|
HC SOM FCTRC 87140
|
Facility
|
IP
|
$19.81
|
|
|
Service Code
|
CPT 87140
|
| Hospital Charge Code |
900914726
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$14.86 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.41
|
| Rate for Payer: Heritage Provider Network Senior |
$13.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$14.86
|
|
|
HC SOM FDSAC 82657
|
Facility
|
OP
|
$168.92
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900914885
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.17 |
| Max. Negotiated Rate |
$164.17 |
| Rate for Payer: Adventist Health Commercial |
$33.78
|
| Rate for Payer: Aetna of CA Gatekeeper |
$90.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.17
|
| 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 |
$168.92
|
| Rate for Payer: Cash Price |
$168.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$109.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.39
|
| Rate for Payer: Dignity Health Senior |
$22.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$104.56
|
| Rate for Payer: Heritage Provider Network Senior |
$104.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$80.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.93
|
| Rate for Payer: Multiplan Commercial |
$126.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.17
|
| Rate for Payer: TriValley Medical Group Senior |
$22.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22.17
|
|
|
HC SOM FDSAC 82657
|
Facility
|
IP
|
$168.92
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900914885
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.57 |
| Max. Negotiated Rate |
$126.69 |
| Rate for Payer: Adventist Health Commercial |
$33.78
|
| Rate for Payer: Cash Price |
$168.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.36
|
| Rate for Payer: Heritage Provider Network Senior |
$114.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.23
|
| Rate for Payer: Multiplan Commercial |
$126.69
|
|
|
HC SOM FDXM 82542
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914744
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.28 |
| Max. Negotiated Rate |
$164.17 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$69.39
|
| 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 |
$164.17
|
| 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 |
$101.00
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$65.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Senior |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$62.52
|
| Rate for Payer: Heritage Provider Network Senior |
$62.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$48.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.35
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
| 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 FDXM 82542
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914744
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.28 |
| Max. Negotiated Rate |
$75.75 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.38
|
| Rate for Payer: Heritage Provider Network Senior |
$68.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.25
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
|
|
HC SOM FEAGR 86682
|
Facility
|
IP
|
$52.57
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900914927
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$39.43 |
| Rate for Payer: Adventist Health Commercial |
$10.51
|
| Rate for Payer: Cash Price |
$52.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.59
|
| Rate for Payer: Heritage Provider Network Senior |
$35.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.14
|
| Rate for Payer: Multiplan Commercial |
$39.43
|
|
|
HC SOM FEAGR 86682
|
Facility
|
OP
|
$52.57
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900914927
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$119.85 |
| Rate for Payer: Adventist Health Commercial |
$10.51
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.85
|
| Rate for Payer: Blue Shield of California Commercial |
$104.66
|
| Rate for Payer: Blue Shield of California EPN |
$83.95
|
| Rate for Payer: Cash Price |
$52.57
|
| Rate for Payer: Cash Price |
$52.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: Dignity Health Senior |
$13.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.17
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.54
|
| Rate for Payer: Heritage Provider Network Senior |
$32.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.39
|
| Rate for Payer: Multiplan Commercial |
$39.43
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.01
|
| Rate for Payer: TriValley Medical Group Senior |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13.01
|
|
|
HC SOM FELBAMATE S
|
Facility
|
IP
|
$21.17
|
|
|
Service Code
|
CPT 80167
|
| Hospital Charge Code |
900914198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$15.88 |
| Rate for Payer: Adventist Health Commercial |
$4.23
|
| Rate for Payer: Cash Price |
$21.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.33
|
| Rate for Payer: Heritage Provider Network Senior |
$14.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.29
|
| Rate for Payer: Multiplan Commercial |
$15.88
|
|
|
HC SOM FELBAMATE S
|
Facility
|
OP
|
$21.17
|
|
|
Service Code
|
CPT 80167
|
| Hospital Charge Code |
900914198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$107.37 |
| Rate for Payer: Adventist Health Commercial |
$4.23
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.54
|
| 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 |
$60.23
|
| Rate for Payer: Blue Shield of California Commercial |
$107.37
|
| Rate for Payer: Blue Shield of California EPN |
$86.12
|
| Rate for Payer: Cash Price |
$21.17
|
| Rate for Payer: Cash Price |
$21.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.10
|
| Rate for Payer: Heritage Provider Network Senior |
$13.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.49
|
| Rate for Payer: Multiplan Commercial |
$15.88
|
| 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 FENTU
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
900915270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| 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 Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
|
|
HC SOM FENTU
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
900915270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$170.38 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.38
|
| 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 |
$38.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.25
|
| Rate for Payer: Dignity Health Senior |
$38.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.86
|
| Rate for Payer: Heritage Provider Network Senior |
$27.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.25
|
| Rate for Payer: Vantage Medical Group Senior |
$38.25
|
|
|
HC SOM FESC 83789
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$164.17 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$72.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$93.43
|
| 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 |
$164.17
|
| 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 |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$88.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.52
|
| Rate for Payer: Dignity Health Senior |
$24.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.18
|
| Rate for Payer: Heritage Provider Network Senior |
$84.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$64.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.38
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| 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
|
|
|
HC SOM FESC 83789
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.62 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.07
|
| Rate for Payer: Heritage Provider Network Senior |
$92.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
|
|
HC SOM FFTP 86780
|
Facility
|
OP
|
$28.60
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
900914768
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$158.39 |
| Rate for Payer: Adventist Health Commercial |
$5.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.39
|
| Rate for Payer: Blue Shield of California Commercial |
$109.27
|
| Rate for Payer: Blue Shield of California EPN |
$87.64
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: Dignity Health Senior |
$13.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.70
|
| Rate for Payer: Heritage Provider Network Senior |
$17.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.68
|
| Rate for Payer: Multiplan Commercial |
