|
HC SOM PCDES AMPA-R AB CBA
|
Facility
|
OP
|
$37.72
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| 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 |
$17.39
|
| Rate for Payer: Blue Shield of California Commercial |
$26.29
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Cigna of CA HMO |
$24.14
|
| Rate for Payer: Cigna of CA PPO |
$27.91
|
| 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 |
$26.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$32.06
|
| Rate for Payer: Global Benefits Group Commercial |
$22.63
|
| 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 |
$23.95
|
| 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 |
$9.05
|
| 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 |
$30.18
|
| Rate for Payer: Networks By Design Commercial |
$24.52
|
| Rate for Payer: Prime Health Services Commercial |
$32.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.63
|
| 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
|
$37.72
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915489
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$100.25
|
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| 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 |
$17.39
|
| Rate for Payer: Blue Shield of California Commercial |
$26.29
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Cigna of CA HMO |
$24.14
|
| Rate for Payer: Cigna of CA PPO |
$27.91
|
| 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 |
$26.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$32.06
|
| Rate for Payer: Global Benefits Group Commercial |
$22.63
|
| 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 |
$23.95
|
| 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 |
$9.05
|
| 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 |
$30.18
|
| Rate for Payer: Networks By Design Commercial |
$24.52
|
| Rate for Payer: Prime Health Services Commercial |
$32.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.63
|
| 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
|
$37.72
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915489
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$32.06 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.09
|
| Rate for Payer: EPIC Health Plan Senior |
$15.09
|
| Rate for Payer: Galaxy Health WC |
$32.06
|
| Rate for Payer: Global Benefits Group Commercial |
$22.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.05
|
| Rate for Payer: Multiplan Commercial |
$30.18
|
| Rate for Payer: Networks By Design Commercial |
$24.52
|
| Rate for Payer: Prime Health Services Commercial |
$32.06
|
|
|
HC SOM PCDES CASPR2 IGG CBA
|
Facility
|
OP
|
$37.73
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915495
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Adventist Health Commercial |
$7.55
|
| 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 |
$17.39
|
| Rate for Payer: Blue Shield of California Commercial |
$26.30
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Cigna of CA HMO |
$24.15
|
| Rate for Payer: Cigna of CA PPO |
$27.92
|
| 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 |
$26.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$32.07
|
| Rate for Payer: Global Benefits Group Commercial |
$22.64
|
| 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 |
$23.96
|
| 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 |
$9.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$30.18
|
| Rate for Payer: Networks By Design Commercial |
$24.52
|
| Rate for Payer: Prime Health Services Commercial |
$32.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.64
|
| 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 CASPR2 IGG CBA
|
Facility
|
IP
|
$37.73
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915495
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$32.07 |
| Rate for Payer: Adventist Health Commercial |
$7.55
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.09
|
| Rate for Payer: EPIC Health Plan Senior |
$15.09
|
| Rate for Payer: Galaxy Health WC |
$32.07
|
| Rate for Payer: Global Benefits Group Commercial |
$22.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.06
|
| Rate for Payer: Multiplan Commercial |
$30.18
|
| Rate for Payer: Networks By Design Commercial |
$24.52
|
| Rate for Payer: Prime Health Services Commercial |
$32.07
|
|
|
HC SOM PCDES DPPX AB CBA
|
Facility
|
OP
|
$37.73
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Adventist Health Commercial |
$7.55
|
| 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 |
$17.39
|
| Rate for Payer: Blue Shield of California Commercial |
$26.30
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Cigna of CA HMO |
$24.15
|
| Rate for Payer: Cigna of CA PPO |
$27.92
|
| 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 |
$26.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$32.07
|
| Rate for Payer: Global Benefits Group Commercial |
$22.64
|
| 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 |
$23.96
|
| 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 |
$9.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$30.18
|
| Rate for Payer: Networks By Design Commercial |
$24.52
|
| Rate for Payer: Prime Health Services Commercial |
$32.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.64
|
| 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
|
$37.73
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$32.07 |
| Rate for Payer: Adventist Health Commercial |
$7.55
