|
HC SOM PCDES AMPA-R AB CBA
|
Facility
|
OP
|
$37.72
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.31
|
| 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 |
$37.72
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.52
|
| 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 |
$24.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.35
|
| Rate for Payer: Heritage Provider Network Senior |
$23.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$28.29
|
| 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 PCDES AMPA-R AB CBA
|
Facility
|
IP
|
$37.72
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$28.29 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.29
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.54
|
| Rate for Payer: Heritage Provider Network Senior |
$25.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.43
|
| Rate for Payer: Multiplan Commercial |
$28.29
|
|
|
HC SOM PCDES ANNA1
|
Facility
|
IP
|
$37.72
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915489
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$28.29 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.29
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.54
|
| Rate for Payer: Heritage Provider Network Senior |
$25.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.43
|
| Rate for Payer: Multiplan Commercial |
$28.29
|
|
|
HC SOM PCDES ANNA1
|
Facility
|
OP
|
$37.72
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915489
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.31
|
| 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 |
$37.72
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.52
|
| 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 |
$24.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.35
|
| Rate for Payer: Heritage Provider Network Senior |
$23.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$28.29
|
| 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 PCDES CASPR2 IGG CBA
|
Facility
|
IP
|
$37.73
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915495
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$28.30 |
| Rate for Payer: Adventist Health Commercial |
$7.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.30
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.54
|
| Rate for Payer: Heritage Provider Network Senior |
$25.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.43
|
| Rate for Payer: Multiplan Commercial |
$28.30
|
|
|
HC SOM PCDES CASPR2 IGG CBA
|
Facility
|
OP
|
$37.73
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915495
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$7.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.32
|
| 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 |
$37.73
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.52
|
| 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 |
$24.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.35
|
| Rate for Payer: Heritage Provider Network Senior |
$23.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$28.30
|
| 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 PCDES DPPX AB CBA
|
Facility
|
IP
|
$37.73
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$28.30 |
| Rate for Payer: Adventist Health Commercial |
$7.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.30
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.54
|
| Rate for Payer: Heritage Provider Network Senior |
$25.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.43
|
| Rate for Payer: Multiplan Commercial |
$28.30
|
|
|
HC SOM PCDES DPPX AB CBA
|
Facility
|
OP
|
$37.73
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$7.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.32
|
| 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 |
$37.73
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.52
|
| 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 |
$24.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.35
|
| Rate for Payer: Heritage Provider Network Senior |
$23.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$28.30
|
| 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 PCDES GABA-B-R AB CBA
|
Facility
|
OP
|
$37.72
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915492
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: EPIC Health Plan Commercial |
$24.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.31
|
| 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 |
$37.72
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.52
|
| 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: Heritage Provider Network Commercial |
$23.35
|
| Rate for Payer: Heritage Provider Network Senior |
$23.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$28.29
|
| 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 PCDES GABA-B-R AB CBA
|
Facility
|
IP
|
$37.72
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915492
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$28.29 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.29
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.54
|
| Rate for Payer: Heritage Provider Network Senior |
$25.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.43
|
| Rate for Payer: Multiplan Commercial |
$28.29
|
|
|
HC SOM PCDES GAD65 AB
|
Facility
|
IP
|
$73.79
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915487
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.36 |
| Max. Negotiated Rate |
$55.34 |
| Rate for Payer: Adventist Health Commercial |
$14.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.52
|
| Rate for Payer: Cash Price |
$73.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.96
|
| Rate for Payer: Heritage Provider Network Senior |
$49.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.45
|
| Rate for Payer: Multiplan Commercial |
$55.34
|
|
|
HC SOM PCDES GAD65 AB
|
Facility
|
OP
|
$73.79
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915487
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.36 |
| Max. Negotiated Rate |
$146.00 |
| Rate for Payer: Adventist Health Commercial |
$14.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.00
|
| Rate for Payer: Blue Shield of California Commercial |
$133.75
|
| Rate for Payer: Blue Shield of California EPN |
$107.28
|
| Rate for Payer: Cash Price |
$73.79
|
| Rate for Payer: Cash Price |
$73.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$23.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.68
|
| Rate for Payer: Heritage Provider Network Senior |
$45.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$35.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31.58
|
| Rate for Payer: Multiplan Commercial |
$55.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.57
|
| Rate for Payer: TriValley Medical Group Senior |
$23.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM PCDES GFAP IFA
|
Facility
|
IP
|
$37.73
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915499
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$28.30 |
| Rate for Payer: Adventist Health Commercial |
$7.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.30
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.54
|
| Rate for Payer: Heritage Provider Network Senior |
$25.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.43
|
