|
HC SOM ENC MGLUR1 AB IFA, CSF
|
Facility
OP
|
$45.34
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915414
|
|
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 MGLUR1 AB IFA, CSF
|
Facility
IP
|
$45.34
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915414
|
|
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 NIF IFA, CSF
|
Facility
IP
|
$45.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915419
|
|
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 NIF IFA, CSF
|
Facility
OP
|
$45.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915419
|
|
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 NMDA-R AB CBA, CSF
|
Facility
OP
|
$45.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915409
|
|
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 NMDA-R AB CBA, CSF
|
Facility
IP
|
$45.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915409
|
|
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 PCA-1, CSF
|
Facility
OP
|
$45.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915406
|
|
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 PCA-1, CSF
|
Facility
IP
|
$45.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915406
|
|
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 PCA-2, CSF
|
Facility
OP
|
$45.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915403
|
|
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 PCA-2, CSF
|
Facility
IP
|
$45.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915403
|
|
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 PCA TR, CSF
|
Facility
OP
|
$45.34
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915401
|
|
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 PCA TR, CSF
|
Facility
IP
|
$45.34
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915401
|
|
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 ENDOMYSIAL IGA AB
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
900911423
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM ENDOMYSIAL IGA AB
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
900911423
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$63.07 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.23
|
| Rate for Payer: BCBS Transplant Transplant |
$15.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15.45
|
| Rate for Payer: Blue Shield of California EPN |
$12.15
|
| Rate for Payer: Caremore Medicare Advantage |
$12.09
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.09
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.83
|
| Rate for Payer: IEHP medi-cal |
$19.95
|
| Rate for Payer: IEHP Medicare Advantage |
$12.09
|
| Rate for Payer: Innovage PACE Commercial |
$18.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$12.82
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: Riverside University Health MISP |
$13.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.79
|
| Rate for Payer: United Healthcare All Other HMO |
$9.79
|
| Rate for Payer: United Healthcare HMO Rider |
$9.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: Vantage Medical Group Senior |
$12.09
|
|
|
HC SOM ENS AGNA-1
|
Facility
IP
|
$52.49
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915388
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$47.24 |
| Rate for Payer: Cash Price |
$23.62
|
| Rate for Payer: Central Health Plan Commercial |
$41.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 AGNA-1
|
Facility
OP
|
$52.49
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915388
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.76 |
| 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 |
$31.49
|
| Rate for Payer: Blue Shield of California Commercial |
$32.44
|
| Rate for Payer: Blue Shield of California EPN |
$25.51
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$23.62
|
| Rate for Payer: Cash Price |
$23.62
|
| 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 |
$18.08
|
| 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 |
$44.62
|
| Rate for Payer: Global Benefits Group Commercial |
$31.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$39.37
|
| 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 |
$35.01
|
| 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: Prime Health Services Commercial |
$44.62
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$31.49
|
| Rate for Payer: Riverside University Health 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 |
$9.76
|
| 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 ENS AMPA-R AB CBA
|
Facility
IP
|
$52.49
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915390
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$47.24 |
| Rate for Payer: Cash Price |
$23.62
|
| Rate for Payer: Central Health Plan Commercial |
$41.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 AMPA-R AB CBA
|
Facility
OP
|
$52.49
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915390
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.76 |
| 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 |
$31.49
|
| Rate for Payer: Blue Shield of California Commercial |
$32.44
|
| Rate for Payer: Blue Shield of California EPN |
$25.51
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$23.62
|
| Rate for Payer: Cash Price |
$23.62
|
| 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 |
$18.08
|
| 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 |
$44.62
|
| Rate for Payer: Global Benefits Group Commercial |
$31.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$39.37
|
| 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 |
$35.01
|
| 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: Prime Health Services Commercial |
$44.62
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$31.49
|
| Rate for Payer: Riverside University Health 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 |
$9.76
|
| 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 ENS AMPHYIPHYSIN AB
|
Facility
OP
|
$52.49
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915387
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.76 |
| 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 |
$31.49
|
| Rate for Payer: Blue Shield of California Commercial |
$32.44
|
| Rate for Payer: Blue Shield of California EPN |
$25.51
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$23.62
|
| Rate for Payer: Cash Price |
$23.62
|
| 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 |
$18.08
|
| 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 |
$44.62
|
| Rate for Payer: Global Benefits Group Commercial |
$31.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$39.37
|
| 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 |
$35.01
|
| 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: Prime Health Services Commercial |
$44.62
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$31.49
|
| Rate for Payer: Riverside University Health 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 |
$9.76
|
| 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 ENS AMPHYIPHYSIN AB
|
Facility
IP
|
$52.49
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915387
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$47.24 |
| Rate for Payer: Cash Price |
$23.62
|
| Rate for Payer: Central Health Plan Commercial |
$41.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 ANNA-1
|
Facility
IP
|
$52.49
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915384
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$47.24 |
| Rate for Payer: Cash Price |
$23.62
|
| Rate for Payer: Central Health Plan Commercial |
$41.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 ANNA-1
|
Facility
OP
|
$52.49
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915384
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.76 |
| 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 |
$31.49
|
| Rate for Payer: Blue Shield of California Commercial |
$32.44
|
| Rate for Payer: Blue Shield of California EPN |
$25.51
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$23.62
|
| Rate for Payer: Cash Price |
$23.62
|
| 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 |
$18.08
|
| 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 |
$44.62
|
| Rate for Payer: Global Benefits Group Commercial |
$31.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$39.37
|
| 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 |
$35.01
|
| 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: Prime Health Services Commercial |
$44.62
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$31.49
|
| Rate for Payer: Riverside University Health 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 |
$9.76
|
| 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 ENS ANNA-2
|
Facility
IP
|
$52.49
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915385
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$47.24 |
| Rate for Payer: Cash Price |
$23.62
|
| Rate for Payer: Central Health Plan Commercial |
$41.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 ANNA-2
|
Facility
OP
|
$52.49
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915385
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.76 |
| 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 |
$31.49
|
| Rate for Payer: Blue Shield of California Commercial |
$32.44
|
| Rate for Payer: Blue Shield of California EPN |
$25.51
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$23.62
|
| Rate for Payer: Cash Price |
$23.62
|
| 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 |
$18.08
|
| 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 |
$44.62
|
| Rate for Payer: Global Benefits Group Commercial |
$31.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$39.37
|
| 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 |
$35.01
|
| 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: Prime Health Services Commercial |
$44.62
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$31.49
|
| Rate for Payer: Riverside University Health 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 |
$9.76
|
| 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 ENS ANNA-3
|
Facility
IP
|
$52.49
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915382
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$47.24 |
| Rate for Payer: Cash Price |
$23.62
|
| Rate for Payer: Central Health Plan Commercial |
$41.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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
|
|
