|
HC SOM PCDEC CASPR2-IGG
|
Facility
|
OP
|
$50.20
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915449
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$30.47
|
| Rate for Payer: Blue Shield of California EPN |
$19.93
|
| Rate for Payer: Cash Price |
$50.20
|
| Rate for Payer: Cash Price |
$50.20
|
| Rate for Payer: Central Health Plan Commercial |
$40.16
|
| Rate for Payer: Cigna of CA HMO |
$32.13
|
| Rate for Payer: Cigna of CA PPO |
$37.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$42.67
|
| Rate for Payer: Global Benefits Group Commercial |
$30.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.04
|
| 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 |
$37.65
|
| Rate for Payer: Networks By Design Commercial |
$32.63
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$42.67
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDEC DPPX AB IFA
|
Facility
|
IP
|
$50.20
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$45.18 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Cash Price |
$50.20
|
| Rate for Payer: Central Health Plan Commercial |
$40.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.08
|
| Rate for Payer: EPIC Health Plan Senior |
$20.08
|
| Rate for Payer: Galaxy Health WC |
$42.67
|
| Rate for Payer: Global Benefits Group Commercial |
$30.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.04
|
| Rate for Payer: Multiplan Commercial |
$37.65
|
| Rate for Payer: Networks By Design Commercial |
$32.63
|
| Rate for Payer: Prime Health Services Commercial |
$42.67
|
|
|
HC SOM PCDEC DPPX AB IFA
|
Facility
|
OP
|
$50.20
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$30.47
|
| Rate for Payer: Blue Shield of California EPN |
$19.93
|
| Rate for Payer: Cash Price |
$50.20
|
| Rate for Payer: Cash Price |
$50.20
|
| Rate for Payer: Central Health Plan Commercial |
$40.16
|
| Rate for Payer: Cigna of CA HMO |
$32.13
|
| Rate for Payer: Cigna of CA PPO |
$37.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$42.67
|
| Rate for Payer: Global Benefits Group Commercial |
$30.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.04
|
| 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 |
$37.65
|
| Rate for Payer: Networks By Design Commercial |
$32.63
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$42.67
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDEC GABA-B-R AB CBA
|
Facility
|
IP
|
$50.20
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915446
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$45.18 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Cash Price |
$50.20
|
| Rate for Payer: Central Health Plan Commercial |
$40.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.08
|
| Rate for Payer: EPIC Health Plan Senior |
$20.08
|
| Rate for Payer: Galaxy Health WC |
$42.67
|
| Rate for Payer: Global Benefits Group Commercial |
$30.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.04
|
| Rate for Payer: Multiplan Commercial |
$37.65
|
| Rate for Payer: Networks By Design Commercial |
$32.63
|
| Rate for Payer: Prime Health Services Commercial |
$42.67
|
|
|
HC SOM PCDEC GABA-B-R AB CBA
|
Facility
|
OP
|
$50.20
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915446
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$30.47
|
| Rate for Payer: Blue Shield of California EPN |
$19.93
|
| Rate for Payer: Cash Price |
$50.20
|
| Rate for Payer: Cash Price |
$50.20
|
| Rate for Payer: Central Health Plan Commercial |
$40.16
|
| Rate for Payer: Cigna of CA HMO |
$32.13
|
| Rate for Payer: Cigna of CA PPO |
$37.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$42.67
|
| Rate for Payer: Global Benefits Group Commercial |
$30.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.04
|
| 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 |
$37.65
|
| Rate for Payer: Networks By Design Commercial |
$32.63
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$42.67
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDEC GAD65 AB
|
Facility
|
OP
|
$98.18
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.09 |
| Max. Negotiated Rate |
$111.86 |
| Rate for Payer: Adventist Health Commercial |
$19.64
|
| Rate for Payer: Adventist Health Medi-Cal |
$23.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.70
|
| Rate for Payer: Blue Shield of California Commercial |
$59.60
|
| Rate for Payer: Blue Shield of California EPN |
$38.98
|
| Rate for Payer: Cash Price |
$98.18
|
| Rate for Payer: Cash Price |
$98.18
|
| Rate for Payer: Central Health Plan Commercial |
$78.54
|
| Rate for Payer: Cigna of CA HMO |
$62.84
|
| Rate for Payer: Cigna of CA PPO |
$72.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.82
|
| Rate for Payer: EPIC Health Plan Senior |
$23.57
|
| Rate for Payer: Galaxy Health WC |
$83.45
|
| Rate for Payer: Global Benefits Group Commercial |
$58.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.36
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.57
|
| Rate for Payer: InnovAge PACE Commercial |
$35.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.64
|
| 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 |
$73.64
|
| Rate for Payer: Networks By Design Commercial |
$63.82
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23.57
|
| Rate for Payer: Prime Health Services Commercial |
$83.45
|
| Rate for Payer: Prime Health Services Medicare |
