|
HC SOM ENC AMPA-R AB CBA, CSF
|
Facility
IP
|
$45.34
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915410
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$40.81 |
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Central Health Plan Commercial |
$36.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.14
|
| Rate for Payer: Galaxy Health WC |
$38.54
|
| Rate for Payer: Global Benefits Group Commercial |
$27.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.07
|
| Rate for Payer: Multiplan Commercial |
$34.00
|
| Rate for Payer: Networks By Design Commercial |
$29.47
|
| Rate for Payer: Prime Health Services Commercial |
$38.54
|
|
|
HC SOM ENC AMPHYIPHYSIN AB, CSF
|
Facility
IP
|
$45.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915407
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Central Health Plan Commercial |
$36.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.13
|
| Rate for Payer: Galaxy Health WC |
$38.53
|
| Rate for Payer: Global Benefits Group Commercial |
$27.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.07
|
| Rate for Payer: Multiplan Commercial |
$34.00
|
| Rate for Payer: Networks By Design Commercial |
$29.46
|
| Rate for Payer: Prime Health Services Commercial |
$38.53
|
|
|
HC SOM ENC AMPHYIPHYSIN AB, CSF
|
Facility
OP
|
$45.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915407
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare 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 |
$106.99
|
| Rate for Payer: BCBS Transplant Transplant |
$27.20
|
| Rate for Payer: Blue Shield of California Commercial |
$28.01
|
| Rate for Payer: Blue Shield of California EPN |
$22.03
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Central Health Plan Commercial |
$36.26
|
| Rate for Payer: Cigna of CA HMO |
$29.01
|
| Rate for Payer: Cigna of CA PPO |
$33.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$38.53
|
| Rate for Payer: Global Benefits Group Commercial |
$27.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$34.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: IEHP medi-cal |
$19.88
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Innovage PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.07
|
| 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 |
$34.00
|
| Rate for Payer: Networks By Design Commercial |
$29.46
|
| Rate for Payer: Prime Health Services Commercial |
$38.53
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$27.20
|
| Rate for Payer: Riverside University Health MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENC ANNA-1, CSF
|
Facility
OP
|
$45.34
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915404
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare 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 |
$106.99
|
| Rate for Payer: BCBS Transplant Transplant |
$27.20
|
| Rate for Payer: Blue Shield of California Commercial |
$28.02
|
| Rate for Payer: Blue Shield of California EPN |
$22.04
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Central Health Plan Commercial |
$36.27
|
| Rate for Payer: Cigna of CA HMO |
$29.02
|
| Rate for Payer: Cigna of CA PPO |
$33.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$38.54
|
| Rate for Payer: Global Benefits Group Commercial |
$27.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.81
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$34.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: IEHP medi-cal |
$19.88
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Innovage PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.07
|
| 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 |
$34.00
|
| Rate for Payer: Networks By Design Commercial |
$29.47
|
| Rate for Payer: Prime Health Services Commercial |
$38.54
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$27.20
|
| Rate for Payer: Riverside University Health MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENC ANNA-1, CSF
|
Facility
IP
|
$45.34
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915404
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$40.81 |
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Central Health Plan Commercial |
$36.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.14
|
| Rate for Payer: Galaxy Health WC |
$38.54
|
| Rate for Payer: Global Benefits Group Commercial |
$27.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.07
|
| Rate for Payer: Multiplan Commercial |
$34.00
|
| Rate for Payer: Networks By Design Commercial |
$29.47
|
| Rate for Payer: Prime Health Services Commercial |
$38.54
|
|
|
HC SOM ENC ANNA-2, CSF
|
Facility
IP
|
$45.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915405
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Central Health Plan Commercial |
$36.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.13
|
| Rate for Payer: Galaxy Health WC |
$38.53
|
| Rate for Payer: Global Benefits Group Commercial |
$27.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.07
|
| Rate for Payer: Multiplan Commercial |
$34.00
|
| Rate for Payer: Networks By Design Commercial |
$29.46
|
| Rate for Payer: Prime Health Services Commercial |
$38.53
|
|
|
HC SOM ENC ANNA-2, CSF
|
Facility
OP
|
$45.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915405
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare 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 |
$106.99
|
| Rate for Payer: BCBS Transplant Transplant |
$27.20
|
| Rate for Payer: Blue Shield of California Commercial |
$28.01
|
| Rate for Payer: Blue Shield of California EPN |
$22.03
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Central Health Plan Commercial |
$36.26
|
| Rate for Payer: Cigna of CA HMO |
$29.01
|
| Rate for Payer: Cigna of CA PPO |
$33.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$38.53
|
| Rate for Payer: Global Benefits Group Commercial |
$27.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$34.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: IEHP medi-cal |
$19.88
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Innovage PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.07
