|
HC SOM FBP1 88273
|
Facility
|
OP
|
$84.86
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900914874
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$15.36 |
| Max. Negotiated Rate |
$1,804.13 |
| Rate for Payer: Adventist Health Commercial |
$16.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,804.13
|
| Rate for Payer: Blue Shield of California Commercial |
$258.57
|
| Rate for Payer: Blue Shield of California EPN |
$207.39
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$34.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.53
|
| Rate for Payer: Heritage Provider Network Senior |
$52.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$40.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$46.65
|
| Rate for Payer: Multiplan Commercial |
$63.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$34.81
|
| Rate for Payer: TriValley Medical Group Senior |
$34.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Vantage Medical Group Senior |
$34.81
|
|
|
HC SOM FBP1 88291
|
Facility
|
OP
|
$71.15
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914873
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$177.38 |
| Rate for Payer: Adventist Health Commercial |
$14.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.38
|
| Rate for Payer: Blue Shield of California Commercial |
$37.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.95
|
| Rate for Payer: Cash Price |
$71.15
|
| Rate for Payer: Cash Price |
$71.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.04
|
| Rate for Payer: Heritage Provider Network Senior |
$44.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$33.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.80
|
| Rate for Payer: Multiplan Commercial |
$53.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.48
|
| Rate for Payer: Vantage Medical Group Senior |
$60.48
|
|
|
HC SOM FBP1 88291
|
Facility
|
IP
|
$71.15
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914873
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$53.36 |
| Rate for Payer: Adventist Health Commercial |
$14.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.82
|
| Rate for Payer: Cash Price |
$71.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.17
|
| Rate for Payer: Heritage Provider Network Senior |
$48.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.79
|
| Rate for Payer: Multiplan Commercial |
$53.36
|
|
|
HC SOM FCFQN 86171
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 86171
|
| Hospital Charge Code |
900914248
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$95.12 |
| Rate for Payer: Adventist Health Commercial |
$13.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.12
|
| Rate for Payer: Blue Shield of California Commercial |
$80.64
|
| Rate for Payer: Blue Shield of California EPN |
$64.68
|
| Rate for Payer: Cash Price |
$67.00
|
| Rate for Payer: Cash Price |
$67.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.47
|
| Rate for Payer: Heritage Provider Network Senior |
$41.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$31.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.41
|
| Rate for Payer: Multiplan Commercial |
$50.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.01
|
| Rate for Payer: TriValley Medical Group Senior |
$10.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.01
|
| Rate for Payer: Vantage Medical Group Senior |
$10.01
|
|
|
HC SOM FCFQN 86171
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT 86171
|
| Hospital Charge Code |
900914248
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.13 |
| Max. Negotiated Rate |
$50.25 |
| Rate for Payer: Adventist Health Commercial |
$13.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.15
|
| Rate for Payer: Cash Price |
$67.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.36
|
| Rate for Payer: Heritage Provider Network Senior |
$45.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.75
|
| Rate for Payer: Multiplan Commercial |
$50.25
|
|
|
HC SOM FCTRC 87110
|
Facility
|
OP
|
$69.57
|
|
|
Service Code
|
CPT 87110
|
| Hospital Charge Code |
900914725
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$186.08 |
| Rate for Payer: Adventist Health Commercial |
$13.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$186.08
|
| Rate for Payer: Blue Shield of California Commercial |
$157.65
|
| Rate for Payer: Blue Shield of California EPN |
$126.45
|
| Rate for Payer: Cash Price |
$69.57
|
| Rate for Payer: Cash Price |
$69.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$45.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.06
|
| Rate for Payer: Heritage Provider Network Senior |
$43.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$33.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26.26
|
| Rate for Payer: Multiplan Commercial |
$52.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.60
|
| Rate for Payer: TriValley Medical Group Senior |
$19.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.56
|
| Rate for Payer: Vantage Medical Group Senior |
$19.60
|
|
|
HC SOM FCTRC 87110
|
Facility
|
IP
|
$69.57
|
|
|
Service Code
|
CPT 87110
|
| Hospital Charge Code |
900914725
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$52.18 |
| Rate for Payer: Adventist Health Commercial |
$13.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.80
|
| Rate for Payer: Cash Price |
$69.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.10
|
| Rate for Payer: Heritage Provider Network Senior |
$47.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.39
|
| Rate for Payer: Multiplan Commercial |
$52.18
|
|
|
HC SOM FCTRC 87140
|
Facility
|
OP
|
$19.81
|
|
|
Service Code
|
CPT 87140
|
| Hospital Charge Code |
900914726
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$52.99 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.99
|
| Rate for Payer: Blue Shield of California Commercial |
$44.87
|
| Rate for Payer: Blue Shield of California EPN |
$35.99
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.69
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.26
|
| Rate for Payer: Heritage Provider Network Senior |
$12.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.46
|
| Rate for Payer: Multiplan Commercial |
$14.86
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.57
|
| Rate for Payer: TriValley Medical Group Senior |
$5.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Vantage Medical Group Senior |
$5.57
|
|
|
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: Aetna of CA Non-Gatekeeper |
$12.76
|
| 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 Foundation Hospitals 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 |
$170.74 |
| Rate for Payer: Adventist Health Commercial |
$33.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$104.39
|
| 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 |
$170.74
|
