|
HC SOM PARIETAL CELL AB
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911267
|
|
Hospital Revenue Code
|
301
|
| 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 PARIETAL CELL AB
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911267
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$231.08 |
| 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 |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.08
|
| 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 |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| 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 |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM PARVOVIRUS B19 AB IGG
|
Facility
|
OP
|
$11.23
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
900912538
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$148.69 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.69
|
| Rate for Payer: Blue Shield of California Commercial |
$7.51
|
| Rate for Payer: Blue Shield of California EPN |
$4.96
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Cigna of CA HMO |
$7.19
|
| Rate for Payer: Cigna of CA PPO |
$8.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.29
|
| Rate for Payer: EPIC Health Plan Senior |
$15.03
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.14
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.18
|
| Rate for Payer: United Healthcare All Other HMO |
$12.18
|
| Rate for Payer: United Healthcare HMO Rider |
$12.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.53
|
| Rate for Payer: Vantage Medical Group Senior |
$15.03
|
|
|
HC SOM PARVOVIRUS B19 AB IGG
|
Facility
|
IP
|
$11.23
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
900912538
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: EPIC Health Plan Senior |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
|
|
HC SOM PARVOVIRUS B19 AB IGM
|
Facility
|
IP
|
$11.23
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
900912694
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: EPIC Health Plan Senior |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
|
|
HC SOM PARVOVIRUS B19 AB IGM
|
Facility
|
OP
|
$11.23
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
900912694
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$148.69 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.69
|
| Rate for Payer: Blue Shield of California Commercial |
$7.51
|
| Rate for Payer: Blue Shield of California EPN |
$4.96
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Cigna of CA HMO |
$7.19
|
| Rate for Payer: Cigna of CA PPO |
$8.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.29
|
| Rate for Payer: EPIC Health Plan Senior |
$15.03
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.14
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.18
|
| Rate for Payer: United Healthcare All Other HMO |
$12.18
|
| Rate for Payer: United Healthcare HMO Rider |
$12.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.53
|
| Rate for Payer: Vantage Medical Group Senior |
$15.03
|
|
|
HC SOM PARVOVIRUS B19 PCR BF
|
Facility
|
OP
|
$41.48
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912782
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$335.41 |
| Rate for Payer: Adventist Health Commercial |
$8.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.41
|
| Rate for Payer: Blue Shield of California Commercial |
$27.75
|
| Rate for Payer: Blue Shield of California EPN |
$18.33
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Cigna of CA HMO |
$26.55
|
| Rate for Payer: Cigna of CA PPO |
$30.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$35.26
|
| Rate for Payer: Global Benefits Group Commercial |
$24.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$33.18
|
| Rate for Payer: Networks By Design Commercial |
$26.96
|
| Rate for Payer: Prime Health Services Commercial |
$35.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM PARVOVIRUS B19 PCR BF
|
Facility
|
IP
|
$41.48
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912782
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$35.26 |
| Rate for Payer: Adventist Health Commercial |
$8.30
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.59
|
| Rate for Payer: EPIC Health Plan Senior |
$16.59
|
| Rate for Payer: Galaxy Health WC |
$35.26
|
| Rate for Payer: Global Benefits Group Commercial |
$24.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.96
|
| Rate for Payer: Multiplan Commercial |
$33.18
|
| Rate for Payer: Networks By Design Commercial |
$26.96
|
| Rate for Payer: Prime Health Services Commercial |
$35.26
|
|
|
HC SOM PARVOVIRUS PCR
|
Facility
|
OP
|
$41.48
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911590
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$335.41 |
| Rate for Payer: Adventist Health Commercial |
$8.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.41
|
