|
HC SOM ENS IGLON5 IFA
|
Facility
|
OP
|
$52.49
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915398
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$10.50
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.88
|
| 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 Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$31.86
|
| Rate for Payer: Blue Shield of California EPN |
$20.84
|
| Rate for Payer: Cash Price |
$52.49
|
| Rate for Payer: Cash Price |
$52.49
|
| Rate for Payer: Central Health Plan Commercial |
$41.99
|
| Rate for Payer: Cigna of CA HMO |
$33.59
|
| Rate for Payer: Cigna of CA PPO |
$38.84
|
| 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 |
$44.62
|
| Rate for Payer: Global Benefits Group Commercial |
$31.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.24
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$39.37
|
| Rate for Payer: Networks By Design Commercial |
$34.12
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$44.62
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS IGLON5 IFA
|
Facility
|
IP
|
$52.49
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915398
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$47.24 |
| Rate for Payer: Adventist Health Commercial |
$10.50
|
| Rate for Payer: Cash Price |
$52.49
|
| Rate for Payer: Central Health Plan Commercial |
$41.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.00
|
| Rate for Payer: EPIC Health Plan Senior |
$21.00
|
| Rate for Payer: Galaxy Health WC |
$44.62
|
| Rate for Payer: Global Benefits Group Commercial |
$31.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$39.37
|
| Rate for Payer: Networks By Design Commercial |
$34.12
|
| Rate for Payer: Prime Health Services Commercial |
$44.62
|
|
|
HC SOM ENS LGI1-IGG CBA
|
Facility
|
OP
|
$44.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915392
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$8.81
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.76
|
| 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 Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$26.75
|
| Rate for Payer: Blue Shield of California EPN |
$17.50
|
| Rate for Payer: Cash Price |
$44.07
|
| Rate for Payer: Cash Price |
$44.07
|
| Rate for Payer: Central Health Plan Commercial |
$35.26
|
| Rate for Payer: Cigna of CA HMO |
$28.20
|
| Rate for Payer: Cigna of CA PPO |
$32.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$37.46
|
| Rate for Payer: Global Benefits Group Commercial |
$26.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.66
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$33.05
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$37.46
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS LGI1-IGG CBA
|
Facility
|
IP
|
$44.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915392
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$39.66 |
| Rate for Payer: Adventist Health Commercial |
$8.81
|
| Rate for Payer: Cash Price |
$44.07
|
| Rate for Payer: Central Health Plan Commercial |
$35.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.63
|
| Rate for Payer: EPIC Health Plan Senior |
$17.63
|
| Rate for Payer: Galaxy Health WC |
$37.46
|
| Rate for Payer: Global Benefits Group Commercial |
$26.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.81
|
| Rate for Payer: Multiplan Commercial |
$33.05
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: Prime Health Services Commercial |
$37.46
|
|
|
HC SOM ENS MGLUR1 AB IFA
|
Facility
|
IP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915394
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$39.67 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Central Health Plan Commercial |
$35.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.63
|
| Rate for Payer: EPIC Health Plan Senior |
$17.63
|
| Rate for Payer: Galaxy Health WC |
$37.47
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.82
|
| Rate for Payer: Multiplan Commercial |
$33.06
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: Prime Health Services Commercial |
$37.47
|
|
|
HC SOM ENS MGLUR1 AB IFA
|
Facility
|
OP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915394
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.77
|
| 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 Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$26.76
|
| Rate for Payer: Blue Shield of California EPN |
$17.50
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Central Health Plan Commercial |
$35.26
|
| Rate for Payer: Cigna of CA HMO |
$28.21
|
| Rate for Payer: Cigna of CA PPO |
$32.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$37.47
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$33.06
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$37.47
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS NEUROCHONDRIN IFA
|
Facility
|
OP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915476
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.77
|
| 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 Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$26.76
|
| Rate for Payer: Blue Shield of California EPN |
$17.50
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Central Health Plan Commercial |
$35.26
|
| Rate for Payer: Cigna of CA HMO |
$28.21
|
| Rate for Payer: Cigna of CA PPO |
$32.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$37.47
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$33.06
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$37.47
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS NEUROCHONDRIN IFA
|
Facility
|
IP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915476
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$39.67 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Central Health Plan Commercial |
$35.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.63
|
| Rate for Payer: EPIC Health Plan Senior |
$17.63
|
| Rate for Payer: Galaxy Health WC |
$37.47
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.82
|
| Rate for Payer: Multiplan Commercial |
$33.06
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: Prime Health Services Commercial |
