|
HC SOM OXCARBAZEPINE LEVEL
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
900912537
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.88
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC SOM PANCREATIC ELASTASE/STOOL
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 82653
|
| Hospital Charge Code |
900912993
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$132.31 |
| Rate for Payer: Adventist Health Commercial |
$16.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.37
|
| Rate for Payer: Blue Shield of California Commercial |
$132.31
|
| Rate for Payer: Blue Shield of California EPN |
$106.12
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$52.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.52
|
| Rate for Payer: Heritage Provider Network Senior |
$49.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$38.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30.78
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.97
|
| Rate for Payer: TriValley Medical Group Senior |
$22.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.27
|
| Rate for Payer: Vantage Medical Group Senior |
$22.97
|
|
|
HC SOM PANCREATIC ELASTASE/STOOL
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 82653
|
| Hospital Charge Code |
900912993
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Adventist Health Commercial |
$16.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$51.52
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.16
|
| Rate for Payer: Heritage Provider Network Senior |
$54.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
|
|
HC SOM PANCREATIC POLYPEPTIDE
|
Facility
|
OP
|
$96.30
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911326
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.43 |
| Max. Negotiated Rate |
$128.29 |
| Rate for Payer: Adventist Health Commercial |
$19.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.51
|
| 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 |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$62.59
|
| 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 |
$56.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.61
|
| Rate for Payer: Heritage Provider Network Senior |
$59.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$45.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$72.22
|
| 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 PANCREATIC POLYPEPTIDE
|
Facility
|
IP
|
$96.30
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911326
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.43 |
| Max. Negotiated Rate |
$72.22 |
| Rate for Payer: Adventist Health Commercial |
$19.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$62.02
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.20
|
| Rate for Payer: Heritage Provider Network Senior |
$65.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.07
|
| Rate for Payer: Multiplan Commercial |
$72.22
|
|
|
HC SOM PARANEOPL EVAL ACHR AB
|
Facility
|
OP
|
$39.35
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914660
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$128.29 |
| Rate for Payer: Adventist Health Commercial |
$7.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.32
|
| 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 |
$39.35
|
| Rate for Payer: Cash Price |
$39.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.58
|
| 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 |
$23.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.36
|
| Rate for Payer: Heritage Provider Network Senior |
$24.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$29.51
|
| 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 PARANEOPL EVAL ACHR AB
|
Facility
|
IP
|
$39.35
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914660
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$29.51 |
| Rate for Payer: Adventist Health Commercial |
$7.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.34
|
| Rate for Payer: Cash Price |
$39.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.64
|
| Rate for Payer: Heritage Provider Network Senior |
$26.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Multiplan Commercial |
$29.51
|
|
|
HC SOM PARANEOPL EVAL AGNA1
|
Facility
|
IP
|
$61.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914652
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$45.83 |
| Rate for Payer: Adventist Health Commercial |
$12.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.35
|
| Rate for Payer: Cash Price |
$61.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.37
|
| Rate for Payer: Heritage Provider Network Senior |
$41.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.28
|
| Rate for Payer: Multiplan Commercial |
$45.83
|
|
|
HC SOM PARANEOPL EVAL AGNA1
|
Facility
|
OP
|
$61.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914652
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$12.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.77
|
| 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 |
$61.11
|
| Rate for Payer: Cash Price |
$61.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.72
|
| 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 |
$36.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.83
|
| Rate for Payer: Heritage Provider Network Senior |
$37.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$29.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$45.83
|
| 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 PARANEOPL EVAL AMPH AB
|
Facility
|
IP
|
$61.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914656
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$45.83 |
| Rate for Payer: Adventist Health Commercial |
$12.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.35
|
| Rate for Payer: Cash Price |
$61.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.37
|
| Rate for Payer: Heritage Provider Network Senior |
$41.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.28
|
| Rate for Payer: Multiplan Commercial |
$45.83
|
|
|
HC SOM PARANEOPL EVAL AMPH AB
|
Facility
|
OP
|
$61.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914656
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$12.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.77
|
| 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 |
$61.11
|
| Rate for Payer: Cash Price |
$61.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.72
|
| 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 |
$36.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.83
|
| Rate for Payer: Heritage Provider Network Senior |
$37.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$29.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$45.83
|
| 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 PARANEOPL EVAL ANNA1
|
Facility
|
IP
|
$61.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914649
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$45.83 |
| Rate for Payer: Adventist Health Commercial |
$12.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.35
|
| Rate for Payer: Cash Price |
$61.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.37
|
| Rate for Payer: Heritage Provider Network Senior |
$41.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.28
|
| Rate for Payer: Multiplan Commercial |
$45.83
|
|
|
HC SOM PARANEOPL EVAL ANNA1
|
Facility
|
OP
|
$61.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914649
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Cigna of CA HMO/PPO |
$39.72
|
| Rate for Payer: Adventist Health Commercial |
$12.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.77
|
| 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 |
$61.11
|
| Rate for Payer: Cash Price |
$61.11
|
| 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 |
$36.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.83
|
