|
HC SOM ELECTROPHORES,PROTEN,RANDM
|
Facility
|
OP
|
$20.05
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912891
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$172.56 |
| Rate for Payer: Adventist Health Commercial |
$4.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$172.56
|
| Rate for Payer: Blue Shield of California Commercial |
$13.41
|
| Rate for Payer: Blue Shield of California EPN |
$8.86
|
| Rate for Payer: Cash Price |
$20.05
|
| Rate for Payer: Cash Price |
$20.05
|
| Rate for Payer: Cigna of CA HMO |
$12.83
|
| Rate for Payer: Cigna of CA PPO |
$14.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.07
|
| Rate for Payer: EPIC Health Plan Senior |
$17.83
|
| Rate for Payer: Galaxy Health WC |
$17.04
|
| Rate for Payer: Global Benefits Group Commercial |
$12.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.89
|
| Rate for Payer: Multiplan Commercial |
$16.04
|
| Rate for Payer: Networks By Design Commercial |
$13.03
|
| Rate for Payer: Prime Health Services Commercial |
$17.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.45
|
| Rate for Payer: United Healthcare All Other HMO |
$14.45
|
| Rate for Payer: United Healthcare HMO Rider |
$14.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Vantage Medical Group Senior |
$17.83
|
|
|
HC SOM ENC DPPX AB CBA
|
Facility
|
OP
|
$38.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915478
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$119.10 |
| Rate for Payer: Adventist Health Commercial |
$7.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.97
|
| 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 |
$119.10
|
| Rate for Payer: Blue Shield of California Commercial |
$25.47
|
| Rate for Payer: Blue Shield of California EPN |
$16.83
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Cigna of CA HMO |
$24.36
|
| Rate for Payer: Cigna of CA PPO |
$28.17
|
| 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 |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$32.36
|
| Rate for Payer: Global Benefits Group Commercial |
$22.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$30.46
|
| Rate for Payer: Networks By Design Commercial |
$24.75
|
| Rate for Payer: Prime Health Services Commercial |
$32.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| 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 ENC DPPX AB CBA
|
Facility
|
IP
|
$38.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915478
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$32.36 |
| Rate for Payer: Adventist Health Commercial |
$7.61
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.23
|
| Rate for Payer: EPIC Health Plan Senior |
$15.23
|
| Rate for Payer: Galaxy Health WC |
$32.36
|
| Rate for Payer: Global Benefits Group Commercial |
$22.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.14
|
| Rate for Payer: Multiplan Commercial |
$30.46
|
| Rate for Payer: Networks By Design Commercial |
$24.75
|
| Rate for Payer: Prime Health Services Commercial |
$32.36
|
|
|
HC SOM ENC NEUROCHONDRIN IFA
|
Facility
|
IP
|
$38.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915479
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$32.36 |
| Rate for Payer: Adventist Health Commercial |
$7.61
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.23
|
| Rate for Payer: EPIC Health Plan Senior |
$15.23
|
| Rate for Payer: Galaxy Health WC |
$32.36
|
| Rate for Payer: Global Benefits Group Commercial |
$22.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.14
|
| Rate for Payer: Multiplan Commercial |
$30.46
|
| Rate for Payer: Networks By Design Commercial |
$24.75
|
| Rate for Payer: Prime Health Services Commercial |
$32.36
|
|
|
HC SOM ENC NEUROCHONDRIN IFA
|
Facility
|
OP
|
$38.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915479
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$119.10 |
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$32.36
|
| Rate for Payer: Adventist Health Commercial |
$7.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.97
|
| 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 |
$119.10
|
| Rate for Payer: Blue Shield of California Commercial |
$25.47
|
| Rate for Payer: Blue Shield of California EPN |
$16.83
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Cigna of CA HMO |
$24.36
|
| Rate for Payer: Cigna of CA PPO |
$28.17
|
| 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 |
$16.27
|
| Rate for Payer: Global Benefits Group Commercial |
$22.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$30.46
|
| Rate for Payer: Networks By Design Commercial |
$24.75
|
| Rate for Payer: Prime Health Services Commercial |
$32.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| 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 ENC PDE10A IFA
|
Facility
|
OP
|
$38.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915482
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$119.10 |
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$32.36
|
| Rate for Payer: Adventist Health Commercial |
$7.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.97
|
| 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 |
$119.10
|
| Rate for Payer: Blue Shield of California Commercial |
$25.47
|
| Rate for Payer: Blue Shield of California EPN |
$16.83
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Cigna of CA HMO |
$24.36
|
| Rate for Payer: Cigna of CA PPO |
$28.17
|
| 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 |
$16.27
|
| Rate for Payer: Global Benefits Group Commercial |
$22.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$30.46
|
| Rate for Payer: Networks By Design Commercial |
$24.75
|
| Rate for Payer: Prime Health Services Commercial |
$32.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| 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 ENC PDE10A IFA
|
Facility
|
IP
|
$38.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915482
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$32.36 |
| Rate for Payer: Adventist Health Commercial |
$7.61
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.23
|
| Rate for Payer: EPIC Health Plan Senior |
$15.23
|
| Rate for Payer: Galaxy Health WC |
$32.36
|
| Rate for Payer: Global Benefits Group Commercial |
$22.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.14
|
| Rate for Payer: Multiplan Commercial |
$30.46
|
