|
HC SOM ENC GFAP IFA, CSF
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915417
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$28.95 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Senior |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| Rate for Payer: Multiplan Commercial |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
|
|
HC SOM ENC GFAP IFA, CSF
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915417
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.25
|
| 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 |
$124.45
|
| Rate for Payer: Blue Shield of California Commercial |
$15.70
|
| Rate for Payer: Blue Shield of California Commercial |
$23.74
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO |
$21.80
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| 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 |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| 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 ENC IGLON5 IFA, CSF
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915418
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.25
|
| 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 |
$124.45
|
| Rate for Payer: Blue Shield of California Commercial |
$15.70
|
| Rate for Payer: Blue Shield of California Commercial |
$23.74
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO |
$21.80
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| 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 |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| 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 ENC IGLON5 IFA, CSF
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915418
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$28.95 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Senior |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| Rate for Payer: Multiplan Commercial |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
|
|
HC SOM ENC LGI1-IGG CBA, CSF
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915412
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.25
|
| 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 |
$124.45
|
| Rate for Payer: Blue Shield of California Commercial |
$15.70
|
| Rate for Payer: Blue Shield of California Commercial |
$23.74
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO |
$21.80
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| 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 |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| 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 ENC LGI1-IGG CBA, CSF
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915412
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$28.95 |
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Senior |
$13.62
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| Rate for Payer: Multiplan Commercial |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
|
|
HC SOM ENC MGLUR1 AB IFA, CSF
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915414
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$28.95 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Senior |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| Rate for Payer: Multiplan Commercial |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
|
|
HC SOM ENC MGLUR1 AB IFA, CSF
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915414
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.25
|
| 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 |
$124.45
|
| Rate for Payer: Blue Shield of California Commercial |
$15.70
|
| Rate for Payer: Blue Shield of California Commercial |
$23.74
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO |
$21.80
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| 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 |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| 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 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 NEUROCHONDRIN IFA
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915479
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$28.95 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Senior |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| Rate for Payer: Multiplan Commercial |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
|
|
HC SOM ENC NEUROCHONDRIN IFA
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915479
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.25
|
| 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 |
$124.45
|
| Rate for Payer: Blue Shield of California Commercial |
$15.70
|
| Rate for Payer: Blue Shield of California Commercial |
$23.74
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO |
$21.80
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| 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 |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| 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 ENC NIF IFA, CSF
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915419
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$28.95 |
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Senior |
$13.62
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| Rate for Payer: Multiplan Commercial |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
|
|
HC SOM ENC NIF IFA, CSF
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915419
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.25
|
| 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 |
$124.45
|
| Rate for Payer: Blue Shield of California Commercial |
$15.70
|
| Rate for Payer: Blue Shield of California Commercial |
$23.74
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO |
$21.80
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| 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 |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| 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 ENC NMDA-R AB CBA, CSF
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915409
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.25
|
| 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 |
$124.45
|
| Rate for Payer: Blue Shield of California Commercial |
$15.70
|
| Rate for Payer: Blue Shield of California Commercial |
$23.74
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO |
$21.80
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| 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 |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| 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 ENC NMDA-R AB CBA, CSF
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915409
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$28.95 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Senior |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| Rate for Payer: Multiplan Commercial |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
|
|
HC SOM ENC PCA-1, CSF
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915406
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$28.95 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Senior |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| Rate for Payer: Multiplan Commercial |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
|
|
HC SOM ENC PCA-1, CSF
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915406
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.25
|
| 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 |
$124.45
|
| Rate for Payer: Blue Shield of California Commercial |
$15.70
|
| Rate for Payer: Blue Shield of California Commercial |
$23.74
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO |
$21.80
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| 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 |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| 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 ENC PCA-2, CSF
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915403
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$28.95 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Senior |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| Rate for Payer: Multiplan Commercial |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
|
|
HC SOM ENC PCA-2, CSF
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915403
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.25
|
| 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 |
$124.45
|
| Rate for Payer: Blue Shield of California Commercial |
$15.70
|
| Rate for Payer: Blue Shield of California Commercial |
$23.74
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO |
$21.80
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| 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 |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| 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 ENC PCA TR, CSF
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.25
|
| 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 |
$124.45
|
| Rate for Payer: Blue Shield of California Commercial |
$15.70
|
| Rate for Payer: Blue Shield of California Commercial |
$23.74
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO |
$21.80
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| 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 |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| 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 ENC PCA TR, CSF
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$28.95 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Senior |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| Rate for Payer: Multiplan Commercial |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
|
|
HC SOM ENC PDE10A IFA
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915482
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$100.25
|
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| 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 |
$124.45
|
| Rate for Payer: Blue Shield of California Commercial |
$15.70
|
| Rate for Payer: Blue Shield of California Commercial |
$23.74
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO |
$21.80
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| 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 |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| 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 ENC PDE10A IFA
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915482
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$28.95 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Senior |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| Rate for Payer: Multiplan Commercial |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
|
|
HC SOM ENC SEPTIN7 IFA
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915480
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.25
|
| 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 |
$124.45
|
| Rate for Payer: Blue Shield of California Commercial |
$15.70
|
| Rate for Payer: Blue Shield of California Commercial |
$23.74
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO |
$21.80
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| 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 |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| 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 ENC SEPTIN7 IFA
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915480
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$28.95 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Senior |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| Rate for Payer: Multiplan Commercial |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
|
|
HC SOM ENC TRIM46 IFA
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915481
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$28.95 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Senior |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| Rate for Payer: Multiplan Commercial |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
|
