|
HC SOM OLANZAPINE
|
Facility
|
OP
|
$93.80
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910772
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.98 |
| Max. Negotiated Rate |
$138.26 |
| Rate for Payer: Adventist Health Commercial |
$18.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$57.97
|
| 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 |
$93.80
|
| Rate for Payer: Cash Price |
$93.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.97
|
| 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 |
$55.34
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.06
|
| Rate for Payer: Heritage Provider Network Senior |
$58.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$70.35
|
| 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 OLANZAPINE
|
Facility
|
IP
|
$93.80
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910772
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.98 |
| Max. Negotiated Rate |
$70.35 |
| Rate for Payer: Adventist Health Commercial |
$18.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.41
|
| Rate for Payer: Cash Price |
$93.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.50
|
| Rate for Payer: Heritage Provider Network Senior |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.45
|
| Rate for Payer: Multiplan Commercial |
$70.35
|
|
|
HC SOM OLIGOCLONAL BANDS CSF
|
Facility
|
OP
|
$24.97
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
900911235
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$190.87 |
| Rate for Payer: Adventist Health Commercial |
$4.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$190.87
|
| Rate for Payer: Blue Shield of California Commercial |
$161.80
|
| Rate for Payer: Blue Shield of California EPN |
$129.78
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.73
|
| Rate for Payer: EPIC Health Plan Medicare |
$27.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.46
|
| Rate for Payer: Heritage Provider Network Senior |
$15.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36.70
|
| Rate for Payer: Multiplan Commercial |
$18.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.39
|
| Rate for Payer: TriValley Medical Group Senior |
$27.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.13
|
| Rate for Payer: Vantage Medical Group Senior |
$27.39
|
|
|
HC SOM OLIGOCLONAL BANDS CSF
|
Facility
|
IP
|
$24.97
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
900911235
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Adventist Health Commercial |
$4.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.08
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.90
|
| Rate for Payer: Heritage Provider Network Senior |
$16.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$18.73
|
|
|
HC SOM OLIGOCLONAL BANDS SERUM
|
Facility
|
OP
|
$22.86
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
900912657
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$190.87 |
| Rate for Payer: Adventist Health Commercial |
$4.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$190.87
|
| Rate for Payer: Blue Shield of California Commercial |
$161.80
|
| Rate for Payer: Blue Shield of California EPN |
$129.78
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.49
|
| Rate for Payer: EPIC Health Plan Medicare |
$27.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.15
|
| Rate for Payer: Heritage Provider Network Senior |
$14.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36.70
|
| Rate for Payer: Multiplan Commercial |
$17.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.39
|
| Rate for Payer: TriValley Medical Group Senior |
$27.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.13
|
| Rate for Payer: Vantage Medical Group Senior |
$27.39
|
|
|
HC SOM OLIGOCLONAL BANDS SERUM
|
Facility
|
IP
|
$22.86
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
900912657
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$17.14 |
| Rate for Payer: Adventist Health Commercial |
$4.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.72
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.48
|
| Rate for Payer: Heritage Provider Network Senior |
$15.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.71
|
| Rate for Payer: Multiplan Commercial |
$17.14
|
|
|
HC SOM OPATU DRUG SCRN OXYCDN
|
Facility
|
OP
|
$13.93
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
900915279
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$177.19 |
| Rate for Payer: Adventist Health Commercial |
$2.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.19
|
| Rate for Payer: Cash Price |
$13.93
|
| Rate for Payer: Cash Price |
$13.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.62
|
| Rate for Payer: Heritage Provider Network Senior |
$8.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.75
|
| Rate for Payer: Multiplan Commercial |
$10.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.84
|
| Rate for Payer: Vantage Medical Group Senior |
$11.84
|
|
|
HC SOM OPATU DRUG SCRN OXYCDN
|
Facility
|
IP
|
$13.93
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
900915279
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Adventist Health Commercial |
$2.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.97
|
| Rate for Payer: Cash Price |
$13.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.43
|
| Rate for Payer: Heritage Provider Network Senior |
$9.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.48
|
| Rate for Payer: Multiplan Commercial |
