|
HC SOM PCDEC GABA-B-R AB CBA
|
Facility
OP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915446
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$100.92 |
| Rate for Payer: Adventist Health Commercial |
$10.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.92
|
| Rate for Payer: Blue Shield of California Commercial |
$94.14
|
| Rate for Payer: Blue Shield of California EPN |
$73.59
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.13
|
| Rate for Payer: Heritage Provider Network Senior |
$33.13
|
| Rate for Payer: Humana Medicare |
$12.05
|
| Rate for Payer: IEHP Medi-Cal |
$13.46
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| 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 |
$40.14
|
| 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 |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDEC GABA-B-R AB CBA
|
Facility
IP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915446
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$40.14 |
| Rate for Payer: Adventist Health Commercial |
$10.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.77
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.23
|
| Rate for Payer: Heritage Provider Network Senior |
$36.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| Rate for Payer: Multiplan Commercial |
$40.14
|
|
|
HC SOM PCDEC GAD65 AB
|
Facility
IP
|
$104.70
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$78.52 |
| Rate for Payer: Adventist Health Commercial |
$20.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$71.93
|
| Rate for Payer: Cash Price |
$47.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.88
|
| Rate for Payer: Heritage Provider Network Senior |
$70.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.18
|
| Rate for Payer: Multiplan Commercial |
$78.52
|
|
|
HC SOM PCDEC GAD65 AB
|
Facility
OP
|
$104.70
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$129.80 |
| Rate for Payer: Adventist Health Commercial |
$20.94
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$71.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$35.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.71
|
| Rate for Payer: Blue Shield of California Commercial |
$129.80
|
| Rate for Payer: Blue Shield of California EPN |
$101.47
|
| Rate for Payer: Cash Price |
$47.12
|
| Rate for Payer: Cash Price |
$47.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$68.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Senior |
$23.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$23.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.81
|
| Rate for Payer: Heritage Provider Network Senior |
$64.81
|
| Rate for Payer: Humana Medicare |
$23.57
|
| Rate for Payer: IEHP Medi-Cal |
$28.22
|
| Rate for Payer: IEHP Medicare Advantage |
$23.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.18
|
| 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 |
$78.52
|
| 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 |
$35.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM PCDEC GFAP IFA
|
Facility
OP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915452
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$100.92 |
| Rate for Payer: Adventist Health Commercial |
$10.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.92
|
| Rate for Payer: Blue Shield of California Commercial |
$94.14
|
| Rate for Payer: Blue Shield of California EPN |
$73.59
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.13
|
| Rate for Payer: Heritage Provider Network Senior |
$33.13
|
| Rate for Payer: Humana Medicare |
$12.05
|
| Rate for Payer: IEHP Medi-Cal |
$13.46
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| 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 |
$40.14
|
| 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 |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDEC GFAP IFA
|
Facility
IP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915452
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$40.14 |
| Rate for Payer: Adventist Health Commercial |
$10.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.77
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.23
|
| Rate for Payer: Heritage Provider Network Senior |
$36.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| Rate for Payer: Multiplan Commercial |
$40.14
|
|
|
HC SOM PCDEC LGI1-IGG CBA
|
Facility
IP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915448
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$40.14 |
| Rate for Payer: Adventist Health Commercial |
$10.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.77
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.23
|
| Rate for Payer: Heritage Provider Network Senior |
$36.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| Rate for Payer: Multiplan Commercial |
$40.14
|
|
|
HC SOM PCDEC LGI1-IGG CBA
|
Facility
OP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915448
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$100.92 |
| Rate for Payer: Adventist Health Commercial |
$10.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.92
|
| Rate for Payer: Blue Shield of California Commercial |
$94.14
|
| Rate for Payer: Blue Shield of California EPN |
$73.59
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.13
|
| Rate for Payer: Heritage Provider Network Senior |
$33.13
|
| Rate for Payer: Humana Medicare |
$12.05
|
| Rate for Payer: IEHP Medi-Cal |
$13.46
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| 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 |
$40.14
|
| 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 |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDEC MGLUR1 AB IFA
|
Facility
IP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915450
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$40.14 |