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.09
|
| Rate for Payer: EPIC Health Plan Senior |
$15.09
|
| Rate for Payer: Galaxy Health WC |
$32.07
|
| Rate for Payer: Global Benefits Group Commercial |
$22.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.06
|
| Rate for Payer: Multiplan Commercial |
$30.18
|
| Rate for Payer: Networks By Design Commercial |
$24.52
|
| Rate for Payer: Prime Health Services Commercial |
$32.07
|
|
|
HC SOM PCDES GABA-B-R AB CBA
|
Facility
|
OP
|
$37.72
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915492
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| 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 |
$17.39
|
| Rate for Payer: Blue Shield of California Commercial |
$26.29
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Cigna of CA HMO |
$24.14
|
| Rate for Payer: Cigna of CA PPO |
$27.91
|
| 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 |
$26.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$32.06
|
| Rate for Payer: Global Benefits Group Commercial |
$22.63
|
| 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 |
$23.95
|
| 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 |
$9.05
|
| 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 |
$30.18
|
| Rate for Payer: Networks By Design Commercial |
$24.52
|
| Rate for Payer: Prime Health Services Commercial |
$32.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.63
|
| 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
|
IP
|
$37.72
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915492
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$32.06 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.09
|
| Rate for Payer: EPIC Health Plan Senior |
$15.09
|
| Rate for Payer: Galaxy Health WC |
$32.06
|
| Rate for Payer: Global Benefits Group Commercial |
$22.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.05
|
| Rate for Payer: Multiplan Commercial |
$30.18
|
| Rate for Payer: Networks By Design Commercial |
$24.52
|
| Rate for Payer: Prime Health Services Commercial |
$32.06
|
|
|
HC SOM PCDES GAD65 AB
|
Facility
|
IP
|
$73.79
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915487
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.76 |
| Max. Negotiated Rate |
$62.72 |
| Rate for Payer: Adventist Health Commercial |
$14.76
|
| Rate for Payer: Cash Price |
$73.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.52
|
| Rate for Payer: EPIC Health Plan Senior |
$29.52
|
| Rate for Payer: Galaxy Health WC |
$62.72
|
| Rate for Payer: Global Benefits Group Commercial |
$44.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.71
|
| Rate for Payer: Multiplan Commercial |
$59.03
|
| Rate for Payer: Networks By Design Commercial |
$47.96
|
| Rate for Payer: Prime Health Services Commercial |
$62.72
|
|
|
HC SOM PCDES GAD65 AB
|
Facility
|
OP
|
$73.79
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915487
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.76 |
| Max. Negotiated Rate |
$158.71 |
| Rate for Payer: Adventist Health Commercial |
$14.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.71
|
| Rate for Payer: Blue Shield of California Commercial |
$34.02
|
| Rate for Payer: Blue Shield of California Commercial |
$51.43
|
| Rate for Payer: Cash Price |
$73.79
|
| Rate for Payer: Cash Price |
$73.79
|
| Rate for Payer: Cigna of CA HMO |
$47.23
|
| Rate for Payer: Cigna of CA PPO |
$54.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.89
|
| Rate for Payer: EPIC Health Plan Senior |
$25.93
|
| Rate for Payer: Galaxy Health WC |
$62.72
|
| Rate for Payer: Global Benefits Group Commercial |
$44.27
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.58
|
| Rate for Payer: Multiplan Commercial |
$59.03
|
| Rate for Payer: Networks By Design Commercial |
$47.96
|
| Rate for Payer: Prime Health Services Commercial |
$62.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.09
|
| Rate for Payer: United Healthcare All Other HMO |
$19.09
|
| Rate for Payer: United Healthcare HMO Rider |
$19.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$23.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM PCDES GFAP IFA
|
Facility
|
IP
|
$37.73
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915499
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$32.07 |
| Rate for Payer: Adventist Health Commercial |
$7.55
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.09
|
| Rate for Payer: EPIC Health Plan Senior |
$15.09
|
| Rate for Payer: Galaxy Health WC |
$32.07
|
| Rate for Payer: Global Benefits Group Commercial |
$22.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.06
|
| Rate for Payer: Multiplan Commercial |
$30.18
|
| Rate for Payer: Networks By Design Commercial |
$24.52
|
| Rate for Payer: Prime Health Services Commercial |
$32.07
|
|
|
HC SOM PCDES GFAP IFA
|
Facility
|
OP
|
$37.73
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915499
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Adventist Health Commercial |
$7.55
|
| 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 |
$17.39
|
| Rate for Payer: Blue Shield of California Commercial |
$26.30
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Cigna of CA HMO |
$24.15
|
| Rate for Payer: Cigna of CA PPO |
$27.92
|
| 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 |
$26.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$32.07
|
| Rate for Payer: Global Benefits Group Commercial |
$22.64
|