$10.45
|
|
|
HC SOM ORGANIC ACID SCREEN
|
Facility
|
OP
|
$54.12
|
|
|
Service Code
|
CPT 83919
|
| Hospital Charge Code |
900911179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$155.59 |
| Rate for Payer: Adventist Health Commercial |
$10.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.59
|
| 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 |
$54.12
|
| Rate for Payer: Cash Price |
$54.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.50
|
| Rate for Payer: Heritage Provider Network Senior |
$33.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$25.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.04
|
| Rate for Payer: Multiplan Commercial |
$40.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.45
|
| Rate for Payer: TriValley Medical Group Senior |
$16.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.09
|
| Rate for Payer: Vantage Medical Group Senior |
$16.45
|
|
|
HC SOM ORGANIC ACID SCREEN
|
Facility
|
IP
|
$54.12
|
|
|
Service Code
|
CPT 83919
|
| Hospital Charge Code |
900911179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$40.59 |
| Rate for Payer: Adventist Health Commercial |
$10.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.85
|
| Rate for Payer: Cash Price |
$54.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.64
|
| Rate for Payer: Heritage Provider Network Senior |
$36.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.53
|
| Rate for Payer: Multiplan Commercial |
$40.59
|
|
|
HC SOM ORG REFER FOR ID, AEROBIC
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912887
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.98
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.46
|
| Rate for Payer: Heritage Provider Network Senior |
$30.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
|
|
HC SOM ORG REFER FOR ID, AEROBIC
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912887
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$76.64 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.64
|
| Rate for Payer: Blue Shield of California Commercial |
$65.03
|
| Rate for Payer: Blue Shield of California EPN |
$52.16
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.86
|
| Rate for Payer: Heritage Provider Network Senior |
$27.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC SOM ORG REFER FOR ID, ANAEROB
|
Facility
|
IP
|
$23.74
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
900912889
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$17.80 |
| Rate for Payer: Adventist Health Commercial |
$4.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.29
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.07
|
| Rate for Payer: Heritage Provider Network Senior |
$16.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.93
|
| Rate for Payer: Multiplan Commercial |
$17.80
|
|
|
HC SOM ORG REFER FOR ID, ANAEROB
|
Facility
|
OP
|
$23.74
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
900912889
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Adventist Health Commercial |
$4.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.60
|
| Rate for Payer: Blue Shield of California Commercial |
$65.03
|
| Rate for Payer: Blue Shield of California EPN |
$52.16
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.01
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.70
|
| Rate for Payer: Heritage Provider Network Senior |
$14.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$17.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC SOM OROT 83921
|
Facility
|
OP
|
$23.58
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900914729
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$156.23 |
| Rate for Payer: Adventist Health Commercial |
$4.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.57
|
| 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 |
$23.58
|
| Rate for Payer: Cash Price |
$23.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.33
|
| 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 |
$13.91
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.60
|
| Rate for Payer: Heritage Provider Network Senior |
$14.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.42
|
| Rate for Payer: Multiplan Commercial |
$17.68
|
| 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 OROT 83921
|
Facility
|
IP
|
$23.58
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900914729
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$17.68 |
| Rate for Payer: Adventist Health Commercial |
$4.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.19
|
| Rate for Payer: Cash Price |
$23.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.96
|
| Rate for Payer: Heritage Provider Network Senior |
$15.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.89
|
| Rate for Payer: Multiplan Commercial |
$17.68
|
|
|
HC SOM ORTHOPOXVIRUS DNA - LABCORP
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
900915424
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$76.97 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.52
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.66
|
| Rate for Payer: Heritage Provider Network Senior |
$47.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$36.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.76
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.31
|
| Rate for Payer: TriValley Medical Group Senior |
$51.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HC SOM ORTHOPOXVIRUS DNA - LABCORP
