|
HC SOM PARIETAL CELL AB
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911267
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$213.58 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.58
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.47
|
| Rate for Payer: Heritage Provider Network Senior |
$15.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM PARVOVIRUS B19 AB IGG
|
Facility
|
IP
|
$11.23
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
900912538
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.60
|
| Rate for Payer: Heritage Provider Network Senior |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
|
|
HC SOM PARVOVIRUS B19 AB IGG
|
Facility
|
OP
|
$11.23
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
900912538
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$137.43 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.43
|
| Rate for Payer: Blue Shield of California Commercial |
$120.96
|
| Rate for Payer: Blue Shield of California EPN |
$97.02
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.53
|
| Rate for Payer: Dignity Health Senior |
$15.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.95
|
| Rate for Payer: Heritage Provider Network Senior |
$6.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.94
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.03
|
| Rate for Payer: TriValley Medical Group Senior |
$15.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.53
|
| Rate for Payer: Vantage Medical Group Senior |
$15.03
|
|
|
HC SOM PARVOVIRUS B19 AB IGM
|
Facility
|
OP
|
$11.23
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
900912694
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$137.43 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.43
|
| Rate for Payer: Blue Shield of California Commercial |
$120.96
|
| Rate for Payer: Blue Shield of California EPN |
$97.02
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.53
|
| Rate for Payer: Dignity Health Senior |
$15.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.95
|
| Rate for Payer: Heritage Provider Network Senior |
$6.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.94
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.03
|
| Rate for Payer: TriValley Medical Group Senior |
$15.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.53
|
| Rate for Payer: Vantage Medical Group Senior |
$15.03
|
|
|
HC SOM PARVOVIRUS B19 AB IGM
|
Facility
|
IP
|
$11.23
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
900912694
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.60
|
| Rate for Payer: Heritage Provider Network Senior |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
|
|
HC SOM PARVOVIRUS B19 PCR BF
|
Facility
|
IP
|
$41.48
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912782
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$31.11 |
| Rate for Payer: Adventist Health Commercial |
$8.30
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.08
|
| Rate for Payer: Heritage Provider Network Senior |
$28.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.37
|
| Rate for Payer: Multiplan Commercial |
$31.11
|
|
|
HC SOM PARVOVIRUS B19 PCR BF
|
Facility
|
OP
|
$41.48
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912782
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$310.02 |
| Rate for Payer: Adventist Health Commercial |
$8.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.50
|
| 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 |
$41.48
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.96
|
| 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 |
$26.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.68
|
| Rate for Payer: Heritage Provider Network Senior |
$25.68
|
| 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 |
$19.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.37
|
| 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 |
$31.11
|
| 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 PARVOVIRUS PCR
|
Facility
|
IP
|
$41.48
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911590
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$31.11 |
| Rate for Payer: Adventist Health Commercial |
$8.30
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.08
|
| Rate for Payer: Heritage Provider Network Senior |
$28.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.37
|
| Rate for Payer: Multiplan Commercial |
$31.11
|
|
|
HC SOM PARVOVIRUS PCR
|
Facility
|
OP
|
$41.48
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911590
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$310.02 |
| Rate for Payer: Adventist Health Commercial |
$8.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.50
|
| 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 |
$41.48
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.96
|
| 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 |
$26.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.68
|
| Rate for Payer: Heritage Provider Network Senior |
$25.68
|
| 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 |
$19.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.37
|
| 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 |
$31.11
|
| 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 PASSION FRUIT IGE
|
Facility
|
IP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914703
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.06
|
| Rate for Payer: Heritage Provider Network Senior |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
|
|
HC SOM PASSION FRUIT IGE
|
Facility
|
OP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914703
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$144.32 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.32
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.86
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.62
|
| Rate for Payer: Heritage Provider Network Senior |
$4.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SOM PCA3 U
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900913905
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$90.50 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$338.50
|
| Rate for Payer: Heritage Provider Network Senior |
$338.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.00
|
| Rate for Payer: Multiplan Commercial |
$375.00
|
|
|
HC SOM PCA3 U
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900913905
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$90.50 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$267.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$343.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$425.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.00
|
| Rate for Payer: Blue Shield of California Commercial |
$305.00
|
| Rate for Payer: Blue Shield of California EPN |
$244.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$325.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$425.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.00
|
| Rate for Payer: Dignity Health Senior |
$425.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$309.50
|
| Rate for Payer: Heritage Provider Network Senior |