$24.98
|
| Rate for Payer: Riverside University Health System MISP |
$25.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.09
|
| Rate for Payer: United Healthcare All Other HMO |
$19.09
|
| Rate for Payer: United Healthcare HMO Rider |
$19.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$23.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM PCDEC GAD65 AB
|
Facility
|
IP
|
$98.18
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.64 |
| Max. Negotiated Rate |
$88.36 |
| Rate for Payer: Adventist Health Commercial |
$19.64
|
| Rate for Payer: Cash Price |
$98.18
|
| Rate for Payer: Central Health Plan Commercial |
$78.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.27
|
| Rate for Payer: EPIC Health Plan Senior |
$39.27
|
| Rate for Payer: Galaxy Health WC |
$83.45
|
| Rate for Payer: Global Benefits Group Commercial |
$58.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.64
|
| Rate for Payer: Multiplan Commercial |
$73.64
|
| Rate for Payer: Networks By Design Commercial |
$63.82
|
| Rate for Payer: Prime Health Services Commercial |
$83.45
|
|
|
HC SOM PCDEC GFAP IFA
|
Facility
|
OP
|
$50.19
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915452
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$30.47
|
| Rate for Payer: Blue Shield of California EPN |
$19.93
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Central Health Plan Commercial |
$40.15
|
| Rate for Payer: Cigna of CA HMO |
$32.12
|
| Rate for Payer: Cigna of CA PPO |
$37.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$42.66
|
| Rate for Payer: Global Benefits Group Commercial |
$30.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.04
|
| 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 |
$37.64
|
| Rate for Payer: Networks By Design Commercial |
$32.62
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$42.66
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDEC GFAP IFA
|
Facility
|
IP
|
$50.19
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915452
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$45.17 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Central Health Plan Commercial |
$40.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.08
|
| Rate for Payer: EPIC Health Plan Senior |
$20.08
|
| Rate for Payer: Galaxy Health WC |
$42.66
|
| Rate for Payer: Global Benefits Group Commercial |
$30.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.04
|
| Rate for Payer: Multiplan Commercial |
$37.64
|
| Rate for Payer: Networks By Design Commercial |
$32.62
|
| Rate for Payer: Prime Health Services Commercial |
$42.66
|
|
|
HC SOM PCDEC LGI1-IGG CBA
|
Facility
|
OP
|
$50.19
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915448
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$30.47
|
| Rate for Payer: Blue Shield of California EPN |
$19.93
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Central Health Plan Commercial |
$40.15
|
| Rate for Payer: Cigna of CA HMO |
$32.12
|
| Rate for Payer: Cigna of CA PPO |
$37.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$42.66
|
| Rate for Payer: Global Benefits Group Commercial |
$30.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.04
|
| 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 |
$37.64
|
| Rate for Payer: Networks By Design Commercial |
$32.62
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$42.66
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDEC LGI1-IGG CBA
|
Facility
|
IP
|
$50.19
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915448
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$45.17 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Central Health Plan Commercial |
$40.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.08
|
| Rate for Payer: EPIC Health Plan Senior |
$20.08
|
| Rate for Payer: Galaxy Health WC |
$42.66
|
| Rate for Payer: Global Benefits Group Commercial |
$30.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.04
|
| Rate for Payer: Multiplan Commercial |
$37.64
|
| Rate for Payer: Networks By Design Commercial |
$32.62
|
| Rate for Payer: Prime Health Services Commercial |
$42.66
|
|
|
HC SOM PCDEC MGLUR1 AB IFA
|
Facility
|
IP
|
$50.19
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915450
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$45.17 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Central Health Plan Commercial |
$40.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.08
|
| Rate for Payer: EPIC Health Plan Senior |
$20.08
|
| Rate for Payer: Galaxy Health WC |
$42.66
|
| Rate for Payer: Global Benefits Group Commercial |
$30.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.04
|
| Rate for Payer: Multiplan Commercial |
$37.64
|
| Rate for Payer: Networks By Design Commercial |
$32.62
|
| Rate for Payer: Prime Health Services Commercial |
$42.66
|
|
|
HC SOM PCDEC MGLUR1 AB IFA
|
Facility
|
OP
|
$50.19
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915450
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$30.47
|
| Rate for Payer: Blue Shield of California EPN |
$19.93
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Central Health Plan Commercial |
$40.15
|
| Rate for Payer: Cigna of CA HMO |
$32.12
|
| Rate for Payer: Cigna of CA PPO |
$37.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$42.66
|