|
| 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 |
$34.00
|
| Rate for Payer: Networks By Design Commercial |
$29.46
|
| Rate for Payer: Prime Health Services Commercial |
$38.53
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$27.20
|
| Rate for Payer: Riverside University Health MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENC ANNA-3, CSF
|
Facility
IP
|
$45.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915402
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Central Health Plan Commercial |
$36.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.13
|
| Rate for Payer: Galaxy Health WC |
$38.53
|
| Rate for Payer: Global Benefits Group Commercial |
$27.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.07
|
| Rate for Payer: Multiplan Commercial |
$34.00
|
| Rate for Payer: Networks By Design Commercial |
$29.46
|
| Rate for Payer: Prime Health Services Commercial |
$38.53
|
|
|
HC SOM ENC ANNA-3, CSF
|
Facility
OP
|
$45.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915402
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare 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 |
$106.99
|
| Rate for Payer: BCBS Transplant Transplant |
$27.20
|
| Rate for Payer: Blue Shield of California Commercial |
$28.01
|
| Rate for Payer: Blue Shield of California EPN |
$22.03
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Central Health Plan Commercial |
$36.26
|
| Rate for Payer: Cigna of CA HMO |
$29.01
|
| Rate for Payer: Cigna of CA PPO |
$33.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$38.53
|
| Rate for Payer: Global Benefits Group Commercial |
$27.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$34.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: IEHP medi-cal |
$19.88
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Innovage PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.07
|
| 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 |
$34.00
|
| Rate for Payer: Networks By Design Commercial |
$29.46
|
| Rate for Payer: Prime Health Services Commercial |
$38.53
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$27.20
|
| Rate for Payer: Riverside University Health MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENC CASPR2-IGG CBA, CSF
|
Facility
OP
|
$45.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915413
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare 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 |
$106.99
|
| Rate for Payer: BCBS Transplant Transplant |
$27.20
|
| Rate for Payer: Blue Shield of California Commercial |
$28.01
|
| Rate for Payer: Blue Shield of California EPN |
$22.03
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Central Health Plan Commercial |
$36.26
|
| Rate for Payer: Cigna of CA HMO |
$29.01
|
| Rate for Payer: Cigna of CA PPO |
$33.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$38.53
|
| Rate for Payer: Global Benefits Group Commercial |
$27.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$34.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: IEHP medi-cal |
$19.88
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Innovage PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.07
|
| 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 |
$34.00
|
| Rate for Payer: Networks By Design Commercial |
$29.46
|
| Rate for Payer: Prime Health Services Commercial |
$38.53
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$27.20
|
| Rate for Payer: Riverside University Health MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENC CASPR2-IGG CBA, CSF
|
Facility
IP
|
$45.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915413
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Central Health Plan Commercial |
$36.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.13
|
| Rate for Payer: Galaxy Health WC |
$38.53
|
| Rate for Payer: Global Benefits Group Commercial |
$27.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.07
|
| Rate for Payer: Multiplan Commercial |
$34.00
|
| Rate for Payer: Networks By Design Commercial |
$29.46
|
| Rate for Payer: Prime Health Services Commercial |
$38.53
|
|
|
HC SOM ENC CRMP-5-IGG, CSF
|
Facility
OP
|
$45.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915415
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare 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 |
$106.99
|
| Rate for Payer: BCBS Transplant Transplant |
$27.20
|
| Rate for Payer: Blue Shield of California Commercial |
$28.01
|
| Rate for Payer: Blue Shield of California EPN |
$22.03
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Central Health Plan Commercial |
$36.26
|
| Rate for Payer: Cigna of CA HMO |
$29.01
|
| Rate for Payer: Cigna of CA PPO |
$33.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$38.53
|
| Rate for Payer: Global Benefits Group Commercial |
$27.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$34.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: IEHP medi-cal |
$19.88
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Innovage PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.07
|
| 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 |
$34.00
|
| Rate for Payer: Networks By Design Commercial |
$29.46
|
| Rate for Payer: Prime Health Services Commercial |
$38.53
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$27.20
|
| Rate for Payer: Riverside University Health MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENC CRMP-5-IGG, CSF
|
Facility
IP
|
$45.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915415
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Central Health Plan Commercial |
$36.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.13
|
| Rate for Payer: Galaxy Health WC |
$38.53
|
| Rate for Payer: Global Benefits Group Commercial |
$27.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.07
|
| Rate for Payer: Multiplan Commercial |
$34.00
|
| Rate for Payer: Networks By Design Commercial |
$29.46
|
| Rate for Payer: Prime Health Services Commercial |