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
900915424
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$57.75 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.59
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.13
|
| Rate for Payer: Heritage Provider Network Senior |
$52.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
|
|
HC SOM OSTEOCALCIN
|
Facility
|
OP
|
$60.06
|
|
|
Service Code
|
CPT 83937
|
| Hospital Charge Code |
900911399
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.87 |
| Max. Negotiated Rate |
$111.16 |
| Rate for Payer: Adventist Health Commercial |
$12.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.16
|
| Rate for Payer: Blue Shield of California Commercial |
$101.84
|
| Rate for Payer: Blue Shield of California EPN |
$81.68
|
| Rate for Payer: Cash Price |
$60.06
|
| Rate for Payer: Cash Price |
$60.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.44
|
| Rate for Payer: EPIC Health Plan Medicare |
$29.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.18
|
| Rate for Payer: Heritage Provider Network Senior |
$37.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$45.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.85
|
| Rate for Payer: TriValley Medical Group Senior |
$29.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$32.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.84
|
| Rate for Payer: Vantage Medical Group Senior |
$29.85
|
|
|
HC SOM OSTEOCALCIN
|
Facility
|
IP
|
$60.06
|
|
|
Service Code
|
CPT 83937
|
| Hospital Charge Code |
900911399
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.87 |
| Max. Negotiated Rate |
$45.05 |
| Rate for Payer: Adventist Health Commercial |
$12.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.68
|
| Rate for Payer: Cash Price |
$60.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.66
|
| Rate for Payer: Heritage Provider Network Senior |
$40.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.02
|
| Rate for Payer: Multiplan Commercial |
$45.05
|
|
|
HC SOM OXALATE
|
Facility
|
IP
|
$21.64
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
900911124
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$16.23 |
| Rate for Payer: Adventist Health Commercial |
$4.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.94
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.65
|
| Rate for Payer: Heritage Provider Network Senior |
$14.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.41
|
| Rate for Payer: Multiplan Commercial |
$16.23
|
|
|
HC SOM OXALATE
|
Facility
|
OP
|
$21.64
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
900911124
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$122.22 |
| Rate for Payer: Adventist Health Commercial |
$4.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.22
|
| Rate for Payer: Blue Shield of California Commercial |
$103.62
|
| Rate for Payer: Blue Shield of California EPN |
$83.11
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.77
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.40
|
| Rate for Payer: Heritage Provider Network Senior |
$13.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.36
|
| Rate for Payer: Multiplan Commercial |
$16.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.45
|
| Rate for Payer: TriValley Medical Group Senior |
$14.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.89
|
| Rate for Payer: Vantage Medical Group Senior |
$14.45
|
|
|
HC SOM OXALATE PLASMA
|
Facility
|
OP
|
$73.16
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
900910579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$122.22 |
| Rate for Payer: Adventist Health Commercial |
$14.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.22
|
| Rate for Payer: Blue Shield of California Commercial |
$103.62
|
| Rate for Payer: Blue Shield of California EPN |
$83.11
|
| Rate for Payer: Cash Price |
$73.16
|
| Rate for Payer: Cash Price |
$73.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.29
|
| Rate for Payer: Heritage Provider Network Senior |
$45.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$34.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.36
|
| Rate for Payer: Multiplan Commercial |
$54.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.45
|
| Rate for Payer: TriValley Medical Group Senior |
$14.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.89
|
| Rate for Payer: Vantage Medical Group Senior |
$14.45
|
|
|
HC SOM OXALATE PLASMA
|
Facility
|
IP
|
$73.16
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
900910579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$54.87 |
| Rate for Payer: Adventist Health Commercial |
$14.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.12
|
| Rate for Payer: Cash Price |
$73.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.53
|
| Rate for Payer: Heritage Provider Network Senior |
$49.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.29
|
| Rate for Payer: Multiplan Commercial |
$54.87
|
|
|
HC SOM OXCARBAZEPINE LEVEL
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
900912537
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$104.20 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.68
|
| 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 |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.75
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.25
|
| Rate for Payer: TriValley Medical Group Senior |
$13.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