$309.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$238.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$350.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$350.00
|
| Rate for Payer: Multiplan Commercial |
$375.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$250.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$250.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$425.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.00
|
| Rate for Payer: Vantage Medical Group Senior |
$425.00
|
|
|
HC SOM PCDEC AMPA-R AB CBA
|
Facility
|
OP
|
$50.19
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915486
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.08 |
| Max. Negotiated Rate |
$110.08 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.48
|
| 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 |
$110.08
|
| 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 |
$50.19
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.07
|
| Rate for Payer: Heritage Provider Network Senior |
$31.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$37.64
|
| 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 PCDEC AMPA-R AB CBA
|
Facility
|
IP
|
$50.19
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915486
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.08 |
| Max. Negotiated Rate |
$37.64 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.98
|
| Rate for Payer: Heritage Provider Network Senior |
$33.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.55
|
| Rate for Payer: Multiplan Commercial |
$37.64
|
|
|
HC SOM PCDEC ANNA1
|
Facility
|
IP
|
$50.20
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915442
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$37.65 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Cash Price |
$50.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.99
|
| Rate for Payer: Heritage Provider Network Senior |
$33.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.55
|
| Rate for Payer: Multiplan Commercial |
$37.65
|
|
|
HC SOM PCDEC ANNA1
|
Facility
|
OP
|
$50.20
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915442
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$110.08 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.49
|
| 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 |
$110.08
|
| 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 |
$50.20
|
| Rate for Payer: Cash Price |
$50.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.07
|
| Rate for Payer: Heritage Provider Network Senior |
$31.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$37.65
|
| 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 PCDEC CASPR2-IGG
|
Facility
|
IP
|
$50.20
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915449
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$37.65 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Cash Price |
$50.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.99
|
| Rate for Payer: Heritage Provider Network Senior |
$33.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.55
|
| Rate for Payer: Multiplan Commercial |
$37.65
|
|
|
HC SOM PCDEC CASPR2-IGG
|
Facility
|
OP
|
$50.20
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915449
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$110.08 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.49
|
| 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 |
$110.08
|
| 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 |
$50.20
|
| Rate for Payer: Cash Price |
$50.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.07
|
| Rate for Payer: Heritage Provider Network Senior |
$31.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$37.65
|
| 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 PCDEC DPPX AB IFA
|
Facility
|
OP
|
$50.20
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$110.08 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.49
|
| 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 |
$110.08
|
| 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 |
$50.20
|
| Rate for Payer: Cash Price |
$50.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.07
|
| Rate for Payer: Heritage Provider Network Senior |
$31.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$37.65
|
| 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 PCDEC DPPX AB IFA
|
Facility
|
IP
|
$50.20
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$37.65 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Cash Price |
$50.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.99
|
| Rate for Payer: Heritage Provider Network Senior |
$33.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.55
|
| Rate for Payer: Multiplan Commercial |
$37.65
|
|
|
HC SOM PCDEC GABA-B-R AB CBA
|
Facility
|
IP
|
$50.20
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915446
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$37.65 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Cash Price |
$50.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.99
|
| Rate for Payer: Heritage Provider Network Senior |
$33.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.55
|
| Rate for Payer: Multiplan Commercial |
$37.65
|
|
|
HC SOM PCDEC GABA-B-R AB CBA
|
Facility
|
OP
|
$50.20
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915446
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$110.08 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.49
|
| 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 |
$110.08
|
| 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 |
$50.20
|
| Rate for Payer: Cash Price |
$50.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.07
|
| Rate for Payer: Heritage Provider Network Senior |
$31.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$37.65
|
| 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 PCDEC GAD65 AB
|
Facility
|
OP
|
$98.18
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.77 |
| Max. Negotiated Rate |
$140.38 |
| Rate for Payer: Adventist Health Commercial |
$19.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.38
|
| Rate for Payer: Blue Shield of California Commercial |
$133.75
|
| Rate for Payer: Blue Shield of California EPN |
$107.28
|
| Rate for Payer: Cash Price |
$98.18
|
| Rate for Payer: Cash Price |
$98.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Senior |
$23.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$23.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.77
|
| Rate for Payer: Heritage Provider Network Senior |
$60.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.70
|
| Rate for Payer: Multiplan Commercial |
$73.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.57
|
| Rate for Payer: TriValley Medical Group Senior |
$23.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM PCDEC GAD65 AB
|
Facility
|
IP
|
$98.18
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.77 |
| Max. Negotiated Rate |
$73.64 |
| Rate for Payer: Adventist Health Commercial |
$19.64
|
| Rate for Payer: Cash Price |
$98.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.47
|
| Rate for Payer: Heritage Provider Network Senior |
$66.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.55
|
| Rate for Payer: Multiplan Commercial |
$73.64
|
|
