|
HC SOM ENS IGLON5 CBA
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915473
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.05
|
| 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 |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.14
|
| 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 |
$22.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.08
|
| Rate for Payer: Heritage Provider Network Senior |
$21.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| 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 ENS IGLON5 CBA
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915473
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$25.55 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.93
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.06
|
| Rate for Payer: Heritage Provider Network Senior |
$23.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
|
|
HC SOM ENS IGLON5 IFA
|
Facility
|
OP
|
$52.49
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915398
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$10.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.44
|
| 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 |
$52.49
|
| Rate for Payer: Cash Price |
$52.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.12
|
| 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 |
$30.97
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.49
|
| Rate for Payer: Heritage Provider Network Senior |
$32.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$25.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$39.37
|
| 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 ENS IGLON5 IFA
|
Facility
|
IP
|
$52.49
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915398
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$39.37 |
| Rate for Payer: Adventist Health Commercial |
$10.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.80
|
| Rate for Payer: Cash Price |
$52.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.54
|
| Rate for Payer: Heritage Provider Network Senior |
$35.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.12
|
| Rate for Payer: Multiplan Commercial |
$39.37
|
|
|
HC SOM ENS LGI1-IGG CBA
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915392
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.05
|
| 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 |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.14
|
| 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 |
$20.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.08
|
| Rate for Payer: Heritage Provider Network Senior |
$21.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| 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 ENS LGI1-IGG CBA
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915392
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$25.55 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.93
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.06
|
| Rate for Payer: Heritage Provider Network Senior |
$23.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
|
|
HC SOM ENS MGLUR1 AB IFA
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915394
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$25.55 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.93
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.06
|
| Rate for Payer: Heritage Provider Network Senior |
$23.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
|
|
HC SOM ENS MGLUR1 AB IFA
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915394
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.05
|
| 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 |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.14
|
| 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 |
$20.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.08
|
| Rate for Payer: Heritage Provider Network Senior |
$21.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| 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 ENS NEUROCHONDRIN IFA
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915476
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.05
|
| 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 |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.14
|
| 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 |
$22.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.08
|
| Rate for Payer: Heritage Provider Network Senior |
$21.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| 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 ENS NEUROCHONDRIN IFA
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915476
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$25.55 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.93
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.06
|
| Rate for Payer: Heritage Provider Network Senior |
$23.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
|
|
HC SOM ENS NIF IFA
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915399
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.05
|
| 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 |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.14
|
| 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 |
$20.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.08
|
| Rate for Payer: Heritage Provider Network Senior |
$21.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| 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 ENS NIF IFA
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915399
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$25.55 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.93
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.06
|
| Rate for Payer: Heritage Provider Network Senior |
$23.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
|
|
HC SOM ENS NMDA-R AB CBA
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915389
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$25.55 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.93
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.06
|
| Rate for Payer: Heritage Provider Network Senior |
$23.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
|
|
HC SOM ENS NMDA-R AB CBA
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915389
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.05
|
| 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 |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.14
|
| 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 |
$20.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.08
|
| Rate for Payer: Heritage Provider Network Senior |
$21.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| 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 ENS PCA-1
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915386
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.05
|
| 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 |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.14
|
| 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 |
$20.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.08
|
| Rate for Payer: Heritage Provider Network Senior |
$21.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| 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 ENS PCA-1
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915386
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$25.55 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.93
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.06
|
| Rate for Payer: Heritage Provider Network Senior |
$23.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
|
|
HC SOM ENS PCA-2
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915383
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.05
|
| 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 |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.14
|
| 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 |
$20.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.08
|
| Rate for Payer: Heritage Provider Network Senior |
$21.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| 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 ENS PCA-2
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915383
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$25.55 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.93
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.06
|
| Rate for Payer: Heritage Provider Network Senior |
$23.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
|
|
HC SOM ENS PCA TR
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915381
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$25.55 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.93
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.06
|
| Rate for Payer: Heritage Provider Network Senior |
$23.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
|
|
HC SOM ENS PCA TR
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915381
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.05
|
| 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 |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.14
|
| 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 |
$20.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.08
|
| Rate for Payer: Heritage Provider Network Senior |
$21.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| 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 ENS PDE10A IFA
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915475
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$25.55 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.93
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.06
|
| Rate for Payer: Heritage Provider Network Senior |
$23.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
|
|
HC SOM ENS PDE10A IFA
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915475
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.05
|
| 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 |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.14
|
| 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 |
$22.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.08
|
| Rate for Payer: Heritage Provider Network Senior |
$21.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| 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 ENS SEPTIN7 IFA
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915477
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$25.55 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.93
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.06
|
| Rate for Payer: Heritage Provider Network Senior |
$23.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
|
|
HC SOM ENS SEPTIN7 IFA
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915477
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.05
|
| 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 |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.14
|
| 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 |
$22.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.08
|
| Rate for Payer: Heritage Provider Network Senior |
$21.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| 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 ENS TRIM46 IFA
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915474
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.05
|
| 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 |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.14
|
| 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 |
$22.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.08
|
| Rate for Payer: Heritage Provider Network Senior |
$21.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| 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
|
|
