|
HC SOM MYOMARKER3 NONANTIBODY
|
Facility
|
IP
|
$16.90
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900915484
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$12.68 |
| Rate for Payer: Adventist Health Commercial |
$3.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.88
|
| Rate for Payer: Cash Price |
$16.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.44
|
| Rate for Payer: Heritage Provider Network Senior |
$11.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.22
|
| Rate for Payer: Multiplan Commercial |
$12.68
|
|
|
HC SOM MYOMARKER3 NONANTIBODY
|
Facility
|
OP
|
$16.90
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900915484
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$222.13 |
| Rate for Payer: Adventist Health Commercial |
$3.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.13
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$16.90
|
| Rate for Payer: Cash Price |
$16.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.98
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.46
|
| Rate for Payer: Heritage Provider Network Senior |
$10.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$12.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM MYOMARKER3 NUCLEAR AG AB
|
Facility
|
IP
|
$26.28
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900915485
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$19.71 |
| Rate for Payer: Adventist Health Commercial |
$5.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.92
|
| Rate for Payer: Cash Price |
$26.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.79
|
| Rate for Payer: Heritage Provider Network Senior |
$17.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.57
|
| Rate for Payer: Multiplan Commercial |
$19.71
|
|
|
HC SOM MYOMARKER3 NUCLEAR AG AB
|
Facility
|
OP
|
$26.28
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900915485
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$144.59 |
| Rate for Payer: Adventist Health Commercial |
$5.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.59
|
| Rate for Payer: Blue Shield of California Commercial |
$144.35
|
| Rate for Payer: Blue Shield of California EPN |
$115.78
|
| Rate for Payer: Cash Price |
$26.28
|
| Rate for Payer: Cash Price |
$26.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.27
|
| Rate for Payer: Heritage Provider Network Senior |
$16.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$19.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SOM NEOPTERIN
|
Facility
|
OP
|
$179.25
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900913946
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$134.44 |
| Rate for Payer: Adventist Health Commercial |
$35.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.92
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Cash Price |
$179.25
|
| Rate for Payer: Cash Price |
$179.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$116.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.96
|
| Rate for Payer: Heritage Provider Network Senior |
$110.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$85.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$134.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.27
|
| Rate for Payer: TriValley Medical Group Senior |
$17.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM NEOPTERIN
|
Facility
|
IP
|
$179.25
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900913946
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.44 |
| Max. Negotiated Rate |
$134.44 |
| Rate for Payer: Adventist Health Commercial |
$35.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$115.44
|
| Rate for Payer: Cash Price |
$179.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.35
|
| Rate for Payer: Heritage Provider Network Senior |
$121.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.81
|
| Rate for Payer: Multiplan Commercial |
$134.44
|
|
|
HC SOM NEUROCONDRIN IFA
|
Facility
|
IP
|
$45.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915453
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Adventist Health Commercial |
$9.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.03
|
| Rate for Payer: Cash Price |
$45.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.51
|
| Rate for Payer: Heritage Provider Network Senior |
$30.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.27
|
| Rate for Payer: Multiplan Commercial |
$33.80
|
|
|
HC SOM NEUROCONDRIN IFA
|
Facility
|
OP
|
$45.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915453
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$9.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.85
|
| 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 |
$114.48
|
| Rate for Payer: Blue Shield of California Commercial |
$97.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.80
|
| Rate for Payer: Cash Price |
$45.07
|
| Rate for Payer: Cash Price |
$45.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.30
|
| 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 |
$29.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.90
|
| Rate for Payer: Heritage Provider Network Senior |
$27.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$33.80
|
| 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 |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| 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 NEURON SPECIFIC ENOLASE CSF
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910766
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Adventist Health Commercial |
$7.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.83
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.05
|
| Rate for Payer: Heritage Provider Network Senior |
$25.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.25
|
| Rate for Payer: Multiplan Commercial |
$27.75
|
|
|
HC SOM NEURON SPECIFIC ENOLASE CSF
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910766
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$122.92 |
| Rate for Payer: Adventist Health Commercial |
$7.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.92
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.83
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.90
|
| Rate for Payer: Heritage Provider Network Senior |
$22.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$27.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.27
|
| Rate for Payer: TriValley Medical Group Senior |
$17.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM NEURON SPECIFIC ENOLASE SERUM
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.32
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.31
|
| Rate for Payer: Heritage Provider Network Senior |
$20.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
|
|
HC SOM NEURON SPECIFIC ENOLASE SERUM
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$122.92 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.92
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.57
|
| Rate for Payer: Heritage Provider Network Senior |
$18.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.27
|
| Rate for Payer: TriValley Medical Group Senior |
$17.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM NEUROTENSIN
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900910768
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.86
|
| 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 |
$270.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$175.50
|
| 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 |
$159.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.13
|
| Rate for Payer: Heritage Provider Network Senior |
$167.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$128.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| 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 NEUROTENSIN
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900910768
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$173.88
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.79
|
| Rate for Payer: Heritage Provider Network Senior |