| 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 |
$23.96
|
| 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 |
$9.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$30.18
|
| Rate for Payer: Networks By Design Commercial |
$24.52
|
| Rate for Payer: Prime Health Services Commercial |
$32.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.64
|
| 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 LGI1 IGG CBA
|
Facility
|
IP
|
$37.72
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915494
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$32.06 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.09
|
| Rate for Payer: EPIC Health Plan Senior |
$15.09
|
| Rate for Payer: Galaxy Health WC |
$32.06
|
| Rate for Payer: Global Benefits Group Commercial |
$22.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.05
|
| Rate for Payer: Multiplan Commercial |
$30.18
|
| Rate for Payer: Networks By Design Commercial |
$24.52
|
| Rate for Payer: Prime Health Services Commercial |
$32.06
|
|
|
HC SOM PCDES LGI1 IGG CBA
|
Facility
|
OP
|
$37.72
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915494
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| 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 |
$17.39
|
| Rate for Payer: Blue Shield of California Commercial |
$26.29
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Cigna of CA HMO |
$24.14
|
| Rate for Payer: Cigna of CA PPO |
$27.91
|
| 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 |
$26.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$32.06
|
| Rate for Payer: Global Benefits Group Commercial |
$22.63
|
| 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 |
$23.95
|
| 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 |
$9.05
|
| 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 |
$30.18
|
| Rate for Payer: Networks By Design Commercial |
$24.52
|
| Rate for Payer: Prime Health Services Commercial |
$32.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.63
|
| 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 MGLUR1 AB IFA
|
Facility
|
OP
|
$37.73
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915497
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Adventist Health Commercial |
$7.55
|
| 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 |
$17.39
|
| Rate for Payer: Blue Shield of California Commercial |
$26.30
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Cigna of CA HMO |
$24.15
|
| Rate for Payer: Cigna of CA PPO |
$27.92
|
| 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 |
$26.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$32.07
|
| Rate for Payer: Global Benefits Group Commercial |
$22.64
|
| 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 |
$23.96
|
| 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 |
$9.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$30.18
|
| Rate for Payer: Networks By Design Commercial |
$24.52
|
| Rate for Payer: Prime Health Services Commercial |
$32.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.64
|
| 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 MGLUR1 AB IFA
|
Facility
|
IP
|
$37.73
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915497
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$32.07 |
| Rate for Payer: Adventist Health Commercial |
$7.55
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.09
|
| Rate for Payer: EPIC Health Plan Senior |
$15.09
|
| Rate for Payer: Galaxy Health WC |
$32.07
|
| Rate for Payer: Global Benefits Group Commercial |
$22.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.06
|
| Rate for Payer: Multiplan Commercial |
$30.18
|
| Rate for Payer: Networks By Design Commercial |
$24.52
|
| Rate for Payer: Prime Health Services Commercial |
$32.07
|
|
|
HC SOM PCDES MOG FACS
|
Facility
|
OP
|
$118.12
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
900915496
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$100.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$71.19
|
| Rate for Payer: Adventist Health Commercial |
$23.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.02
|
| Rate for Payer: Blue Shield of California Commercial |
$54.45
|
| Rate for Payer: Blue Shield of California Commercial |
$82.33
|
| Rate for Payer: Cash Price |
$118.12
|
| Rate for Payer: Cash Price |
$118.12
|
| Rate for Payer: Cigna of CA HMO |
$75.60
|
| Rate for Payer: Cigna of CA PPO |
$87.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$82.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.25
|
| Rate for Payer: EPIC Health Plan Senior |
$41.50
|
| Rate for Payer: Galaxy Health WC |
$100.40
|
| Rate for Payer: Global Benefits Group Commercial |
$70.87
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$76.78
|
| Rate for Payer: Prime Health Services Commercial |
$100.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.87
|
| 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 |
$37.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC SOM PCDES MOG FACS
|
Facility
|
IP
|
$118.12
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
900915496
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.62 |
| Max. Negotiated Rate |
$100.40 |
| Rate for Payer: Adventist Health Commercial |
$23.62
|
| Rate for Payer: Cash Price |
$118.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$82.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.25
|
| Rate for Payer: EPIC Health Plan Senior |
$47.25
|
| Rate for Payer: Galaxy Health WC |
$100.40