| Rate for Payer: Global Benefits Group Commercial |
$30.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.04
|
| 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 |
$37.64
|
| Rate for Payer: Networks By Design Commercial |
$32.62
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$42.66
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDEC NMDA-R AB CBA
|
Facility
|
OP
|
$50.20
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$30.47
|
| Rate for Payer: Blue Shield of California EPN |
$19.93
|
| Rate for Payer: Cash Price |
$50.20
|
| Rate for Payer: Cash Price |
$50.20
|
| Rate for Payer: Central Health Plan Commercial |
$40.16
|
| Rate for Payer: Cigna of CA HMO |
$32.13
|
| Rate for Payer: Cigna of CA PPO |
$37.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$42.67
|
| Rate for Payer: Global Benefits Group Commercial |
$30.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.04
|
| 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 |
$37.65
|
| Rate for Payer: Networks By Design Commercial |
$32.63
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$42.67
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDEC NMDA-R AB CBA
|
Facility
|
IP
|
$50.20
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$45.18 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Cash Price |
$50.20
|
| Rate for Payer: Central Health Plan Commercial |
$40.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.08
|
| Rate for Payer: EPIC Health Plan Senior |
$20.08
|
| Rate for Payer: Galaxy Health WC |
$42.67
|
| Rate for Payer: Global Benefits Group Commercial |
$30.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.04
|
| Rate for Payer: Multiplan Commercial |
$37.65
|
| Rate for Payer: Networks By Design Commercial |
$32.63
|
| Rate for Payer: Prime Health Services Commercial |
$42.67
|
|
|
HC SOM PCDEC NMO/AQP4 FACS
|
Facility
|
OP
|
$157.17
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915447
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.01 |
| Max. Negotiated Rate |
$141.45 |
| Rate for Payer: Adventist Health Commercial |
$31.43
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.01
|
| Rate for Payer: Blue Shield of California Commercial |
$95.40
|
| Rate for Payer: Blue Shield of California EPN |
$62.40
|
| Rate for Payer: Cash Price |
$157.17
|
| Rate for Payer: Cash Price |
$157.17
|
| Rate for Payer: Central Health Plan Commercial |
$125.74
|
| Rate for Payer: Cigna of CA HMO |
$100.59
|
| Rate for Payer: Cigna of CA PPO |
$116.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.94
|
| Rate for Payer: EPIC Health Plan Senior |
$37.73
|
| Rate for Payer: Galaxy Health WC |
$133.59
|
| Rate for Payer: Global Benefits Group Commercial |
$94.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$141.45
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: InnovAge PACE Commercial |
$56.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$117.88
|
| Rate for Payer: Networks By Design Commercial |
$102.16
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.73
|
| Rate for Payer: Prime Health Services Commercial |
$133.59
|
| Rate for Payer: Prime Health Services Medicare |
$39.99
|
| Rate for Payer: Riverside University Health System MISP |
$41.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC SOM PCDEC NMO/AQP4 FACS
|
Facility
|
IP
|
$157.17
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915447
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.43 |
| Max. Negotiated Rate |
$141.45 |
| Rate for Payer: Adventist Health Commercial |
$31.43
|
| Rate for Payer: Cash Price |
$157.17
|
| Rate for Payer: Central Health Plan Commercial |
$125.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.87
|
| Rate for Payer: EPIC Health Plan Senior |
$62.87
|
| Rate for Payer: Galaxy Health WC |
$133.59
|
| Rate for Payer: Global Benefits Group Commercial |
$94.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$141.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$97.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.43
|
| Rate for Payer: Multiplan Commercial |
$117.88
|
| Rate for Payer: Networks By Design Commercial |
$102.16
|
| Rate for Payer: Prime Health Services Commercial |
$133.59
|
|
|
HC SOM PCDEC PCA-TR
|
Facility
|
IP
|
$50.19
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915443
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$45.17 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Central Health Plan Commercial |
$40.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.08
|
| Rate for Payer: EPIC Health Plan Senior |
$20.08
|
| Rate for Payer: Galaxy Health WC |
$42.66
|
| Rate for Payer: Global Benefits Group Commercial |
$30.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.04
|
| Rate for Payer: Multiplan Commercial |
$37.64
|
| Rate for Payer: Networks By Design Commercial |
$32.62
|
| Rate for Payer: Prime Health Services Commercial |
$42.66
|
|
|
HC SOM PCDEC PCA-TR
|
Facility
|
OP
|
$50.19
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915443
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$30.47
|
| Rate for Payer: Blue Shield of California EPN |
$19.93
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Central Health Plan Commercial |
$40.15
|
| Rate for Payer: Cigna of CA HMO |
$32.12
|
| Rate for Payer: Cigna of CA PPO |
