|
HC SOM META GT 26 CHROM ADDIT
|
Facility
|
IP
|
$14.15
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900915306
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$10.61 |
| Rate for Payer: Adventist Health Commercial |
$2.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.11
|
| Rate for Payer: Cash Price |
$14.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.58
|
| Rate for Payer: Heritage Provider Network Senior |
$9.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: Multiplan Commercial |
$10.61
|
|
|
HC SOM META GT 26 CHROM ADDIT
|
Facility
|
OP
|
$14.15
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900915306
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$153.22 |
| Rate for Payer: Adventist Health Commercial |
$2.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.22
|
| Rate for Payer: Blue Shield of California Commercial |
$152.87
|
| Rate for Payer: Blue Shield of California EPN |
$122.61
|
| Rate for Payer: Cash Price |
$14.15
|
| Rate for Payer: Cash Price |
$14.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$26.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.76
|
| Rate for Payer: Heritage Provider Network Senior |
$8.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36.06
|
| Rate for Payer: Multiplan Commercial |
$10.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$26.91
|
| Rate for Payer: TriValley Medical Group Senior |
$26.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Vantage Medical Group Senior |
$26.91
|
|
|
HC SOM META GT 26 CHROM ANAL
|
Facility
|
OP
|
$110.85
|
|
|
Service Code
|
CPT 88245
|
| Hospital Charge Code |
900915292
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$1,367.61 |
| Rate for Payer: Adventist Health Commercial |
$22.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,367.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1,197.96
|
| Rate for Payer: Blue Shield of California EPN |
$960.87
|
| Rate for Payer: Cash Price |
$110.85
|
| Rate for Payer: Cash Price |
$110.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$72.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$173.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.62
|
| Rate for Payer: Heritage Provider Network Senior |
$68.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$173.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$52.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$199.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$232.05
|
| Rate for Payer: Multiplan Commercial |
$83.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$173.17
|
| Rate for Payer: TriValley Medical Group Senior |
$173.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$187.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$187.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.49
|
| Rate for Payer: Vantage Medical Group Senior |
$173.17
|
|
|
HC SOM META GT 26 CHROM ANAL
|
Facility
|
IP
|
$110.85
|
|
|
Service Code
|
CPT 88245
|
| Hospital Charge Code |
900915292
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$83.14 |
| Rate for Payer: Adventist Health Commercial |
$22.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$71.39
|
| Rate for Payer: Cash Price |
$110.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$75.05
|
| Rate for Payer: Heritage Provider Network Senior |
$75.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.71
|
| Rate for Payer: Multiplan Commercial |
$83.14
|
|
|
HC SOM META LT 15
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
900915299
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$80.50
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.62
|
| Rate for Payer: Heritage Provider Network Senior |
$84.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
|
|
HC SOM META LT 15
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
900915299
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$1,706.85 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$282.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,706.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,446.74
|
| Rate for Payer: Blue Shield of California EPN |
$1,160.41
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$282.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$188.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$188.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.38
|
| Rate for Payer: Heritage Provider Network Senior |
$77.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$188.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$59.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$216.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$252.68
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$188.57
|
| Rate for Payer: TriValley Medical Group Senior |
$188.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$203.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$203.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$282.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.43
|
| Rate for Payer: Vantage Medical Group Senior |
$188.57
|
|
|
HC SOM METANEPHRINES,FRACT,FREE,P
|
Facility
|
OP
|
$24.26
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912922
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$160.89 |
| Rate for Payer: Adventist Health Commercial |
$4.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.89
|
| Rate for Payer: Blue Shield of California Commercial |
$136.34
|
| Rate for Payer: Blue Shield of California EPN |
$109.36
|
| Rate for Payer: Cash Price |
$24.26
|
| Rate for Payer: Cash Price |
$24.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.31
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.02
|
| Rate for Payer: Heritage Provider Network Senior |
$15.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.70
|
| Rate for Payer: Multiplan Commercial |
$18.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.94
|
| Rate for Payer: TriValley Medical Group Senior |