$37.47
|
|
|
HC SOM ENS NIF IFA
|
Facility
|
OP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915399
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.77
|
| 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 Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$26.76
|
| Rate for Payer: Blue Shield of California EPN |
$17.50
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Central Health Plan Commercial |
$35.26
|
| Rate for Payer: Cigna of CA HMO |
$28.21
|
| Rate for Payer: Cigna of CA PPO |
$32.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$37.47
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$33.06
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$37.47
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS NIF IFA
|
Facility
|
IP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915399
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$39.67 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Central Health Plan Commercial |
$35.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.63
|
| Rate for Payer: EPIC Health Plan Senior |
$17.63
|
| Rate for Payer: Galaxy Health WC |
$37.47
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.82
|
| Rate for Payer: Multiplan Commercial |
$33.06
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: Prime Health Services Commercial |
$37.47
|
|
|
HC SOM ENS NMDA-R AB CBA
|
Facility
|
IP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915389
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$39.67 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Central Health Plan Commercial |
$35.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.63
|
| Rate for Payer: EPIC Health Plan Senior |
$17.63
|
| Rate for Payer: Galaxy Health WC |
$37.47
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.82
|
| Rate for Payer: Multiplan Commercial |
$33.06
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: Prime Health Services Commercial |
$37.47
|
|
|
HC SOM ENS NMDA-R AB CBA
|
Facility
|
OP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915389
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.77
|
| 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 Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$26.76
|
| Rate for Payer: Blue Shield of California EPN |
$17.50
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Central Health Plan Commercial |
$35.26
|
| Rate for Payer: Cigna of CA HMO |
$28.21
|
| Rate for Payer: Cigna of CA PPO |
$32.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$37.47
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$33.06
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$37.47
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS PCA-1
|
Facility
|
IP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915386
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$39.67 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Central Health Plan Commercial |
$35.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.63
|
| Rate for Payer: EPIC Health Plan Senior |
$17.63
|
| Rate for Payer: Galaxy Health WC |
$37.47
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.82
|
| Rate for Payer: Multiplan Commercial |
$33.06
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: Prime Health Services Commercial |
$37.47
|
|
|
HC SOM ENS PCA-1
|
Facility
|
OP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915386
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.77
|
| 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 Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$26.76
|
| Rate for Payer: Blue Shield of California EPN |
$17.50
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Central Health Plan Commercial |
$35.26
|
| Rate for Payer: Cigna of CA HMO |
$28.21
|
| Rate for Payer: Cigna of CA PPO |
$32.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$37.47
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$33.06
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$37.47
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS PCA-2
|
Facility
|
IP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915383
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$39.67 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Central Health Plan Commercial |
$35.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.63
|
| Rate for Payer: EPIC Health Plan Senior |
$17.63
|
| Rate for Payer: Galaxy Health WC |
$37.47
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.82
|
| Rate for Payer: Multiplan Commercial |
$33.06
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: Prime Health Services Commercial |
$37.47
|
|
|
HC SOM ENS PCA-2
|
Facility
|
OP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915383
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.77
|
| 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 Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$26.76
|
| Rate for Payer: Blue Shield of California EPN |
$17.50
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Central Health Plan Commercial |
$35.26
|
| Rate for Payer: Cigna of CA HMO |
$28.21
|
| Rate for Payer: Cigna of CA PPO |
$32.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$37.47
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$33.06
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$37.47
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS PCA TR
|
Facility
|
OP
|
$44.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915381
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$8.81
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.76
|
| 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 Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$26.75
|
| Rate for Payer: Blue Shield of California EPN |
$17.50
|
| Rate for Payer: Cash Price |
$44.07
|
| Rate for Payer: Cash Price |
$44.07
|
| Rate for Payer: Central Health Plan Commercial |
$35.26
|
| Rate for Payer: Cigna of CA HMO |
$28.20
|
| Rate for Payer: Cigna of CA PPO |
$32.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$37.46
|
| Rate for Payer: Global Benefits Group Commercial |
