIV-1 GENOTYPIC RESISTANCE
|
Facility
|
OP
|
$441.82
|
|
|
Service Code
|
CPT 0219U
|
| Hospital Charge Code |
900915502
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$79.97 |
| Max. Negotiated Rate |
$4,161.64 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$273.04
|
| Rate for Payer: Adventist Health Commercial |
$88.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,087.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$797.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$725.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,161.64
|
| Rate for Payer: Cash Price |
$441.82
|
| Rate for Payer: Cash Price |
$441.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$287.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,087.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$797.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$725.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$287.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$725.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$273.49
|
| Rate for Payer: Heritage Provider Network Senior |
$273.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$725.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$210.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$833.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$971.50
|
| Rate for Payer: Multiplan Commercial |
$331.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$725.00
|
| Rate for Payer: TriValley Medical Group Senior |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$783.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$783.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,087.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$797.50
|
| Rate for Payer: Vantage Medical Group Senior |
$725.00
|
|
|
HC SOM HIV-1 PROVIRAL DNA
|
Facility
|
IP
|
$50.27
|
|
|
Service Code
|
CPT 87535
|
| Hospital Charge Code |
900914170
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$37.70 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.37
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.03
|
| Rate for Payer: Heritage Provider Network Senior |
$34.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.57
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
|
|
HC SOM HIV-1 PROVIRAL DNA
|
Facility
|
OP
|
$50.27
|
|
|
Service Code
|
CPT 87535
|
| Hospital Charge Code |
900914170
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.07
|
| 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 |
$322.42
|
| 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 |
$50.27
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.12
|
| Rate for Payer: Heritage Provider Network Senior |
$31.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
| 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 HIV-1 RNA QUANT WITH REFLEX
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
900915501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$684.81 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.65
|
| Rate for Payer: Blue Shield of California Commercial |
$684.81
|
| Rate for Payer: Blue Shield of California EPN |
$549.27
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$85.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.23
|
| Rate for Payer: Heritage Provider Network Senior |
$40.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$85.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$31.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$97.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$114.03
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$85.10
|
| Rate for Payer: TriValley Medical Group Senior |
$85.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$91.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$91.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.61
|
| Rate for Payer: Vantage Medical Group Senior |
$85.10
|
|
|
HC SOM HIV-1 RNA QUANT WITH REFLEX
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
900915501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.86
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.01
|
| Rate for Payer: Heritage Provider Network Senior |
$44.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.25
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
|
|
HC SOM HIV2 86702
|
Facility
|
OP
|
$19.37
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900914737
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$130.40 |
| Rate for Payer: Adventist Health Commercial |
$3.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.40
|
| Rate for Payer: Blue Shield of California Commercial |
$108.75
|
| Rate for Payer: Blue Shield of California EPN |
$87.23
|
| Rate for Payer: Cash Price |
$19.37
|
| Rate for Payer: Cash Price |
$19.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.43
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.99
|
| Rate for Payer: Heritage Provider Network Senior |
$11.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.12
|
| Rate for Payer: Multiplan Commercial |
$14.53
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.52
|
| Rate for Payer: TriValley Medical Group Senior |
$13.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC SOM HIV2 86702
|
Facility
|
IP
|
$19.37
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900914737
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$14.53 |
| Rate for Payer: Adventist Health Commercial |
$3.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.47
|
| Rate for Payer: Cash Price |
$19.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.11
|
| Rate for Payer: Heritage Provider Network Senior |
$13.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.84
|
| Rate for Payer: Multiplan Commercial |
$14.53
|
|
|
HC SOM HIV-2 ANTIBODY
|
Facility
|
IP
|
$45.24
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900915309
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$33.93 |
| Rate for Payer: Adventist Health Commercial |
$9.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.13
|
| Rate for Payer: Cash Price |
$45.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.63
|
| Rate for Payer: Heritage Provider Network Senior |
