|
HC SOM MCLON IFE U
|
Facility
|
IP
|
$28.86
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
900912768
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Adventist Health Commercial |
$5.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.59
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.54
|
| Rate for Payer: Heritage Provider Network Senior |
$19.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.21
|
| Rate for Payer: Multiplan Commercial |
$21.64
|
|
|
HC SOM MCLON IFE U
|
Facility
|
OP
|
$28.86
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
900912768
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$236.16 |
| Rate for Payer: Adventist Health Commercial |
$5.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.13
|
| Rate for Payer: Blue Shield of California Commercial |
$236.16
|
| Rate for Payer: Blue Shield of California EPN |
$189.42
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.03
|
| Rate for Payer: EPIC Health Plan Medicare |
$29.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.86
|
| Rate for Payer: Heritage Provider Network Senior |
$17.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39.33
|
| Rate for Payer: Multiplan Commercial |
$21.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.35
|
| Rate for Payer: TriValley Medical Group Senior |
$29.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.28
|
| Rate for Payer: Vantage Medical Group Senior |
$29.35
|
|
|
HC SOM MCLON PROT ELEC. U
|
Facility
|
OP
|
$17.53
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$165.88 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.88
|
| Rate for Payer: Blue Shield of California Commercial |
$143.54
|
| Rate for Payer: Blue Shield of California EPN |
$115.13
|
| Rate for Payer: Cash Price |
$17.53
|
| Rate for Payer: Cash Price |
$17.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.34
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.85
|
| Rate for Payer: Heritage Provider Network Senior |
$10.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.89
|
| Rate for Payer: Multiplan Commercial |
$13.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.83
|
| Rate for Payer: TriValley Medical Group Senior |
$17.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Vantage Medical Group Senior |
$17.83
|
|
|
HC SOM MCLON PROT ELEC. U
|
Facility
|
IP
|
$17.53
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$13.15 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.29
|
| Rate for Payer: Cash Price |
$17.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.87
|
| Rate for Payer: Heritage Provider Network Senior |
$11.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.38
|
| Rate for Payer: Multiplan Commercial |
$13.15
|
|
|
HC SOM MCLON T. PROT U
|
Facility
|
IP
|
$3.61
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.71 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.32
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.44
|
| Rate for Payer: Heritage Provider Network Senior |
$2.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$2.71
|
|
|
HC SOM MCLON T. PROT U
|
Facility
|
OP
|
$3.61
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$34.90 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.90
|
| Rate for Payer: Blue Shield of California Commercial |
$29.49
|
| Rate for Payer: Blue Shield of California EPN |
$23.65
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.13
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$2.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.67
|
| Rate for Payer: TriValley Medical Group Senior |
$3.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
HC SOM MEASLES AB CSF IGG
|
Facility
|
OP
|
$24.16
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900911355
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$122.35 |
| Rate for Payer: Adventist Health Commercial |
$4.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.35
|
| Rate for Payer: Blue Shield of California Commercial |
$103.68
|
| Rate for Payer: Blue Shield of California EPN |
$83.16
|
| Rate for Payer: Cash Price |
$24.16
|
| Rate for Payer: Cash Price |
$24.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.96
|
| Rate for Payer: Heritage Provider Network Senior |
$14.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$18.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.88
|
| Rate for Payer: TriValley Medical Group Senior |
$12.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM MEASLES AB CSF IGG
|
Facility
|
IP
|
$24.16
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900911355
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$18.12 |
| Rate for Payer: Adventist Health Commercial |
$4.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.56
|
| Rate for Payer: Cash Price |
$24.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.36
|
| Rate for Payer: Heritage Provider Network Senior |
$16.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.04
|
| Rate for Payer: Multiplan Commercial |
$18.12
|
|
|
HC SOM MEASLES AB IGM CSF
|
Facility
|
OP
|
$24.15
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900912655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$122.35 |
| Rate for Payer: Adventist Health Commercial |
$4.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.35
|
| Rate for Payer: Blue Shield of California Commercial |
$103.68
|
| Rate for Payer: Blue Shield of California EPN |
$83.16
|
| Rate for Payer: Cash Price |
$24.15
|
| Rate for Payer: Cash Price |
$24.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.95
|
| Rate for Payer: Heritage Provider Network Senior |
$14.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$18.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.88
|
| Rate for Payer: TriValley Medical Group Senior |