$38.53
|
|
|
HC SOM ENC DPPX AB IFA, CSF
|
Facility
IP
|
$45.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915416
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Central Health Plan Commercial |
$36.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.13
|
| Rate for Payer: Galaxy Health WC |
$38.53
|
| Rate for Payer: Global Benefits Group Commercial |
$27.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.07
|
| Rate for Payer: Multiplan Commercial |
$34.00
|
| Rate for Payer: Networks By Design Commercial |
$29.46
|
| Rate for Payer: Prime Health Services Commercial |
$38.53
|
|
|
HC SOM ENC DPPX AB IFA, CSF
|
Facility
OP
|
$45.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915416
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare 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 |
$106.99
|
| Rate for Payer: BCBS Transplant Transplant |
$27.20
|
| Rate for Payer: Blue Shield of California Commercial |
$28.01
|
| Rate for Payer: Blue Shield of California EPN |
$22.03
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Central Health Plan Commercial |
$36.26
|
| Rate for Payer: Cigna of CA HMO |
$29.01
|
| Rate for Payer: Cigna of CA PPO |
$33.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$38.53
|
| Rate for Payer: Global Benefits Group Commercial |
$27.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$34.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: IEHP medi-cal |
$19.88
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Innovage PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.07
|
| 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 |
$34.00
|
| Rate for Payer: Networks By Design Commercial |
$29.46
|
| Rate for Payer: Prime Health Services Commercial |
$38.53
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$27.20
|
| Rate for Payer: Riverside University Health MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENC GABA-B-R AB CBA, CSF
|
Facility
IP
|
$45.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915411
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Central Health Plan Commercial |
$36.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.13
|
| Rate for Payer: Galaxy Health WC |
$38.53
|
| Rate for Payer: Global Benefits Group Commercial |
$27.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.07
|
| Rate for Payer: Multiplan Commercial |
$34.00
|
| Rate for Payer: Networks By Design Commercial |
$29.46
|
| Rate for Payer: Prime Health Services Commercial |
$38.53
|
|
|
HC SOM ENC GABA-B-R AB CBA, CSF
|
Facility
OP
|
$45.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915411
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare 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 |
$106.99
|
| Rate for Payer: BCBS Transplant Transplant |
$27.20
|
| Rate for Payer: Blue Shield of California Commercial |
$28.01
|
| Rate for Payer: Blue Shield of California EPN |
$22.03
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Central Health Plan Commercial |
$36.26
|
| Rate for Payer: Cigna of CA HMO |
$29.01
|
| Rate for Payer: Cigna of CA PPO |
$33.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$38.53
|
| Rate for Payer: Global Benefits Group Commercial |
$27.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$34.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: IEHP medi-cal |
$19.88
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Innovage PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.07
|
| 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 |
$34.00
|
| Rate for Payer: Networks By Design Commercial |
$29.46
|
| Rate for Payer: Prime Health Services Commercial |
$38.53
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$27.20
|
| Rate for Payer: Riverside University Health MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENC GAD65 AB, CSF
|
Facility
IP
|
$88.68
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915400
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$79.81 |
| Rate for Payer: Cash Price |
$39.91
|
| Rate for Payer: Central Health Plan Commercial |
$70.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.47
|
| Rate for Payer: Galaxy Health WC |
$75.38
|
| Rate for Payer: Global Benefits Group Commercial |
$53.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$66.51
|
| Rate for Payer: Networks By Design Commercial |
$57.64
|
| Rate for Payer: Prime Health Services Commercial |
$75.38
|
|
|
HC SOM ENC GAD65 AB, CSF
|
Facility
OP
|
$88.68
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915400
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$136.45 |
| Rate for Payer: Adventist Health Medi-Cal |
$23.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$35.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.45
|
| Rate for Payer: BCBS Transplant Transplant |
$53.21
|
| Rate for Payer: Blue Shield of California Commercial |
$54.80
|
| Rate for Payer: Blue Shield of California EPN |
$43.10
|
| Rate for Payer: Caremore Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$39.91
|
| Rate for Payer: Cash Price |
$39.91
|
| Rate for Payer: Central Health Plan Commercial |
$70.94
|
| Rate for Payer: Cigna of CA HMO |
$56.76
|
| Rate for Payer: Cigna of CA PPO |
$65.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.57
|
| Rate for Payer: Galaxy Health WC |
$75.38
|
| Rate for Payer: Global Benefits Group Commercial |
$53.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.81
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$66.51
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38.65
|
| Rate for Payer: IEHP medi-cal |
$38.89
|
| Rate for Payer: IEHP Medicare Advantage |
$23.57
|
| Rate for Payer: Innovage PACE Commercial |
$35.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.58
|
| Rate for Payer: Multiplan Commercial |
$66.51
|
| Rate for Payer: Networks By Design Commercial |
$57.64
|
| Rate for Payer: Prime Health Services Commercial |
$75.38
|
| Rate for Payer: Prime Health Services Medicare |
$24.98
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$53.21
|