| 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 Medicare Advantage |
$22.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.66
|
| 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) Medicare Advantage |
$22.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$80.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.71
|
| 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: Aetna of CA Non-Gatekeeper |
$108.78
|
| 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 Foundation Hospitals 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
|
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: Aetna of CA Non-Gatekeeper |
$65.04
|
| 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 Foundation Hospitals Medi-Cal |
$18.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.25
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
|
|
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 |
$170.74 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$62.42
|
| 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 |
$170.74
|
| 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 Medicare Advantage |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.59
|
| 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) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$48.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.28
|
| 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 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 |
$124.65 |
| Rate for Payer: Adventist Health Commercial |
$10.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.49
|
| 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 |
$124.65
|
| 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 Medicare Advantage |
$13.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.02
|
| 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) Medicare Advantage |
$13.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$25.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.43
|
| 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 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: Aetna of CA Non-Gatekeeper |
$33.86
|
| 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 Foundation Hospitals Medi-Cal |
$9.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.14
|
| Rate for Payer: Multiplan Commercial |
$39.43
|
|
|
HC SOM FELBAMATE S
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 80167
|
| Hospital Charge Code |
900914198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.10
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.93
|
| Rate for Payer: Heritage Provider Network Senior |
$16.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SOM FELBAMATE S
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 80167
|
| Hospital Charge Code |
900914198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$107.37 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.45
|
| 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 |
$62.64
|
| 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 |
$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 |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| 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) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| 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
|
OP
|
$49.50
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
900915270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$177.19 |
| Rate for Payer: Adventist Health Commercial |
$9.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.19
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.64
|
| Rate for Payer: Heritage Provider Network Senior |
$30.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.65
|
| Rate for Payer: Multiplan Commercial |
$37.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.08
|
| Rate for Payer: Vantage Medical Group Senior |
$42.08
|
|
|
HC SOM FENTU
|
Facility
|
IP
|
$49.50
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
900915270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$37.12 |
| Rate for Payer: Adventist Health Commercial |
$9.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.88
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.51
|
| Rate for Payer: Heritage Provider Network Senior |
$33.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.38
|
| Rate for Payer: Multiplan Commercial |
$37.12
|
|
|
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: Aetna of CA Non-Gatekeeper |
$87.58
|
| 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 Foundation Hospitals Medi-Cal |
$24.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
|
|
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 |
$170.74 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$84.05
|
| 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 |
$170.74
|
| 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 Medicare Advantage |
$24.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.24
|
| 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) Medicare Advantage |
$24.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$64.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.31
|
| 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 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: Aetna of CA Non-Gatekeeper |
$18.42
|
| 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 Foundation Hospitals Medi-Cal |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$21.45
|
|
|
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 |
$164.73 |
| Rate for Payer: Adventist Health Commercial |
$5.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.67
|
| 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 |
$164.73
|
| 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 Medicare Advantage |
$13.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.87
|
| 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) Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.74
|
| 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 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: Aetna of CA Non-Gatekeeper |
$241.50
|
| 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 Foundation Hospitals 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 |
$67.88 |
| Max. Negotiated Rate |
$2,038.35 |
| Rate for Payer: Adventist Health Commercial |
$75.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$231.75
|
| 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 |
$1,934.98
|
| 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 Medicare Advantage |
$257.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.25
|
| 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) Medicare Advantage |
$257.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$178.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$344.98
|
| 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
|
|