|
| Rate for Payer: Global Benefits Group Commercial |
$70.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.35
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$76.78
|
| Rate for Payer: Prime Health Services Commercial |
$100.40
|
|
|
HC SOM PCDES NEUROCONDRIN IFA
|
Facility
|
IP
|
$37.73
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915500
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$32.07 |
| Rate for Payer: Adventist Health Commercial |
$7.55
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.09
|
| Rate for Payer: EPIC Health Plan Senior |
$15.09
|
| Rate for Payer: Galaxy Health WC |
$32.07
|
| Rate for Payer: Global Benefits Group Commercial |
$22.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.06
|
| Rate for Payer: Multiplan Commercial |
$30.18
|
| Rate for Payer: Networks By Design Commercial |
$24.52
|
| Rate for Payer: Prime Health Services Commercial |
$32.07
|
|
|
HC SOM PCDES NEUROCONDRIN IFA
|
Facility
|
OP
|
$37.73
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915500
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Cigna of CA PPO |
$27.92
|
| Rate for Payer: Adventist Health Commercial |
$7.55
|
| 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 |
$17.39
|
| Rate for Payer: Blue Shield of California Commercial |
$26.30
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Cigna of CA HMO |
$24.15
|
| 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 |
$26.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$32.07
|
| Rate for Payer: Global Benefits Group Commercial |
$22.64
|
| 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 |
$23.96
|
| 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 |
$9.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$30.18
|
| Rate for Payer: Networks By Design Commercial |
$24.52
|
| Rate for Payer: Prime Health Services Commercial |
$32.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.64
|
| 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 NMDA-R AB CBA
|
Facility
|
OP
|
$37.72
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| 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 |
$17.39
|
| Rate for Payer: Blue Shield of California Commercial |
$26.29
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Cigna of CA HMO |
$24.14
|
| Rate for Payer: Cigna of CA PPO |
$27.91
|
| 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 |
$26.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$32.06
|
| Rate for Payer: Global Benefits Group Commercial |
$22.63
|
| 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 |
$23.95
|
| 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 |
$9.05
|
| 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 |
$30.18
|
| Rate for Payer: Networks By Design Commercial |
$24.52
|
| Rate for Payer: Prime Health Services Commercial |
$32.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.63
|
| 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 NMDA-R AB CBA
|
Facility
|
IP
|
$37.72
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$32.06 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.09
|
| Rate for Payer: EPIC Health Plan Senior |
$15.09
|
| Rate for Payer: Galaxy Health WC |
$32.06
|
| Rate for Payer: Global Benefits Group Commercial |
$22.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.05
|
| Rate for Payer: Multiplan Commercial |
$30.18
|
| Rate for Payer: Networks By Design Commercial |
$24.52
|
| Rate for Payer: Prime Health Services Commercial |
$32.06
|
|
|
HC SOM PCDES NMO/AQP4 FACS
|
Facility
|
IP
|
$118.12
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915493
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.62 |
| Max. Negotiated Rate |
$100.40 |
| Rate for Payer: Adventist Health Commercial |
$23.62
|
| Rate for Payer: Cash Price |
$118.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$82.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.25
|
| Rate for Payer: EPIC Health Plan Senior |
$47.25
|
| Rate for Payer: Galaxy Health WC |
$100.40
|
| Rate for Payer: Global Benefits Group Commercial |
$70.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.35
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$76.78
|
| Rate for Payer: Prime Health Services Commercial |
$100.40
|
|
|
HC SOM PCDES NMO/AQP4 FACS
|
Facility
|
OP
|
$118.12
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915493
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$100.40 |
| Rate for Payer: Cigna of CA PPO |
$87.41
|
| Rate for Payer: Adventist Health Commercial |
$23.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$71.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.02
|
| Rate for Payer: Blue Shield of California Commercial |
$54.45
|
| Rate for Payer: Blue Shield of California Commercial |
$82.33
|
| Rate for Payer: Cash Price |
$118.12
|
| Rate for Payer: Cash Price |
$118.12
|
| Rate for Payer: Cigna of CA HMO |
$75.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$82.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.25
|
| Rate for Payer: EPIC Health Plan Senior |
$41.50
|
| Rate for Payer: Galaxy Health WC |
$100.40
|
| Rate for Payer: Global Benefits Group Commercial |
$70.87
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$76.78
|
| Rate for Payer: Prime Health Services Commercial |
$100.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.87
|
| 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 |
$37.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