| Rate for Payer: Adventist Health Commercial |
$10.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.77
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.23
|
| Rate for Payer: Heritage Provider Network Senior |
$36.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| Rate for Payer: Multiplan Commercial |
$40.14
|
|
|
HC SOM PCDEC MGLUR1 AB IFA
|
Facility
OP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915450
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$100.92 |
| Rate for Payer: Adventist Health Commercial |
$10.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.92
|
| Rate for Payer: Blue Shield of California Commercial |
$94.14
|
| Rate for Payer: Blue Shield of California EPN |
$73.59
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.13
|
| Rate for Payer: Heritage Provider Network Senior |
$33.13
|
| Rate for Payer: Humana Medicare |
$12.05
|
| Rate for Payer: IEHP Medi-Cal |
$13.46
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| 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 |
$40.14
|
| 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 |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDEC NMDA-R AB CBA
|
Facility
IP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$40.14 |
| Rate for Payer: Adventist Health Commercial |
$10.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.77
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.23
|
| Rate for Payer: Heritage Provider Network Senior |
$36.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| Rate for Payer: Multiplan Commercial |
$40.14
|
|
|
HC SOM PCDEC NMDA-R AB CBA
|
Facility
OP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$100.92 |
| Rate for Payer: Adventist Health Commercial |
$10.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.92
|
| Rate for Payer: Blue Shield of California Commercial |
$94.14
|
| Rate for Payer: Blue Shield of California EPN |
$73.59
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.13
|
| Rate for Payer: Heritage Provider Network Senior |
$33.13
|
| Rate for Payer: Humana Medicare |
$12.05
|
| Rate for Payer: IEHP Medi-Cal |
$13.46
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| 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 |
$40.14
|
| 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 |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDEC NMO/AQP4 FACS
|
Facility
IP
|
$167.59
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915447
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.33 |
| Max. Negotiated Rate |
$125.69 |
| Rate for Payer: Adventist Health Commercial |
$33.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$115.13
|
| Rate for Payer: Cash Price |
$75.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.46
|
| Rate for Payer: Heritage Provider Network Senior |
$113.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.90
|
| Rate for Payer: Multiplan Commercial |
$125.69
|
|
|
HC SOM PCDEC NMO/AQP4 FACS
|
Facility
OP
|
$167.59
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915447
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$125.69 |
| Rate for Payer: Adventist Health Commercial |
$33.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$115.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$56.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.40
|
| Rate for Payer: Blue Shield of California Commercial |
$67.36
|
| Rate for Payer: Blue Shield of California EPN |
$52.66
|
| Rate for Payer: Cash Price |
$75.42
|
| Rate for Payer: Cash Price |
$75.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$108.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Senior |
$37.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.74
|
| Rate for Payer: Heritage Provider Network Senior |
$103.74
|
| Rate for Payer: Humana Medicare |
$37.73
|
| Rate for Payer: IEHP Medi-Cal |
$18.80
|
| Rate for Payer: IEHP Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$71.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.54
|
| Rate for Payer: Multiplan Commercial |
$125.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.73
|
| Rate for Payer: TriValley Medical Group Senior |
$37.73
|
| 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 |
$56.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC SOM PCDEC PCA-TR
|
Facility
IP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915443
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$40.14 |
| Rate for Payer: Adventist Health Commercial |
$10.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.77
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.23
|
| Rate for Payer: Heritage Provider Network Senior |
$36.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| Rate for Payer: Multiplan Commercial |
$40.14
|
|
|
HC SOM PCDEC PCA-TR
|
Facility
OP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915443
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$100.92 |
| Rate for Payer: Adventist Health Commercial |
$10.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.92
|
| Rate for Payer: Blue Shield of California Commercial |
$94.14
|
| Rate for Payer: Blue Shield of California EPN |
$73.59
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.13
|
| Rate for Payer: Heritage Provider Network Senior |
$33.13
|
| Rate for Payer: Humana Medicare |
$12.05
|
| Rate for Payer: IEHP Medi-Cal |
$13.46
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.38
|
| 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 |
$40.14
|
| 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 |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PENICILLIN G IGE
|
Facility
IP
|
$4.75
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912843
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.26