$37.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$42.66
|
| Rate for Payer: Global Benefits Group Commercial |
$30.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.04
|
| 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 |
$37.64
|
| Rate for Payer: Networks By Design Commercial |
$32.62
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$42.66
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDES AMPA-R AB CBA
|
Facility
|
IP
|
$48.65
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$43.78 |
| Rate for Payer: Adventist Health Commercial |
$9.73
|
| Rate for Payer: Cash Price |
$48.65
|
| Rate for Payer: Central Health Plan Commercial |
$38.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.46
|
| Rate for Payer: EPIC Health Plan Senior |
$19.46
|
| Rate for Payer: Galaxy Health WC |
$41.35
|
| Rate for Payer: Global Benefits Group Commercial |
$29.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.73
|
| Rate for Payer: Multiplan Commercial |
$36.49
|
| Rate for Payer: Networks By Design Commercial |
$31.62
|
| Rate for Payer: Prime Health Services Commercial |
$41.35
|
|
|
HC SOM PCDES AMPA-R AB CBA
|
Facility
|
OP
|
$48.65
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$9.73
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$29.53
|
| Rate for Payer: Blue Shield of California EPN |
$19.31
|
| Rate for Payer: Cash Price |
$48.65
|
| Rate for Payer: Cash Price |
$48.65
|
| Rate for Payer: Central Health Plan Commercial |
$38.92
|
| Rate for Payer: Cigna of CA HMO |
$31.14
|
| Rate for Payer: Cigna of CA PPO |
$36.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$41.35
|
| Rate for Payer: Global Benefits Group Commercial |
$29.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.73
|
| 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 |
$36.49
|
| Rate for Payer: Networks By Design Commercial |
$31.62
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$41.35
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDES ANNA1
|
Facility
|
OP
|
$48.65
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915489
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$9.73
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$29.53
|
| Rate for Payer: Blue Shield of California EPN |
$19.31
|
| Rate for Payer: Cash Price |
$48.65
|
| Rate for Payer: Cash Price |
$48.65
|
| Rate for Payer: Central Health Plan Commercial |
$38.92
|
| Rate for Payer: Cigna of CA HMO |
$31.14
|
| Rate for Payer: Cigna of CA PPO |
$36.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$41.35
|
| Rate for Payer: Global Benefits Group Commercial |
$29.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.73
|
| 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 |
$36.49
|
| Rate for Payer: Networks By Design Commercial |
$31.62
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$41.35
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDES ANNA1
|
Facility
|
IP
|
$48.65
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915489
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$43.78 |
| Rate for Payer: Adventist Health Commercial |
$9.73
|
| Rate for Payer: Cash Price |
$48.65
|
| Rate for Payer: Central Health Plan Commercial |
$38.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.46
|
| Rate for Payer: EPIC Health Plan Senior |
$19.46
|
| Rate for Payer: Galaxy Health WC |
$41.35
|
| Rate for Payer: Global Benefits Group Commercial |
$29.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.73
|
| Rate for Payer: Multiplan Commercial |
$36.49
|
| Rate for Payer: Networks By Design Commercial |
$31.62
|
| Rate for Payer: Prime Health Services Commercial |
$41.35
|
|
|
HC SOM PCDES CASPR2 IGG CBA
|
Facility
|
IP
|
$48.65
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915495
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$43.78 |
| Rate for Payer: Adventist Health Commercial |
$9.73
|
| Rate for Payer: Cash Price |
$48.65
|
| Rate for Payer: Central Health Plan Commercial |
$38.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.46
|
| Rate for Payer: EPIC Health Plan Senior |
$19.46
|
| Rate for Payer: Galaxy Health WC |
$41.35
|
| Rate for Payer: Global Benefits Group Commercial |
$29.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.73
|
| Rate for Payer: Multiplan Commercial |
$36.49
|
| Rate for Payer: Networks By Design Commercial |
$31.62
|
| Rate for Payer: Prime Health Services Commercial |
$41.35
|
|
|
HC SOM PCDES CASPR2 IGG CBA
|
Facility
|
OP
|
$48.65
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915495
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$9.73
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$29.53
|
| Rate for Payer: Blue Shield of California EPN |
$19.31
|
| Rate for Payer: Cash Price |
$48.65
|
| Rate for Payer: Cash Price |
$48.65
|
| Rate for Payer: Central Health Plan Commercial |
$38.92
|
| Rate for Payer: Cigna of CA HMO |
$31.14
|
| Rate for Payer: Cigna of CA PPO |
$36.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$41.35
|
| Rate for Payer: Global Benefits Group Commercial |
$29.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.73
|
| 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 |
$36.49
|
| Rate for Payer: Networks By Design Commercial |
$31.62
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$41.35
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