$26.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.66
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$33.05
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$37.46
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS PCA TR
|
Facility
|
IP
|
$44.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915381
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$39.66 |
| Rate for Payer: Adventist Health Commercial |
$8.81
|
| Rate for Payer: Cash Price |
$44.07
|
| Rate for Payer: Central Health Plan Commercial |
$35.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.63
|
| Rate for Payer: EPIC Health Plan Senior |
$17.63
|
| Rate for Payer: Galaxy Health WC |
$37.46
|
| Rate for Payer: Global Benefits Group Commercial |
$26.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.81
|
| Rate for Payer: Multiplan Commercial |
$33.05
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: Prime Health Services Commercial |
$37.46
|
|
|
HC SOM ENS PDE10A IFA
|
Facility
|
IP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915475
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$39.67 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Central Health Plan Commercial |
$35.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.63
|
| Rate for Payer: EPIC Health Plan Senior |
$17.63
|
| Rate for Payer: Galaxy Health WC |
$37.47
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.82
|
| Rate for Payer: Multiplan Commercial |
$33.06
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: Prime Health Services Commercial |
$37.47
|
|
|
HC SOM ENS PDE10A IFA
|
Facility
|
OP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915475
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.77
|
| 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 Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$26.76
|
| Rate for Payer: Blue Shield of California EPN |
$17.50
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Central Health Plan Commercial |
$35.26
|
| Rate for Payer: Cigna of CA HMO |
$28.21
|
| Rate for Payer: Cigna of CA PPO |
$32.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$37.47
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$33.06
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$37.47
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS SEPTIN7 IFA
|
Facility
|
OP
|
$44.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915477
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$8.81
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.76
|
| 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 Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$26.75
|
| Rate for Payer: Blue Shield of California EPN |
$17.50
|
| Rate for Payer: Cash Price |
$44.07
|
| Rate for Payer: Cash Price |
$44.07
|
| Rate for Payer: Central Health Plan Commercial |
$35.26
|
| Rate for Payer: Cigna of CA HMO |
$28.20
|
| Rate for Payer: Cigna of CA PPO |
$32.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$37.46
|
| Rate for Payer: Global Benefits Group Commercial |
$26.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.66
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$33.05
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$37.46
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS SEPTIN7 IFA
|
Facility
|
IP
|
$44.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915477
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$39.66 |
| Rate for Payer: Adventist Health Commercial |
$8.81
|
| Rate for Payer: Cash Price |
$44.07
|
| Rate for Payer: Central Health Plan Commercial |
$35.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.63
|
| Rate for Payer: EPIC Health Plan Senior |
$17.63
|
| Rate for Payer: Galaxy Health WC |
$37.46
|
| Rate for Payer: Global Benefits Group Commercial |
$26.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.81
|
| Rate for Payer: Multiplan Commercial |
$33.05
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: Prime Health Services Commercial |
$37.46
|
|
|
HC SOM ENS TRIM46 IFA
|
Facility
|
OP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915474
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.77
|
| 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 Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$26.76
|
| Rate for Payer: Blue Shield of California EPN |
$17.50
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Central Health Plan Commercial |
$35.26
|
| Rate for Payer: Cigna of CA HMO |
$28.21
|
| Rate for Payer: Cigna of CA PPO |
$32.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$37.47
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$33.06
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$37.47
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS TRIM46 IFA
|
Facility
|
IP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915474
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$39.67 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Central Health Plan Commercial |
$35.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.63
|
| Rate for Payer: EPIC Health Plan Senior |
$17.63
|
| Rate for Payer: Galaxy Health WC |
$37.47
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.82
|
| Rate for Payer: Multiplan Commercial |
$33.06
|
| Rate for Payer: Networks By Design Commercial |
$28.65
|
| Rate for Payer: Prime Health Services Commercial |
$37.47
|
|
|
HC SOM ENTEROVIRUS PCR, BLOOD
|
Facility
|
IP
|
$39.23
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
900910691
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.85 |
| Max. Negotiated Rate |
$35.31 |
| Rate for Payer: Adventist Health Commercial |
$7.85
|
| Rate for Payer: Cash Price |
$39.23
|
| Rate for Payer: Central Health Plan Commercial |
$31.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.69
|
| Rate for Payer: EPIC Health Plan Senior |
$15.69
|
| Rate for Payer: Galaxy Health WC |
$33.35
|
| Rate for Payer: Global Benefits Group Commercial |
$23.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.85
|
| Rate for Payer: Multiplan Commercial |
$29.42
|
| Rate for Payer: Networks By Design Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Commercial |
$33.35
|
|