$16.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
|
|
HC SOM METANEPHRINES,FRACT,FREE,P
|
Facility
|
IP
|
$24.26
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912922
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Adventist Health Commercial |
$4.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.62
|
| Rate for Payer: Cash Price |
$24.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.42
|
| Rate for Payer: Heritage Provider Network Senior |
$16.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: Multiplan Commercial |
$18.20
|
|
|
HC SOM METHADONE CONFIRMATION, U
|
Facility
|
IP
|
$114.08
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
900912918
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.65 |
| Max. Negotiated Rate |
$85.56 |
| Rate for Payer: Adventist Health Commercial |
$22.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$73.47
|
| Rate for Payer: Cash Price |
$114.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.23
|
| Rate for Payer: Heritage Provider Network Senior |
$77.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.52
|
| Rate for Payer: Multiplan Commercial |
$85.56
|
|
|
HC SOM METHADONE CONFIRMATION, U
|
Facility
|
OP
|
$114.08
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
900912918
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.65 |
| Max. Negotiated Rate |
$148.75 |
| Rate for Payer: Adventist Health Commercial |
$22.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.75
|
| Rate for Payer: Cash Price |
$114.08
|
| Rate for Payer: Cash Price |
$114.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$74.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.62
|
| Rate for Payer: Heritage Provider Network Senior |
$70.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$54.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$79.86
|
| Rate for Payer: Multiplan Commercial |
$85.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$57.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$57.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.97
|
| Rate for Payer: Vantage Medical Group Senior |
$96.97
|
|
|
HC SOM METHANPHETAMINE QUANT
|
Facility
|
OP
|
$16.18
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
900912822
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$141.59 |
| Rate for Payer: Adventist Health Commercial |
$3.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.59
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.02
|
| Rate for Payer: Heritage Provider Network Senior |
$10.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.33
|
| Rate for Payer: Multiplan Commercial |
$12.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: Vantage Medical Group Senior |
$13.75
|
|
|
HC SOM METHANPHETAMINE QUANT
|
Facility
|
IP
|
$16.18
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
900912822
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$12.13 |
| Rate for Payer: Adventist Health Commercial |
$3.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.42
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.95
|
| Rate for Payer: Heritage Provider Network Senior |
$10.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.04
|
| Rate for Payer: Multiplan Commercial |
$12.13
|
|
|
HC SOM METHEMOGLOBIN
|
Facility
|
IP
|
$26.57
|
|
|
Service Code
|
CPT 83050
|
| Hospital Charge Code |
900915429
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$19.93 |
| Rate for Payer: Adventist Health Commercial |
$5.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.11
|
| Rate for Payer: Cash Price |
$26.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.99
|
| Rate for Payer: Heritage Provider Network Senior |
$17.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.64
|
| Rate for Payer: Multiplan Commercial |
$19.93
|
|
|
HC SOM METHEMOGLOBIN
|
Facility
|
OP
|
$26.57
|
|
|
Service Code
|
CPT 83050
|
| Hospital Charge Code |
900915429
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$69.55 |
| Rate for Payer: Adventist Health Commercial |
$5.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.55
|
| Rate for Payer: Blue Shield of California Commercial |
$58.92
|
| Rate for Payer: Blue Shield of California EPN |
$47.26
|
| Rate for Payer: Cash Price |
$26.57
|
| Rate for Payer: Cash Price |
$26.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.27
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.45
|
| Rate for Payer: Heritage Provider Network Senior |
$16.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.99
|
| Rate for Payer: Multiplan Commercial |
$19.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.20
|
| Rate for Payer: TriValley Medical Group Senior |
$8.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.02
|
| Rate for Payer: Vantage Medical Group Senior |
$8.20
|
|
|
HC SOM METHYLMALONIC ACID
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900911265
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.59
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.19
|
| Rate for Payer: Heritage Provider Network Senior |
$12.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
|
|
HC SOM METHYLMALONIC ACID
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900911265
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$156.23 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.23
|
| Rate for Payer: Blue Shield of California Commercial |
$132.48
|
| Rate for Payer: Blue Shield of California EPN |
$106.26
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.42
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.21
|
| Rate for Payer: TriValley Medical Group Senior |
$21.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.33
|
| Rate for Payer: Vantage Medical Group Senior |
$21.21
|
|
|
HC SOM METHYLMALONIC ACID URINE
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900910587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.59
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.19