$12.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM MEASLES AB IGM CSF
|
Facility
|
IP
|
$24.15
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900912655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$18.11 |
| Rate for Payer: Adventist Health Commercial |
$4.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.55
|
| Rate for Payer: Cash Price |
$24.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.35
|
| Rate for Payer: Heritage Provider Network Senior |
$16.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.04
|
| Rate for Payer: Multiplan Commercial |
$18.11
|
|
|
HC SOM MECONIUM AMPHETAMINE CONFIRM
|
Facility
|
OP
|
$98.89
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
900912830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$753.07 |
| Rate for Payer: Adventist Health Commercial |
$19.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$171.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$753.07
|
| Rate for Payer: Blue Shield of California Commercial |
$460.45
|
| Rate for Payer: Blue Shield of California EPN |
$369.32
|
| Rate for Payer: Cash Price |
$98.89
|
| Rate for Payer: Cash Price |
$98.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$171.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$125.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$114.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.21
|
| Rate for Payer: Heritage Provider Network Senior |
$61.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$114.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$47.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$131.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$153.34
|
| Rate for Payer: Multiplan Commercial |
$74.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$114.43
|
| Rate for Payer: TriValley Medical Group Senior |
$114.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$123.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$123.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$171.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$125.87
|
| Rate for Payer: Vantage Medical Group Senior |
$114.43
|
|
|
HC SOM MECONIUM AMPHETAMINE CONFIRM
|
Facility
|
IP
|
$98.89
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
900912830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$74.17 |
| Rate for Payer: Adventist Health Commercial |
$19.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.69
|
| Rate for Payer: Cash Price |
$98.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.95
|
| Rate for Payer: Heritage Provider Network Senior |
$66.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.72
|
| Rate for Payer: Multiplan Commercial |
$74.17
|
|
|
HC SOM MECONIUM COCAINE CONFIRM
|
Facility
|
OP
|
$86.41
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
900912832
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$138.07 |
| Rate for Payer: Adventist Health Commercial |
$17.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.07
|
| Rate for Payer: Cash Price |
$86.41
|
| Rate for Payer: Cash Price |
$86.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$56.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.49
|
| Rate for Payer: Heritage Provider Network Senior |
$53.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$41.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$60.49
|
| Rate for Payer: Multiplan Commercial |
$64.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$43.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$43.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.45
|
| Rate for Payer: Vantage Medical Group Senior |
$73.45
|
|
|
HC SOM MECONIUM COCAINE CONFIRM
|
Facility
|
IP
|
$86.41
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
900912832
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$64.81 |
| Rate for Payer: Adventist Health Commercial |
$17.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.65
|
| Rate for Payer: Cash Price |
$86.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.50
|
| Rate for Payer: Heritage Provider Network Senior |
$58.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$64.81
|
|
|
HC SOM MECONIUM METHAMPHETAMINE CONF
|
Facility
|
IP
|
$23.42
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
900912831
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$17.57 |
| Rate for Payer: Adventist Health Commercial |
$4.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.08
|
| Rate for Payer: Cash Price |
$23.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.86
|
| Rate for Payer: Heritage Provider Network Senior |
$15.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.86
|
| Rate for Payer: Multiplan Commercial |
$17.57
|
|
|
HC SOM MECONIUM METHAMPHETAMINE CONF
|
Facility
|
OP
|
$23.42
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
900912831
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$141.59 |
| Rate for Payer: Adventist Health Commercial |
$4.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.59
|
| Rate for Payer: Cash Price |
$23.42
|
| Rate for Payer: Cash Price |
$23.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.50
|
| Rate for Payer: Heritage Provider Network Senior |
$14.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.39
|
| Rate for Payer: Multiplan Commercial |
$17.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.91
|
| Rate for Payer: Vantage Medical Group Senior |
$19.91
|
|
|
HC SOM MECONIUM OPIATE CONFIRM
|
Facility
|
OP
|
$49.07
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
900912833
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$177.19 |
| Rate for Payer: Adventist Health Commercial |
$9.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.19
|
| Rate for Payer: Cash Price |
$49.07
|
| Rate for Payer: Cash Price |