$30.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.31
|
| Rate for Payer: Multiplan Commercial |
$33.93
|
|
|
HC SOM HIV-2 ANTIBODY
|
Facility
|
OP
|
$45.24
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900915309
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$130.40 |
| Rate for Payer: Adventist Health Commercial |
$9.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.40
|
| Rate for Payer: Blue Shield of California Commercial |
$108.75
|
| Rate for Payer: Blue Shield of California EPN |
$87.23
|
| Rate for Payer: Cash Price |
$45.24
|
| Rate for Payer: Cash Price |
$45.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.69
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.00
|
| Rate for Payer: Heritage Provider Network Senior |
$28.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.12
|
| Rate for Payer: Multiplan Commercial |
$33.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.52
|
| Rate for Payer: TriValley Medical Group Senior |
$13.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC SOM HIV 2 CONFIRM
|
Facility
|
IP
|
$57.80
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900911352
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$43.35 |
| Rate for Payer: Adventist Health Commercial |
$11.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.22
|
| Rate for Payer: Cash Price |
$57.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.13
|
| Rate for Payer: Heritage Provider Network Senior |
$39.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.45
|
| Rate for Payer: Multiplan Commercial |
$43.35
|
|
|
HC SOM HIV 2 CONFIRM
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900911352
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$130.40 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Adventist Health Commercial |
$11.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.40
|
| Rate for Payer: Blue Shield of California Commercial |
$108.75
|
| Rate for Payer: Blue Shield of California Commercial |
$108.75
|
| Rate for Payer: Blue Shield of California EPN |
$87.23
|
| Rate for Payer: Blue Shield of California EPN |
$87.23
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$57.80
|
| Rate for Payer: Cash Price |
$57.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.23
|
| Rate for Payer: Heritage Provider Network Senior |
$35.78
|
| Rate for Payer: Heritage Provider Network Senior |
$40.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$27.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$31.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.12
|
| Rate for Payer: Multiplan Commercial |
$43.35
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.52
|
| Rate for Payer: TriValley Medical Group Senior |
$13.52
|
| Rate for Payer: TriValley Medical Group Senior |
$13.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC SOM HIV DNA (PCR)
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
900911055
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.86
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.01
|
| Rate for Payer: Heritage Provider Network Senior |
$44.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.25
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
|
|
HC SOM HIV DNA (PCR)
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
900911055
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$684.81 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.65
|
| Rate for Payer: Blue Shield of California Commercial |
$684.81
|
| Rate for Payer: Blue Shield of California EPN |
$549.27
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$85.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.23
|
| Rate for Payer: Heritage Provider Network Senior |
$40.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$85.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$31.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$97.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$114.03
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$85.10
|
| Rate for Payer: TriValley Medical Group Senior |
$85.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$91.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$91.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.61
|
| Rate for Payer: Vantage Medical Group Senior |
$85.10
|
|
|
HC SOM HIVE 86703
|
Facility
|
OP
|
$114.45
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900914736
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$134.17 |
| Rate for Payer: Adventist Health Commercial |
$22.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.17
|
| Rate for Payer: Blue Shield of California Commercial |
$110.42
|
| Rate for Payer: Blue Shield of California EPN |
$88.57
|
| Rate for Payer: Cash Price |
$114.45
|
| Rate for Payer: Cash Price |
$114.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$74.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.84
|
| Rate for Payer: Heritage Provider Network Senior |
$70.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$54.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.37
|
| Rate for Payer: Multiplan Commercial |
$85.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.71
|
| Rate for Payer: TriValley Medical Group Senior |
$13.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Vantage Medical Group Senior |
$13.71
|
|
|
HC SOM HIVE 86703
|
Facility
|
IP
|
$114.45
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900914736
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$85.84 |
| Rate for Payer: Adventist Health Commercial |
$22.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$73.71
|
| Rate for Payer: Cash Price |
$114.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.48
|
| Rate for Payer: Heritage Provider Network Senior |
$77.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.61
|
| Rate for Payer: Multiplan Commercial |
$85.84
|
|
|
HC SOM HMUCR ARSENIC/CREAT, RAND, U
|
Facility
|
OP
|
$12.10
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
900915364
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$180.13 |
| Rate for Payer: Adventist Health Commercial |
$2.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.13