$21.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.24
|
| Rate for Payer: TriValley Medical Group Senior |
$13.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC SOM FFTP 86780
|
Facility
|
IP
|
$28.60
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
900914768
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Adventist Health Commercial |
$5.72
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.36
|
| Rate for Payer: Heritage Provider Network Senior |
$19.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$21.45
|
|
|
HC SOM FHBG 87912
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 87912
|
| Hospital Charge Code |
900914883
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$67.88 |
| Max. Negotiated Rate |
$281.25 |
| Rate for Payer: Adventist Health Commercial |
$75.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$253.88
|
| Rate for Payer: Heritage Provider Network Senior |
$253.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
|
|
HC SOM FHBG 87912
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
CPT 87912
|
| Hospital Charge Code |
900914883
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.88 |
| Max. Negotiated Rate |
$2,038.35 |
| Rate for Payer: Adventist Health Commercial |
$75.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$200.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$257.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$386.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$257.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,860.55
|
| Rate for Payer: Blue Shield of California Commercial |
$2,038.35
|
| Rate for Payer: Blue Shield of California EPN |
$1,634.93
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$243.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$386.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.19
|
| Rate for Payer: Dignity Health Senior |
$257.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$257.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$232.12
|
| Rate for Payer: Heritage Provider Network Senior |
$232.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$257.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$178.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$296.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$324.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$324.39
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$257.45
|
| Rate for Payer: TriValley Medical Group Senior |
$257.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$278.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$278.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$386.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.19
|
| Rate for Payer: Vantage Medical Group Senior |
$257.45
|
|
|
HC SOM FHSII 86696
|
Facility
|
IP
|
$37.37
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900914757
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$28.03 |
| Rate for Payer: Adventist Health Commercial |
$7.47
|
| Rate for Payer: Cash Price |
$37.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.30
|
| Rate for Payer: Heritage Provider Network Senior |
$25.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.34
|
| Rate for Payer: Multiplan Commercial |
$28.03
|
|
|
HC SOM FHSII 86696
|
Facility
|
OP
|
$37.37
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900914757
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$176.58 |
| Rate for Payer: Adventist Health Commercial |
$7.47
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.58
|
| Rate for Payer: Blue Shield of California Commercial |
$155.81
|
| Rate for Payer: Blue Shield of California EPN |
$124.97
|
| Rate for Payer: Cash Price |
$37.37
|
| Rate for Payer: Cash Price |
$37.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.29
|
| Rate for Payer: Dignity Health Senior |
$19.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.29
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.13
|
| Rate for Payer: Heritage Provider Network Senior |
$23.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.38
|
| Rate for Payer: Multiplan Commercial |
$28.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.35
|
| Rate for Payer: TriValley Medical Group Senior |
$19.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC SOM FHTL 87798A
|
Facility
|
OP
|
$112.81
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914745
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.42 |
| Max. Negotiated Rate |
$310.02 |
| Rate for Payer: Adventist Health Commercial |
$22.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$60.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.50
|
| 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 |
$310.02
|
| 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 |
$112.81
|
| Rate for Payer: Cash Price |
$112.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$73.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.33
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.83
|
| Rate for Payer: Heritage Provider Network Senior |
$69.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$53.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$84.61
|
| 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 FHTL 87798A
|
Facility
|
IP
|
$112.81
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914745
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.42 |
| Max. Negotiated Rate |
$84.61 |
| Rate for Payer: Adventist Health Commercial |
$22.56
|
| Rate for Payer: Cash Price |
$112.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.37
|
| Rate for Payer: Heritage Provider Network Senior |
$76.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.20
|
| Rate for Payer: Multiplan Commercial |
$84.61
|
|
|
HC SOM FHTL 87798B
|
Facility
|
IP
|
$112.82
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914746
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.42 |
| Max. Negotiated Rate |
$84.61 |
| Rate for Payer: Adventist Health Commercial |
$22.56
|
| Rate for Payer: Cash Price |
$112.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.38
|
| Rate for Payer: Heritage Provider Network Senior |
$76.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.20
|
| Rate for Payer: Multiplan Commercial |
$84.61
|
|
|
HC SOM FHTL 87798B
|
Facility
|
OP
|
$112.82
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914746
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.42 |
| Max. Negotiated Rate |
$310.02 |
| Rate for Payer: Adventist Health Commercial |
$22.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$60.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.51
|
| 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 |
$310.02
|
| 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 |
$112.82
|
| Rate for Payer: Cash Price |
$112.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$73.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.33
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.84
|
| Rate for Payer: Heritage Provider Network Senior |
$69.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$53.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$84.61
|
| 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 FIAIA 80299
|
Facility
|
IP
|
$238.75
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900915257
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.21 |
| Max. Negotiated Rate |
$179.06 |
| Rate for Payer: Adventist Health Commercial |
$47.75
|
| Rate for Payer: Cash Price |
$238.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$161.63
|
| Rate for Payer: Heritage Provider Network Senior |
$161.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.69
|
| Rate for Payer: Multiplan Commercial |
$179.06
|
|
|
HC SOM FIAIA 80299
|
Facility
|
OP
|
$238.75
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900915257
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$179.06 |
| Rate for Payer: Adventist Health Commercial |
$47.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$127.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$164.02
|
| 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 |
$132.94
|
| 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 |
$238.75
|
| Rate for Payer: Cash Price |
$238.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$155.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.79
|
| Rate for Payer: Heritage Provider Network Senior |
$147.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$113.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.49
|
| Rate for Payer: Multiplan Commercial |
$179.06
|
| 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
|
|