$182.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
|
|
HC SOM NEUROTRANSMITTER METAB
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914688
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$170.74 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.74
|
| Rate for Payer: Blue Shield of California Commercial |
$145.32
|
| Rate for Payer: Blue Shield of California EPN |
$116.56
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$126.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.70
|
| Rate for Payer: Heritage Provider Network Senior |
$120.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$93.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.09
|
| Rate for Payer: TriValley Medical Group Senior |
$24.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM NEUROTRANSMITTER METAB
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914688
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.30 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$125.58
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.01
|
| Rate for Payer: Heritage Provider Network Senior |
$132.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.75
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
|
|
HC SOM N.GONORRHOEAE AMP DNA FEMALE U
|
Facility
|
OP
|
$26.27
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912876
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$5.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.23
|
| 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 |
$26.27
|
| Rate for Payer: Cash Price |
$26.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.08
|
| 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 |
$15.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.26
|
| Rate for Payer: Heritage Provider Network Senior |
$16.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$19.70
|
| 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 N.GONORRHOEAE AMP DNA FEMALE U
|
Facility
|
IP
|
$26.27
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912876
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$19.70 |
| Rate for Payer: Adventist Health Commercial |
$5.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.92
|
| Rate for Payer: Cash Price |
$26.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.78
|
| Rate for Payer: Heritage Provider Network Senior |
$17.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.57
|
| Rate for Payer: Multiplan Commercial |
$19.70
|
|
|
HC SOM NICOTINE
|
Facility
|
OP
|
$20.35
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
900910769
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$273.39 |
| Rate for Payer: Adventist Health Commercial |
$4.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$273.39
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.60
|
| Rate for Payer: Heritage Provider Network Senior |
$12.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.24
|
| Rate for Payer: Multiplan Commercial |
$15.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.30
|
| Rate for Payer: Vantage Medical Group Senior |
$17.30
|
|
|
HC SOM NICOTINE
|
Facility
|
IP
|
$20.35
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
900910769
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$15.26 |
| Rate for Payer: Adventist Health Commercial |
$4.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.11
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.78
|
| Rate for Payer: Heritage Provider Network Senior |
$13.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.09
|
| Rate for Payer: Multiplan Commercial |
$15.26
|
|
|
HC SOM NITROGEN STOOL
|
Facility
|
IP
|
$67.27
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900911229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.18 |
| Max. Negotiated Rate |
$50.45 |
| Rate for Payer: Adventist Health Commercial |
$13.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.32
|
| Rate for Payer: Cash Price |
$67.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.54
|
| Rate for Payer: Heritage Provider Network Senior |
$45.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.82
|
| Rate for Payer: Multiplan Commercial |
$50.45
|
|
|
HC SOM NITROGEN STOOL
|
Facility
|
OP
|
$67.27
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900911229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.18 |
| Max. Negotiated Rate |
$57.18 |
| Rate for Payer: Adventist Health Commercial |
$13.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.65
|
| Rate for Payer: Blue Shield of California Commercial |
$41.03
|
| Rate for Payer: Blue Shield of California EPN |
$32.83
|
| Rate for Payer: Cash Price |
$67.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$57.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$57.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.64
|
| Rate for Payer: Heritage Provider Network Senior |
$41.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$32.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.09
|
| Rate for Payer: Multiplan Commercial |
$50.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$33.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$33.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57.18
|
| Rate for Payer: Vantage Medical Group Senior |
$57.18
|
|
|
HC SOM NMDCS 86255
|
Facility
|
IP
|
$344.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914769
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.32 |
| Max. Negotiated Rate |
$258.25 |
| Rate for Payer: Adventist Health Commercial |
$68.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$221.75
|
| Rate for Payer: Cash Price |
$344.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$233.11
|
| Rate for Payer: Heritage Provider Network Senior |
$233.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.08
|
| Rate for Payer: Multiplan Commercial |
$258.25
|
|
|
HC SOM NMDCS 86255
|
Facility
|
OP
|
$344.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914769
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$258.25 |
| Rate for Payer: Adventist Health Commercial |
$68.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$212.80
|
| 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 |
$114.48
|
| Rate for Payer: Blue Shield of California Commercial |
$97.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.80
|
| Rate for Payer: Cash Price |
$344.33
|
| Rate for Payer: Cash Price |
$344.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$223.81
|
| 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 |
$203.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.14
|
| Rate for Payer: Heritage Provider Network Senior |
$213.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$164.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$258.25
|
| 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 |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| 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 NMHIN 83789
|
Facility
|
OP
|
$162.45
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914806
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$170.74 |
| Rate for Payer: Adventist Health Commercial |
$32.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$100.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.74
|
| Rate for Payer: Blue Shield of California Commercial |
$145.32
|
| Rate for Payer: Blue Shield of California EPN |
$116.56
|
| Rate for Payer: Cash Price |
$162.45
|
| Rate for Payer: Cash Price |
$162.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$105.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.56
|
| Rate for Payer: Heritage Provider Network Senior |
$100.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$77.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.31
|
| Rate for Payer: Multiplan Commercial |
$121.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.11
|
| Rate for Payer: TriValley Medical Group Senior |
$24.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Vantage Medical Group Senior |
$24.11
|
|