| Rate for Payer: Blue Shield of California Commercial |
$27.75
|
| Rate for Payer: Blue Shield of California EPN |
$18.33
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Cigna of CA HMO |
$26.55
|
| Rate for Payer: Cigna of CA PPO |
$30.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$35.26
|
| Rate for Payer: Global Benefits Group Commercial |
$24.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$33.18
|
| Rate for Payer: Networks By Design Commercial |
$26.96
|
| Rate for Payer: Prime Health Services Commercial |
$35.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM PARVOVIRUS PCR
|
Facility
|
IP
|
$41.48
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911590
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$35.26 |
| Rate for Payer: Adventist Health Commercial |
$8.30
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.59
|
| Rate for Payer: EPIC Health Plan Senior |
$16.59
|
| Rate for Payer: Galaxy Health WC |
$35.26
|
| Rate for Payer: Global Benefits Group Commercial |
$24.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.96
|
| Rate for Payer: Multiplan Commercial |
$33.18
|
| Rate for Payer: Networks By Design Commercial |
$26.96
|
| Rate for Payer: Prime Health Services Commercial |
$35.26
|
|
|
HC SOM PASSION FRUIT IGE
|
Facility
|
OP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914703
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$156.13 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.13
|
| Rate for Payer: Blue Shield of California Commercial |
$5.00
|
| Rate for Payer: Blue Shield of California EPN |
$3.30
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cigna of CA HMO |
$4.78
|
| Rate for Payer: Cigna of CA PPO |
$5.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$6.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$5.98
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Prime Health Services Commercial |
$6.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SOM PASSION FRUIT IGE
|
Facility
|
IP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914703
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.35 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.99
|
| Rate for Payer: EPIC Health Plan Senior |
$2.99
|
| Rate for Payer: Galaxy Health WC |
$6.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: Multiplan Commercial |
$5.98
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Prime Health Services Commercial |
$6.35
|
|
|
HC SOM PCA3 U
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900913905
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$200.00
|
| Rate for Payer: Galaxy Health WC |
$425.00
|
| Rate for Payer: Global Benefits Group Commercial |
$300.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$333.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Multiplan Commercial |
$400.00
|
| Rate for Payer: Networks By Design Commercial |
$325.00
|
| Rate for Payer: Prime Health Services Commercial |
$425.00
|
|
|
HC SOM PCA3 U
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900913905
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Galaxy Health WC |
$425.00
|
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$327.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$425.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$307.05
|
| Rate for Payer: Blue Shield of California Commercial |
$334.50
|
| Rate for Payer: Blue Shield of California EPN |
$221.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna of CA HMO |
$320.00
|
| Rate for Payer: Cigna of CA PPO |
$370.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$425.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$425.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$200.00
|
| Rate for Payer: Global Benefits Group Commercial |
$300.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$333.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$350.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$350.00
|
| Rate for Payer: Multiplan Commercial |
$400.00
|
| Rate for Payer: Networks By Design Commercial |
$325.00
|
| Rate for Payer: Prime Health Services Commercial |
$425.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$300.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$300.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$250.00
|
| Rate for Payer: United Healthcare All Other HMO |
$250.00
|
| Rate for Payer: United Healthcare HMO Rider |
$250.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$250.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$425.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.00
|
| Rate for Payer: Vantage Medical Group Senior |
$425.00
|
|
|
HC SOM PCDEC AMPA-R AB CBA
|
Facility
|
OP
|
$50.19
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915486
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$119.10 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.92