| Rate for Payer: Networks By Design Commercial |
$24.75
|
| Rate for Payer: Prime Health Services Commercial |
$32.36
|
|
|
HC SOM ENC SEPTIN7 IFA
|
Facility
|
OP
|
$38.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915480
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$119.10 |
| Rate for Payer: Adventist Health Commercial |
$7.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.97
|
| 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 |
$119.10
|
| Rate for Payer: Blue Shield of California Commercial |
$25.47
|
| Rate for Payer: Blue Shield of California EPN |
$16.83
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Cigna of CA HMO |
$24.36
|
| Rate for Payer: Cigna of CA PPO |
$28.17
|
| 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 |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$32.36
|
| Rate for Payer: Global Benefits Group Commercial |
$22.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$30.46
|
| Rate for Payer: Networks By Design Commercial |
$24.75
|
| Rate for Payer: Prime Health Services Commercial |
$32.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| 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 ENC SEPTIN7 IFA
|
Facility
|
IP
|
$38.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915480
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$32.36 |
| Rate for Payer: Adventist Health Commercial |
$7.61
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.23
|
| Rate for Payer: EPIC Health Plan Senior |
$15.23
|
| Rate for Payer: Galaxy Health WC |
$32.36
|
| Rate for Payer: Global Benefits Group Commercial |
$22.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.14
|
| Rate for Payer: Multiplan Commercial |
$30.46
|
| Rate for Payer: Networks By Design Commercial |
$24.75
|
| Rate for Payer: Prime Health Services Commercial |
$32.36
|
|
|
HC SOM ENC TRIM46 IFA
|
Facility
|
OP
|
$38.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915481
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$119.10 |
| Rate for Payer: Adventist Health Commercial |
$7.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.96
|
| 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 |
$119.10
|
| Rate for Payer: Blue Shield of California Commercial |
$25.46
|
| Rate for Payer: Blue Shield of California EPN |
$16.82
|
| Rate for Payer: Cash Price |
$38.06
|
| Rate for Payer: Cash Price |
$38.06
|
| Rate for Payer: Cigna of CA HMO |
$24.36
|
| Rate for Payer: Cigna of CA PPO |
$28.16
|
| 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 |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$32.35
|
| Rate for Payer: Global Benefits Group Commercial |
$22.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$30.45
|
| Rate for Payer: Networks By Design Commercial |
$24.74
|
| Rate for Payer: Prime Health Services Commercial |
$32.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| 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 ENC TRIM46 IFA
|
Facility
|
IP
|
$38.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915481
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$32.35 |
| Rate for Payer: Adventist Health Commercial |
$7.61
|
| Rate for Payer: Cash Price |
$38.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.22
|
| Rate for Payer: EPIC Health Plan Senior |
$15.22
|
| Rate for Payer: Galaxy Health WC |
$32.35
|
| Rate for Payer: Global Benefits Group Commercial |
$22.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.13
|
| Rate for Payer: Multiplan Commercial |
$30.45
|
| Rate for Payer: Networks By Design Commercial |
$24.74
|
| Rate for Payer: Prime Health Services Commercial |
$32.35
|
|
|
HC SOM ENDOMYSIAL IGA AB
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
900911423
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$33.65 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.65
|
| Rate for Payer: Blue Shield of California Commercial |
$16.73
|
| Rate for Payer: Blue Shield of California EPN |
$11.05
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.32
|
| Rate for Payer: EPIC Health Plan Senior |
$12.09
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.79
|
| Rate for Payer: United Healthcare All Other HMO |
$9.79
|
| Rate for Payer: United Healthcare HMO Rider |
$9.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.79
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: Vantage Medical Group Senior |
$12.09
|
|
|
HC SOM ENDOMYSIAL IGA AB
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
900911423
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM ENS DPPX CBA
|
Facility
|
OP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915472
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$119.10 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.91
|
| 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 |
$119.10
|
| Rate for Payer: Blue Shield of California Commercial |
$29.49
|
| Rate for Payer: Blue Shield of California EPN |
$19.48
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cigna of CA HMO |
$28.21
|
| Rate for Payer: Cigna of CA PPO |
$32.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$37.47
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$35.26
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: Prime Health Services Commercial |
$37.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS DPPX CBA
|
Facility
|
IP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915472
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$37.47 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.63
|
| Rate for Payer: EPIC Health Plan Senior |
$17.63
|
| Rate for Payer: Galaxy Health WC |
$37.47
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.58
|
| Rate for Payer: Multiplan Commercial |
$35.26
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: Prime Health Services Commercial |
$37.47
|
|
|
HC SOM ENS IGLON5 CBA
|
Facility
|
IP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915473
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$37.47 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.63
|
| Rate for Payer: EPIC Health Plan Senior |
$17.63
|
| Rate for Payer: Galaxy Health WC |
$37.47
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.58
|
| Rate for Payer: Multiplan Commercial |
$35.26
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: Prime Health Services Commercial |
$37.47
|
|
|
HC SOM ENS IGLON5 CBA