$49.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.37
|
| Rate for Payer: Heritage Provider Network Senior |
$30.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.35
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.71
|
| Rate for Payer: Vantage Medical Group Senior |
$41.71
|
|
|
HC SOM MECONIUM OPIATE CONFIRM
|
Facility
|
IP
|
$49.07
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
900912833
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$36.80 |
| Rate for Payer: Adventist Health Commercial |
$9.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.60
|
| Rate for Payer: Cash Price |
$49.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.22
|
| Rate for Payer: Heritage Provider Network Senior |
$33.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.27
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
|
|
HC SOM MECONIUM OPIATE CONFIRM OXYCODONE
|
Facility
|
IP
|
$40.93
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
900915377
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$30.70 |
| Rate for Payer: Adventist Health Commercial |
$8.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.36
|
| Rate for Payer: Cash Price |
$40.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.71
|
| Rate for Payer: Heritage Provider Network Senior |
$27.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.23
|
| Rate for Payer: Multiplan Commercial |
$30.70
|
|
|
HC SOM MECONIUM OPIATE CONFIRM OXYCODONE
|
Facility
|
OP
|
$40.93
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
900915377
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$177.19 |
| Rate for Payer: Adventist Health Commercial |
$8.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.19
|
| Rate for Payer: Cash Price |
$40.93
|
| Rate for Payer: Cash Price |
$40.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.34
|
| Rate for Payer: Heritage Provider Network Senior |
$25.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.65
|
| Rate for Payer: Multiplan Commercial |
$30.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.79
|
| Rate for Payer: Vantage Medical Group Senior |
$34.79
|
|
|
HC SOM MECONIUM PCP CONFIRM
|
Facility
|
OP
|
$98.89
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900912835
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$122.54 |
| Rate for Payer: Adventist Health Commercial |
$19.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.54
|
| Rate for Payer: Blue Shield of California Commercial |
$112.26
|
| Rate for Payer: Blue Shield of California EPN |
$90.04
|
| Rate for Payer: Cash Price |
$98.89
|
| Rate for Payer: Cash Price |
$98.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.21
|
| Rate for Payer: Heritage Provider Network Senior |
$61.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$47.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$69.22
|
| Rate for Payer: Multiplan Commercial |
$74.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$40.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$40.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$84.06
|
|
|
HC SOM MECONIUM PCP CONFIRM
|
Facility
|
IP
|
$98.89
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900912835
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$74.17 |
| Rate for Payer: Adventist Health Commercial |
$19.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.69
|
| Rate for Payer: Cash Price |
$98.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.95
|
| Rate for Payer: Heritage Provider Network Senior |
$66.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.72
|
| Rate for Payer: Multiplan Commercial |
$74.17
|
|
|
HC SOM MECONIUM THC LAB REF CONFIRM
|
Facility
|
IP
|
$76.10
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
900912834
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$57.08 |
| Rate for Payer: Adventist Health Commercial |
$15.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.01
|
| Rate for Payer: Cash Price |
$76.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.52
|
| Rate for Payer: Heritage Provider Network Senior |
$51.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.02
|
| Rate for Payer: Multiplan Commercial |
$57.08
|
|
|
HC SOM MECONIUM THC LAB REF CONFIRM
|
Facility
|
OP
|
$76.10
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
900912834
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$215.74 |
| Rate for Payer: Adventist Health Commercial |
$15.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$215.74
|
| Rate for Payer: Cash Price |
$76.10
|
| Rate for Payer: Cash Price |
$76.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$49.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.11
|
| Rate for Payer: Heritage Provider Network Senior |
$47.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$36.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$53.27
|
| Rate for Payer: Multiplan Commercial |
$57.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$38.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$38.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.69
|
| Rate for Payer: Vantage Medical Group Senior |
$64.69
|
|
|
HC SOM MENMS 81405
|
Facility
|
IP
|
$556.35
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914742
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$100.70 |
| Max. Negotiated Rate |
$417.26 |
| Rate for Payer: Adventist Health Commercial |
$111.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$358.29
|
| Rate for Payer: Cash Price |
$556.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.65
|
| Rate for Payer: Heritage Provider Network Senior |
$376.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$100.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.09
|
| Rate for Payer: Multiplan Commercial |
$417.26
|
|