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Multiplan Commercial |
$3.56
|
|
|
HC SOM PENICILLIN G IGE
|
Facility
OP
|
$4.75
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912843
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$132.31 |
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
| Rate for Payer: Blue Shield of California Commercial |
$40.81
|
| Rate for Payer: Blue Shield of California EPN |
$31.90
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.09
|
| 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 |
$3.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.94
|
| Rate for Payer: Heritage Provider Network Senior |
$2.94
|
| Rate for Payer: Humana Medicare |
$5.22
|
| Rate for Payer: IEHP Medi-Cal |
$7.24
|
| Rate for Payer: IEHP Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| 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 |
$3.56
|
| 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 PENICILLIN V IGE
|
Facility
IP
|
$4.75
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912842
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.26
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Multiplan Commercial |
$3.56
|
|
|
HC SOM PENICILLIN V IGE
|
Facility
OP
|
$4.75
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912842
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$132.31 |
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
| Rate for Payer: Blue Shield of California Commercial |
$40.81
|
| Rate for Payer: Blue Shield of California EPN |
$31.90
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.09
|
| 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 |
$3.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.94
|
| Rate for Payer: Heritage Provider Network Senior |
$2.94
|
| Rate for Payer: Humana Medicare |
$5.22
|
| Rate for Payer: IEHP Medi-Cal |
$7.24
|
| Rate for Payer: IEHP Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| 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 |
$3.56
|
| 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 PERNIC ANEM CASC B12
|
Facility
IP
|
$79.28
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
900914690
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.35 |
| Max. Negotiated Rate |
$59.46 |
| Rate for Payer: Adventist Health Commercial |
$15.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.47
|
| Rate for Payer: Cash Price |
$35.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.67
|
| Rate for Payer: Heritage Provider Network Senior |
$53.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.82
|
| Rate for Payer: Multiplan Commercial |
$59.46
|
|
|
HC SOM PERNIC ANEM CASC B12
|
Facility
OP
|
$79.28
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
900914690
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.35 |
| Max. Negotiated Rate |
$126.17 |
| Rate for Payer: Adventist Health Commercial |
$15.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.17
|
| Rate for Payer: Blue Shield of California Commercial |
$117.73
|
| Rate for Payer: Blue Shield of California EPN |
$92.03
|
| Rate for Payer: Cash Price |
$35.68
|
| Rate for Payer: Cash Price |
$35.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.59
|
| Rate for Payer: Dignity Health Senior |
$15.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.07
|
| Rate for Payer: Heritage Provider Network Senior |
$49.07
|
| Rate for Payer: Humana Medicare |
$15.08
|
| Rate for Payer: IEHP Medi-Cal |
$20.79
|
| Rate for Payer: IEHP Medicare Advantage |
$15.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.00
|
| Rate for Payer: Multiplan Commercial |
$59.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.08
|
| Rate for Payer: TriValley Medical Group Senior |
$15.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Vantage Medical Group Senior |
$15.08
|
|
|
HC SOM PHENCYCLIDINE CONFIRM, U
|
Facility
IP
|
$61.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900912920
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$45.75 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.91
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.30
|
| Rate for Payer: Heritage Provider Network Senior |
$41.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.25
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
|
|
HC SOM PHENCYCLIDINE CONFIRM, U
|
Facility
OP
|
$61.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900912920
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$108.95 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$33.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$45.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.02
|
| Rate for Payer: Blue Shield of California Commercial |
$108.95
|
| Rate for Payer: Blue Shield of California EPN |
$85.17
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.85
|
| Rate for Payer: Dignity Health Senior |
$51.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.76
|
| Rate for Payer: Heritage Provider Network Senior |
$37.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.25
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$40.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$40.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.85
|
| Rate for Payer: Vantage Medical Group Senior |
$51.85
|
|
|
HC SOM PHENOBARBITAL LEVEL
|
Facility
IP
|
$16.25
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
900912658
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$12.19 |
| Rate for Payer: Adventist Health Commercial |
$3.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.16
|
| Rate for Payer: Cash Price |
$7.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.00
|
| Rate for Payer: Heritage Provider Network Senior |
$11.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.06
|
| Rate for Payer: Multiplan Commercial |
$12.19
|
|