|
Facility
|
OP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915473
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$119.10 |
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$37.47
|
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.91
|
| 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 |
$119.10
|
| Rate for Payer: Blue Shield of California Commercial |
$29.49
|
| Rate for Payer: Blue Shield of California EPN |
$19.48
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cigna of CA HMO |
$28.21
|
| Rate for Payer: Cigna of CA PPO |
$32.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$35.26
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: Prime Health Services Commercial |
$37.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS NEUROCHONDRIN IFA
|
Facility
|
OP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915476
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$119.10 |
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$37.47
|
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.91
|
| 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 |
$119.10
|
| Rate for Payer: Blue Shield of California Commercial |
$29.49
|
| Rate for Payer: Blue Shield of California EPN |
$19.48
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cigna of CA HMO |
$28.21
|
| Rate for Payer: Cigna of CA PPO |
$32.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$35.26
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: Prime Health Services Commercial |
$37.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS NEUROCHONDRIN IFA
|
Facility
|
IP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915476
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$37.47 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.63
|
| Rate for Payer: EPIC Health Plan Senior |
$17.63
|
| Rate for Payer: Galaxy Health WC |
$37.47
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.58
|
| Rate for Payer: Multiplan Commercial |
$35.26
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: Prime Health Services Commercial |
$37.47
|
|
|
HC SOM ENS PDE10A IFA
|
Facility
|
OP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915475
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$119.10 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.91
|
| 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 |
$119.10
|
| Rate for Payer: Blue Shield of California Commercial |
$29.49
|
| Rate for Payer: Blue Shield of California EPN |
$19.48
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cigna of CA HMO |
$28.21
|
| Rate for Payer: Cigna of CA PPO |
$32.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$37.47
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$35.26
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: Prime Health Services Commercial |
$37.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS PDE10A IFA
|
Facility
|
IP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915475
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$37.47 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.63
|
| Rate for Payer: EPIC Health Plan Senior |
$17.63
|
| Rate for Payer: Galaxy Health WC |
$37.47
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.58
|
| Rate for Payer: Multiplan Commercial |
$35.26
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: Prime Health Services Commercial |
$37.47
|
|
|
HC SOM ENS SEPTIN7 IFA
|
Facility
|
IP
|
$44.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915477
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Adventist Health Commercial |
$8.81
|
| Rate for Payer: Cash Price |
$44.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.63
|
| Rate for Payer: EPIC Health Plan Senior |
$17.63
|
| Rate for Payer: Galaxy Health WC |
$37.46
|
| Rate for Payer: Global Benefits Group Commercial |
$26.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.58
|
| Rate for Payer: Multiplan Commercial |
$35.26
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: Prime Health Services Commercial |
$37.46
|
|
|
HC SOM ENS SEPTIN7 IFA
|
Facility
|
OP
|
$44.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915477
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$119.10 |
| Rate for Payer: Adventist Health Commercial |
$8.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.91
|
| 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 |
$119.10
|
| Rate for Payer: Blue Shield of California Commercial |
$29.48
|
| Rate for Payer: Blue Shield of California EPN |
$19.48
|
| Rate for Payer: Cash Price |
$44.07
|
| Rate for Payer: Cash Price |
$44.07
|
| Rate for Payer: Cigna of CA HMO |
$28.20
|
| Rate for Payer: Cigna of CA PPO |
$32.61
|
| 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 |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$37.46
|
| Rate for Payer: Global Benefits Group Commercial |
$26.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$35.26
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: Prime Health Services Commercial |
$37.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS TRIM46 IFA
|
Facility
|
OP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915474
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$119.10 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.91
|
| 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 |
$119.10
|
| Rate for Payer: Blue Shield of California Commercial |
$29.49
|
| Rate for Payer: Blue Shield of California EPN |
$19.48
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cigna of CA HMO |
$28.21
|
| Rate for Payer: Cigna of CA PPO |
$32.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$37.47
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$35.26
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: Prime Health Services Commercial |
$37.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS TRIM46 IFA
|
Facility
|
IP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915474
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$37.47 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.63
|
| Rate for Payer: EPIC Health Plan Senior |
$17.63
|
| Rate for Payer: Galaxy Health WC |
$37.47
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.58
|
| Rate for Payer: Multiplan Commercial |
$35.26
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: Prime Health Services Commercial |
$37.47
|
|