|
| 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 |
$33.58
|
| Rate for Payer: Blue Shield of California EPN |
$22.18
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Cigna of CA HMO |
$32.12
|
| Rate for Payer: Cigna of CA PPO |
$37.14
|
| 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 |
$42.66
|
| Rate for Payer: Global Benefits Group Commercial |
$30.11
|
| 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 |
$33.48
|
| 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 |
$12.05
|
| 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 |
$40.15
|
| Rate for Payer: Networks By Design Commercial |
$32.62
|
| Rate for Payer: Prime Health Services Commercial |
$42.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.11
|
| 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 PCDEC AMPA-R AB CBA
|
Facility
|
IP
|
$50.19
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915486
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$42.66 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.08
|
| Rate for Payer: EPIC Health Plan Senior |
$20.08
|
| Rate for Payer: Galaxy Health WC |
$42.66
|
| Rate for Payer: Global Benefits Group Commercial |
$30.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.05
|
| Rate for Payer: Multiplan Commercial |
$40.15
|
| Rate for Payer: Networks By Design Commercial |
$32.62
|
| Rate for Payer: Prime Health Services Commercial |
$42.66
|
|
|
HC SOM PCDES AMPA-R AB CBA
|
Facility
|
IP
|
$48.65
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$41.35 |
| Rate for Payer: Adventist Health Commercial |
$9.73
|
| Rate for Payer: Cash Price |
$48.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.46
|
| Rate for Payer: EPIC Health Plan Senior |
$19.46
|
| Rate for Payer: Galaxy Health WC |
$41.35
|
| Rate for Payer: Global Benefits Group Commercial |
$29.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.68
|
| Rate for Payer: Multiplan Commercial |
$38.92
|
| Rate for Payer: Networks By Design Commercial |
$31.62
|
| Rate for Payer: Prime Health Services Commercial |
$41.35
|
|
|
HC SOM PCDES AMPA-R AB CBA
|
Facility
|
OP
|
$48.65
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$119.10 |
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$41.35
|
| Rate for Payer: Adventist Health Commercial |
$9.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.91
|
| 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 |
$32.55
|
| Rate for Payer: Blue Shield of California EPN |
$21.50
|
| Rate for Payer: Cash Price |
$48.65
|
| Rate for Payer: Cash Price |
$48.65
|
| Rate for Payer: Cigna of CA HMO |
$31.14
|
| Rate for Payer: Cigna of CA PPO |
$36.00
|
| 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 |
$29.19
|
| 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 |
$32.45
|
| 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 |
$11.68
|
| 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 |
$38.92
|
| Rate for Payer: Networks By Design Commercial |
$31.62
|
| Rate for Payer: Prime Health Services Commercial |
$41.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.19
|
| 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 PCDES ANNA1
|
Facility
|
OP
|
$48.65
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915489
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$119.10 |
| Rate for Payer: Adventist Health Commercial |
$9.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.91
|
| 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 |
$32.55
|
| Rate for Payer: Blue Shield of California EPN |
$21.50
|
| Rate for Payer: Cash Price |
$48.65
|
| Rate for Payer: Cash Price |
$48.65
|
| Rate for Payer: Cigna of CA HMO |
$31.14
|
| Rate for Payer: Cigna of CA PPO |
$36.00
|
| 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 |
$41.35
|
| Rate for Payer: Global Benefits Group Commercial |
$29.19
|
| 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 |
$32.45
|
| 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 |
$11.68
|
| 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 |
$38.92
|
| Rate for Payer: Networks By Design Commercial |
$31.62
|
| Rate for Payer: Prime Health Services Commercial |
$41.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.19
|
| 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 PCDES ANNA1
|
Facility
|
IP
|
$48.65
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915489
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$41.35 |
| Rate for Payer: Adventist Health Commercial |
$9.73
|
| Rate for Payer: Cash Price |
$48.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.46
|
| Rate for Payer: EPIC Health Plan Senior |
$19.46
|
| Rate for Payer: Galaxy Health WC |
$41.35
|
| Rate for Payer: Global Benefits Group Commercial |
$29.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.68
|
| Rate for Payer: Multiplan Commercial |