| Rate for Payer: Riverside University Health MISP |
$25.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.21
|
| 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: Vantage Medical Group Commercial/Exchange |
$35.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM ENC GFAP IFA, CSF
|
Facility
OP
|
$45.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915417
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare 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 |
$106.99
|
| Rate for Payer: BCBS Transplant Transplant |
$27.20
|
| Rate for Payer: Blue Shield of California Commercial |
$28.01
|
| Rate for Payer: Blue Shield of California EPN |
$22.03
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Central Health Plan Commercial |
$36.26
|
| Rate for Payer: Cigna of CA HMO |
$29.01
|
| Rate for Payer: Cigna of CA PPO |
$33.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$38.53
|
| Rate for Payer: Global Benefits Group Commercial |
$27.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$34.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: IEHP medi-cal |
$19.88
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Innovage PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.07
|
| 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 |
$34.00
|
| Rate for Payer: Networks By Design Commercial |
$29.46
|
| Rate for Payer: Prime Health Services Commercial |
$38.53
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$27.20
|
| Rate for Payer: Riverside University Health MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENC GFAP IFA, CSF
|
Facility
IP
|
$45.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915417
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Central Health Plan Commercial |
$36.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.13
|
| Rate for Payer: Galaxy Health WC |
$38.53
|
| Rate for Payer: Global Benefits Group Commercial |
$27.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.07
|
| Rate for Payer: Multiplan Commercial |
$34.00
|
| Rate for Payer: Networks By Design Commercial |
$29.46
|
| Rate for Payer: Prime Health Services Commercial |
$38.53
|
|
|
HC SOM ENC IGLON5 IFA, CSF
|
Facility
IP
|
$45.34
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915418
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$40.81 |
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Central Health Plan Commercial |
$36.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.14
|
| Rate for Payer: Galaxy Health WC |
$38.54
|
| Rate for Payer: Global Benefits Group Commercial |
$27.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.07
|
| Rate for Payer: Multiplan Commercial |
$34.00
|
| Rate for Payer: Networks By Design Commercial |
$29.47
|
| Rate for Payer: Prime Health Services Commercial |
$38.54
|
|
|
HC SOM ENC IGLON5 IFA, CSF
|
Facility
OP
|
$45.34
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915418
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare 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 |
$106.99
|
| Rate for Payer: BCBS Transplant Transplant |
$27.20
|
| Rate for Payer: Blue Shield of California Commercial |
$28.02
|
| Rate for Payer: Blue Shield of California EPN |
$22.04
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Central Health Plan Commercial |
$36.27
|
| Rate for Payer: Cigna of CA HMO |
$29.02
|
| Rate for Payer: Cigna of CA PPO |
$33.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$38.54
|
| Rate for Payer: Global Benefits Group Commercial |
$27.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.81
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$34.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: IEHP medi-cal |
$19.88
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Innovage PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.07
|
| 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 |
$34.00
|
| Rate for Payer: Networks By Design Commercial |
$29.47
|
| Rate for Payer: Prime Health Services Commercial |
$38.54
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$27.20
|
| Rate for Payer: Riverside University Health MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENC LGI1-IGG CBA, CSF
|
Facility
IP
|
$45.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915412
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Central Health Plan Commercial |
$36.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.13
|
| Rate for Payer: Galaxy Health WC |
$38.53
|
| Rate for Payer: Global Benefits Group Commercial |
$27.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.07
|
| Rate for Payer: Multiplan Commercial |
$34.00
|
| Rate for Payer: Networks By Design Commercial |
$29.46
|
| Rate for Payer: Prime Health Services Commercial |
$38.53
|
|
|
HC SOM ENC LGI1-IGG CBA, CSF
|
Facility
OP
|
$45.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915412
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare 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 |
$106.99
|
| Rate for Payer: BCBS Transplant Transplant |
$27.20
|
| Rate for Payer: Blue Shield of California Commercial |
$28.01
|
| Rate for Payer: Blue Shield of California EPN |
$22.03
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Central Health Plan Commercial |
$36.26
|
| Rate for Payer: Cigna of CA HMO |
$29.01
|
| Rate for Payer: Cigna of CA PPO |
$33.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$38.53
|
| Rate for Payer: Global Benefits Group Commercial |
$27.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$34.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: IEHP medi-cal |
$19.88
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Innovage PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.07
|
| 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 |
$34.00
|
| Rate for Payer: Networks By Design Commercial |
$29.46
|
| Rate for Payer: Prime Health Services Commercial |
$38.53
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$27.20
|
| Rate for Payer: Riverside University Health MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