|
| Rate for Payer: Heritage Provider Network Senior |
$12.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
|
|
HC SOM METHYLMALONIC ACID URINE
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900910587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$156.23 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.23
|
| Rate for Payer: Blue Shield of California Commercial |
$132.48
|
| Rate for Payer: Blue Shield of California EPN |
$106.26
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.42
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.21
|
| Rate for Payer: TriValley Medical Group Senior |
$21.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.33
|
| Rate for Payer: Vantage Medical Group Senior |
$21.21
|
|
|
HC SOM MEXILETINE PLASMA
|
Facility
|
IP
|
$83.88
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911280
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$62.91 |
| Rate for Payer: Adventist Health Commercial |
$16.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.02
|
| Rate for Payer: Cash Price |
$83.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$56.79
|
| Rate for Payer: Heritage Provider Network Senior |
$56.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.97
|
| Rate for Payer: Multiplan Commercial |
$62.91
|
|
|
HC SOM MEXILETINE PLASMA
|
Facility
|
OP
|
$83.88
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911280
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$138.26 |
| Rate for Payer: Adventist Health Commercial |
$16.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$51.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.26
|
| Rate for Payer: Blue Shield of California Commercial |
$110.19
|
| Rate for Payer: Blue Shield of California EPN |
$88.38
|
| Rate for Payer: Cash Price |
$83.88
|
| Rate for Payer: Cash Price |
$83.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$54.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.49
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.92
|
| Rate for Payer: Heritage Provider Network Senior |
$51.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$40.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$62.91
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.64
|
| Rate for Payer: TriValley Medical Group Senior |
$18.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM MGLE ACH RECEPTOR BINDING AB
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$201.75 |
| Rate for Payer: Adventist Health Commercial |
$53.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.29
|
| 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 |
$269.00
|
| Rate for Payer: Cash Price |
$269.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$174.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$166.51
|
| Rate for Payer: Heritage Provider Network Senior |
$166.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$128.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$201.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.40
|
| Rate for Payer: TriValley Medical Group Senior |
$18.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM MGLE ACH RECEPTOR BINDING AB
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.69 |
| Max. Negotiated Rate |
$201.75 |
| Rate for Payer: Adventist Health Commercial |
$53.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$173.24
|
| Rate for Payer: Cash Price |
$269.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.11
|
| Rate for Payer: Heritage Provider Network Senior |
$182.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.25
|
| Rate for Payer: Multiplan Commercial |
$201.75
|
|
|
HC SOM MGLE P/Q TYPE CA CHANNEL AB
|
Facility
|
IP
|
$176.17
|
|
|
Service Code
|
CPT 86596
|
| Hospital Charge Code |
900915420
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$132.13 |
| Rate for Payer: Adventist Health Commercial |
$35.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$113.45
|
| Rate for Payer: Cash Price |
$176.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$119.27
|
| Rate for Payer: Heritage Provider Network Senior |
$119.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.04
|
| Rate for Payer: Multiplan Commercial |
$132.13
|
|
|
HC SOM MGLE P/Q TYPE CA CHANNEL AB
|
Facility
|
OP
|
$176.17
|
|
|
Service Code
|
CPT 86596
|
| Hospital Charge Code |
900915420
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$132.13 |
| Rate for Payer: Adventist Health Commercial |
$35.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$108.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.16
|
| Rate for Payer: Blue Shield of California Commercial |
$105.98
|
| Rate for Payer: Blue Shield of California EPN |
$85.01
|
| Rate for Payer: Cash Price |
$176.17
|
| Rate for Payer: Cash Price |
$176.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$114.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.05
|
| Rate for Payer: Heritage Provider Network Senior |
$109.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$84.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$132.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM MGLES 83519A
|
Facility
|
OP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914809
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$128.29 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$78.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.29
|
| 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 |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$82.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.58
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.24
|
| Rate for Payer: Heritage Provider Network Senior |
$78.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$60.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$94.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.40
|
| Rate for Payer: TriValley Medical Group Senior |
$18.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