$38.92
|
| Rate for Payer: Networks By Design Commercial |
$31.62
|
| Rate for Payer: Prime Health Services Commercial |
$41.35
|
|
|
HC SOM PCDES CASPR2 IGG CBA
|
Facility
|
IP
|
$48.65
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915495
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$41.35 |
| Rate for Payer: Adventist Health Commercial |
$9.73
|
| Rate for Payer: Cash Price |
$48.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.46
|
| Rate for Payer: EPIC Health Plan Senior |
$19.46
|
| Rate for Payer: Galaxy Health WC |
$41.35
|
| Rate for Payer: Global Benefits Group Commercial |
$29.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.68
|
| Rate for Payer: Multiplan Commercial |
$38.92
|
| Rate for Payer: Networks By Design Commercial |
$31.62
|
| Rate for Payer: Prime Health Services Commercial |
$41.35
|
|
|
HC SOM PCDES CASPR2 IGG CBA
|
Facility
|
OP
|
$48.65
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915495
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$119.10 |
| Rate for Payer: Adventist Health Commercial |
$9.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.91
|
| 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 |
$32.55
|
| Rate for Payer: Blue Shield of California EPN |
$21.50
|
| Rate for Payer: Cash Price |
$48.65
|
| Rate for Payer: Cash Price |
$48.65
|
| Rate for Payer: Cigna of CA HMO |
$31.14
|
| Rate for Payer: Cigna of CA PPO |
$36.00
|
| 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 |
$41.35
|
| Rate for Payer: Global Benefits Group Commercial |
$29.19
|
| 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 |
$32.45
|
| 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 |
$11.68
|
| 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 |
$38.92
|
| Rate for Payer: Networks By Design Commercial |
$31.62
|
| Rate for Payer: Prime Health Services Commercial |
$41.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.19
|
| 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 PCDES DPPX AB CBA
|
Facility
|
IP
|
$48.65
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$41.35 |
| Rate for Payer: Adventist Health Commercial |
$9.73
|
| Rate for Payer: Cash Price |
$48.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.46
|
| Rate for Payer: EPIC Health Plan Senior |
$19.46
|
| Rate for Payer: Galaxy Health WC |
$41.35
|
| Rate for Payer: Global Benefits Group Commercial |
$29.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.68
|
| Rate for Payer: Multiplan Commercial |
$38.92
|
| Rate for Payer: Networks By Design Commercial |
$31.62
|
| Rate for Payer: Prime Health Services Commercial |
$41.35
|
|
|
HC SOM PCDES DPPX AB CBA
|
Facility
|
OP
|
$48.65
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$119.10 |
| Rate for Payer: Adventist Health Commercial |
$9.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.91
|
| 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 |
$32.55
|
| Rate for Payer: Blue Shield of California EPN |
$21.50
|
| Rate for Payer: Cash Price |
$48.65
|
| Rate for Payer: Cash Price |
$48.65
|
| Rate for Payer: Cigna of CA HMO |
$31.14
|
| Rate for Payer: Cigna of CA PPO |
$36.00
|
| 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 |
$41.35
|
| Rate for Payer: Global Benefits Group Commercial |
$29.19
|
| 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 |
$32.45
|
| 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 |
$11.68
|
| 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 |
$38.92
|
| Rate for Payer: Networks By Design Commercial |
$31.62
|
| Rate for Payer: Prime Health Services Commercial |
$41.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.19
|
| 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 PCDES GABA-B-R AB CBA
|
Facility
|
OP
|
$48.65
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915492
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$119.10 |
| Rate for Payer: Adventist Health Commercial |
$9.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.91
|
| 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 |
$32.55
|
| Rate for Payer: Blue Shield of California EPN |
$21.50
|
| Rate for Payer: Cash Price |
$48.65
|
| Rate for Payer: Cash Price |
$48.65
|
| Rate for Payer: Cigna of CA HMO |
$31.14
|
| Rate for Payer: Cigna of CA PPO |
$36.00
|
| 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 |
$41.35
|
| Rate for Payer: Global Benefits Group Commercial |
$29.19
|
| 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 |
$32.45
|
| 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 |
$11.68
|
| 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 |
$38.92
|
| Rate for Payer: Networks By Design Commercial |
$31.62
|
| Rate for Payer: Prime Health Services Commercial |
$41.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.19
|
| 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
|
|