| Rate for Payer: Multiplan Commercial |
$28.30
|
|
|
HC SOM PCDES GFAP IFA
|
Facility
|
OP
|
$37.73
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915499
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$7.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.32
|
| 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 |
$37.73
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.52
|
| 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 |
$24.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.35
|
| Rate for Payer: Heritage Provider Network Senior |
$23.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$28.30
|
| 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 PCDES LGI1 IGG CBA
|
Facility
|
IP
|
$37.72
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915494
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$28.29 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.29
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.54
|
| Rate for Payer: Heritage Provider Network Senior |
$25.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.43
|
| Rate for Payer: Multiplan Commercial |
$28.29
|
|
|
HC SOM PCDES LGI1 IGG CBA
|
Facility
|
OP
|
$37.72
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915494
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.31
|
| 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 |
$37.72
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.52
|
| 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 |
$24.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.35
|
| Rate for Payer: Heritage Provider Network Senior |
$23.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$28.29
|
| 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 PCDES MGLUR1 AB IFA
|
Facility
|
OP
|
$37.73
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915497
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$7.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.32
|
| 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 |
$37.73
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.52
|
| 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 |
$24.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.35
|
| Rate for Payer: Heritage Provider Network Senior |
$23.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$28.30
|
| 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 PCDES MGLUR1 AB IFA
|
Facility
|
IP
|
$37.73
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915497
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$28.30 |
| Rate for Payer: Adventist Health Commercial |
$7.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.30
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.54
|
| Rate for Payer: Heritage Provider Network Senior |
$25.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.43
|
| Rate for Payer: Multiplan Commercial |
$28.30
|
|
|
HC SOM PCDES MOG FACS
|
Facility
|
OP
|
$118.12
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
900915496
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$88.59 |
| Rate for Payer: Adventist Health Commercial |
$23.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$73.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.22
|
| Rate for Payer: Blue Shield of California Commercial |
$69.41
|
| Rate for Payer: Blue Shield of California EPN |
$55.67
|
| Rate for Payer: Cash Price |
$118.12
|
| Rate for Payer: Cash Price |
$118.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.12
|
| Rate for Payer: Heritage Provider Network Senior |
$73.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$56.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$88.59
|
| 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 |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC SOM PCDES MOG FACS
|
Facility
|
IP
|
$118.12
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
900915496
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.38 |
| Max. Negotiated Rate |
$88.59 |
| Rate for Payer: Adventist Health Commercial |
$23.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$76.07
|
| Rate for Payer: Cash Price |
$118.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.97
|
| Rate for Payer: Heritage Provider Network Senior |
$79.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.53
|
| Rate for Payer: Multiplan Commercial |
$88.59
|
|
|
HC SOM PCDES NEUROCONDRIN IFA
|
Facility
|
IP
|
$37.73
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915500
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$28.30 |
| Rate for Payer: Adventist Health Commercial |
$7.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.30
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.54
|
| Rate for Payer: Heritage Provider Network Senior |
$25.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.43
|
| Rate for Payer: Multiplan Commercial |
$28.30
|
|
|
HC SOM PCDES NEUROCONDRIN IFA
|
Facility
|
OP
|
$37.73
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915500
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$7.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.32
|
| 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 |
$37.73
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.52
|
| 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 |
$24.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.35
|
| Rate for Payer: Heritage Provider Network Senior |
$23.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$28.30
|
| 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 PCDES NMDA-R AB CBA
|
Facility
|
IP
|
$37.72
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$28.29 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.29
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.54
|
| Rate for Payer: Heritage Provider Network Senior |
$25.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.43
|
| Rate for Payer: Multiplan Commercial |
$28.29
|
|
|
HC SOM PCDES NMDA-R AB CBA
|
Facility
|
OP
|
$37.72
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.31
|
| 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 |
$37.72
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.52
|
| 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 |
$24.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.35
|
| Rate for Payer: Heritage Provider Network Senior |
$23.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$28.29
|
| 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 PCDES NMO/AQP4 FACS
|
Facility
|
OP
|
$118.12
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915493
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$88.59 |
| Rate for Payer: Adventist Health Commercial |
$23.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$73.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.22
|
| Rate for Payer: Blue Shield of California Commercial |
$69.41
|
| Rate for Payer: Blue Shield of California EPN |
$55.67
|
| Rate for Payer: Cash Price |
$118.12
|
| Rate for Payer: Cash Price |
$118.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.12
|
| Rate for Payer: Heritage Provider Network Senior |
$73.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$56.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$88.59
|
| 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 |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