|
| Rate for Payer: Blue Shield of California Commercial |
$152.70
|
| Rate for Payer: Blue Shield of California EPN |
$122.48
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.49
|
| Rate for Payer: Heritage Provider Network Senior |
$7.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.42
|
| Rate for Payer: Multiplan Commercial |
$9.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.97
|
| Rate for Payer: TriValley Medical Group Senior |
$18.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.87
|
| Rate for Payer: Vantage Medical Group Senior |
$18.97
|
|
|
HC SOM HMUCR ARSENIC/CREAT, RAND, U
|
Facility
|
IP
|
$12.10
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
900915364
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$9.07 |
| Rate for Payer: Adventist Health Commercial |
$2.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.79
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.19
|
| Rate for Payer: Heritage Provider Network Senior |
$8.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$9.07
|
|
|
HC SOM HMUCR CADMIUM/CREAT, RAND, U
|
Facility
|
IP
|
$15.08
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
900915365
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$11.31 |
| Rate for Payer: Adventist Health Commercial |
$3.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.71
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.21
|
| Rate for Payer: Heritage Provider Network Senior |
$10.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.77
|
| Rate for Payer: Multiplan Commercial |
$11.31
|
|
|
HC SOM HMUCR CADMIUM/CREAT, RAND, U
|
Facility
|
OP
|
$15.08
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
900915365
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$219.64 |
| Rate for Payer: Adventist Health Commercial |
$3.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.64
|
| Rate for Payer: Blue Shield of California Commercial |
$186.22
|
| Rate for Payer: Blue Shield of California EPN |
$149.36
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$23.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.33
|
| Rate for Payer: Heritage Provider Network Senior |
$9.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$11.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.64
|
| Rate for Payer: TriValley Medical Group Senior |
$23.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.00
|
| Rate for Payer: Vantage Medical Group Senior |
$23.64
|
|
|
HC SOM HMUCR CREATININE, RAND, U
|
Facility
|
IP
|
$3.30
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
900915368
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.13
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.48
|
|
|
HC SOM HMUCR CREATININE, RAND, U
|
Facility
|
OP
|
$3.30
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
900915368
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$49.09 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.09
|
| Rate for Payer: Blue Shield of California Commercial |
$41.64
|
| Rate for Payer: Blue Shield of California EPN |
$33.40
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.04
|
| Rate for Payer: Heritage Provider Network Senior |
$2.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$2.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC SOM HMUCR LEAD/CREAT, RAND, U
|
Facility
|
OP
|
$7.72
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
900915367
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$114.93 |
| Rate for Payer: Adventist Health Commercial |
$1.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.93
|
| Rate for Payer: Blue Shield of California Commercial |
$97.40
|
| Rate for Payer: Blue Shield of California EPN |
$78.12
|
| Rate for Payer: Cash Price |
$7.72
|
| Rate for Payer: Cash Price |
$7.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.78
|
| Rate for Payer: Heritage Provider Network Senior |
$4.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$5.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.11
|
| Rate for Payer: TriValley Medical Group Senior |
$12.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Vantage Medical Group Senior |
$12.11
|
|
|
HC SOM HMUCR LEAD/CREAT, RAND, U
|
Facility
|
IP
|
$7.72
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
900915367
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$5.79 |
| Rate for Payer: Adventist Health Commercial |
$1.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.97
|
| Rate for Payer: Cash Price |
$7.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.23
|
| Rate for Payer: Heritage Provider Network Senior |
$5.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.93
|
| Rate for Payer: Multiplan Commercial |
$5.79
|
|
|
HC SOM HMUCR MERCURY/CREAT, RAND, U
|
Facility
|
OP
|
$10.37
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
900915366
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$153.67 |
| Rate for Payer: Adventist Health Commercial |
$2.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.67
|
| Rate for Payer: Blue Shield of California Commercial |
$130.87
|
| Rate for Payer: Blue Shield of California EPN |
$104.97
|
| Rate for Payer: Cash Price |
$10.37
|
| Rate for Payer: Cash Price |
$10.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.42
|
| Rate for Payer: Heritage Provider Network Senior |
$6.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.79
|
| Rate for Payer: Multiplan Commercial |
$7.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.26
|
| Rate for Payer: TriValley Medical Group Senior |
$16.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.89
|
| Rate for Payer: Vantage Medical Group Senior |
$16.26
|
|
|
HC SOM HMUCR MERCURY/CREAT, RAND, U
|
Facility
|
IP
|
$10.37
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
900915366
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Adventist Health Commercial |
$2.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.68
|
| Rate for Payer: Cash Price |
$10.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.02
|
| Rate for Payer: Heritage Provider Network Senior |
$7.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$7.78
|
|