| Rate for Payer: Heritage Provider Network Senior |
$37.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$29.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$45.83
|
| 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 PARANEOPL EVAL ANNA2
|
Facility
|
OP
|
$61.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914650
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$12.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.77
|
| 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 |
$61.11
|
| Rate for Payer: Cash Price |
$61.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.72
|
| 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 |
$36.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.83
|
| Rate for Payer: Heritage Provider Network Senior |
$37.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$29.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$45.83
|
| 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 PARANEOPL EVAL ANNA2
|
Facility
|
IP
|
$61.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914650
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$45.83 |
| Rate for Payer: Adventist Health Commercial |
$12.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.35
|
| Rate for Payer: Cash Price |
$61.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.37
|
| Rate for Payer: Heritage Provider Network Senior |
$41.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.28
|
| Rate for Payer: Multiplan Commercial |
$45.83
|
|
|
HC SOM PARANEOPL EVAL ANNA3
|
Facility
|
OP
|
$61.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$12.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.77
|
| 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 |
$61.11
|
| Rate for Payer: Cash Price |
$61.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.72
|
| 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 |
$36.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.83
|
| Rate for Payer: Heritage Provider Network Senior |
$37.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$29.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$45.83
|
| 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 PARANEOPL EVAL ANNA3
|
Facility
|
IP
|
$61.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$45.83 |
| Rate for Payer: Adventist Health Commercial |
$12.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.35
|
| Rate for Payer: Cash Price |
$61.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.37
|
| Rate for Payer: Heritage Provider Network Senior |
$41.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.28
|
| Rate for Payer: Multiplan Commercial |
$45.83
|
|
|
HC SOM PARANEOPL EVAL CRMP5 AB
|
Facility
|
OP
|
$61.12
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914657
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$12.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.77
|
| 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 |
$61.12
|
| Rate for Payer: Cash Price |
$61.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.73
|
| 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 |
$36.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.83
|
| Rate for Payer: Heritage Provider Network Senior |
$37.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$29.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$45.84
|
| 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 PARANEOPL EVAL CRMP5 AB
|
Facility
|
IP
|
$61.12
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914657
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$45.84 |
| Rate for Payer: Adventist Health Commercial |
$12.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.36
|
| Rate for Payer: Cash Price |
$61.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.38
|
| Rate for Payer: Heritage Provider Network Senior |
$41.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.28
|
| Rate for Payer: Multiplan Commercial |
$45.84
|
|
|
HC SOM PARANEOPL EVAL NEU AB
|
Facility
|
OP
|
$46.36
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914661
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$128.29 |
| Rate for Payer: Adventist Health Commercial |
$9.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.65
|
| 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 |
$46.36
|
| Rate for Payer: Cash Price |
$46.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$30.13
|
| 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 |
$27.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.70
|
| Rate for Payer: Heritage Provider Network Senior |
$28.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$22.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$34.77
|
| 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 PARANEOPL EVAL NEU AB
|
Facility
|
IP
|
$46.36
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914661
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$34.77 |
| Rate for Payer: Adventist Health Commercial |
$9.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.86
|
| Rate for Payer: Cash Price |
$46.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.39
|
| Rate for Payer: Heritage Provider Network Senior |
$31.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$34.77
|
|
|
HC SOM PARANEOPL EVAL NTYPE AB
|
Facility
|
IP
|
$32.31
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914659
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$24.23 |
| Rate for Payer: Adventist Health Commercial |
$6.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.81
|
| Rate for Payer: Cash Price |
$32.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.87
|
| Rate for Payer: Heritage Provider Network Senior |
$21.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.08
|
| Rate for Payer: Multiplan Commercial |
$24.23
|
|
|
HC SOM PARANEOPL EVAL NTYPE AB
|
Facility
|
OP
|
$32.31
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914659
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$128.29 |
| Rate for Payer: Adventist Health Commercial |
$6.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.97
|
| 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 |
$32.31
|
| Rate for Payer: Cash Price |
$32.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21.00
|
| 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 |
$19.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.00
|
| Rate for Payer: Heritage Provider Network Senior |
$20.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$15.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$24.23
|
| 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 PARANEOPL EVAL PCA1
|
Facility
|
OP
|
$61.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914653
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$12.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.77
|
| 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 |
$61.11
|
| Rate for Payer: Cash Price |
$61.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.72
|
| 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 |
$36.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.83
|
| Rate for Payer: Heritage Provider Network Senior |
$37.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$29.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$45.83
|
| 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 PARANEOPL EVAL PCA1
|
Facility
|
IP
|
$61.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914653
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$45.83 |
| Rate for Payer: Adventist Health Commercial |
$12.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.35
|
| Rate for Payer: Cash Price |
$61.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.37
|
| Rate for Payer: Heritage Provider Network Senior |
$41.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.28
|
| Rate for Payer: Multiplan Commercial |
$45.83
|
|
