|
HC SOM PCDES DPPX AB CBA
|
Facility
|
OP
|
$48.65
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915498
|
|
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 DPPX AB CBA
|
Facility
|
IP
|
$48.65
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915498
|
|
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 GABA-B-R AB CBA
|
Facility
|
IP
|
$48.65
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915492
|
|
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 GABA-B-R AB CBA
|
Facility
|
OP
|
$48.65
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915492
|
|
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 GAD65 AB
|
Facility
|
IP
|
$95.16
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915487
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.03 |
| Max. Negotiated Rate |
$85.64 |
| Rate for Payer: Adventist Health Commercial |
$19.03
|
| Rate for Payer: Cash Price |
$95.16
|
| Rate for Payer: Central Health Plan Commercial |
$76.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.06
|
| Rate for Payer: EPIC Health Plan Senior |
$38.06
|
| Rate for Payer: Galaxy Health WC |
$80.89
|
| Rate for Payer: Global Benefits Group Commercial |
$57.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$85.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.03
|
| Rate for Payer: Multiplan Commercial |
$71.37
|
| Rate for Payer: Networks By Design Commercial |
$61.85
|
| Rate for Payer: Prime Health Services Commercial |
$80.89
|
|
|
HC SOM PCDES GAD65 AB
|
Facility
|
OP
|
$95.16
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915487
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.03 |
| Max. Negotiated Rate |
$111.86 |
| Rate for Payer: Adventist Health Commercial |
$19.03
|
| Rate for Payer: Adventist Health Medi-Cal |
$23.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.79
|
| 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 |
$57.76
|
| Rate for Payer: Blue Shield of California EPN |
$37.78
|
| Rate for Payer: Cash Price |
$95.16
|
| Rate for Payer: Cash Price |
$95.16
|
| Rate for Payer: Central Health Plan Commercial |
$76.13
|
| Rate for Payer: Cigna of CA HMO |
$60.90
|
| Rate for Payer: Cigna of CA PPO |
$70.42
|
| 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 |
$80.89
|
| Rate for Payer: Global Benefits Group Commercial |
$57.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$85.64
|
| 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 |
$63.47
|
| 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 |
$19.03
|
| 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 |
$71.37
|
| Rate for Payer: Networks By Design Commercial |
$61.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23.57
|
| Rate for Payer: Prime Health Services Commercial |
$80.89
|
| 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 |
$57.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.09
|
| Rate for Payer: United Healthcare All Other HMO |
$19.09
|
| Rate for Payer: United Healthcare HMO Rider |
$19.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$23.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM PCDES GFAP IFA
|
Facility
|
IP
|
$48.65
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915499
|
|
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 GFAP IFA
|
Facility
|
OP
|
$48.65
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915499
|
|
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 LGI1 IGG CBA
|
Facility
|
OP
|
$48.65
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915494
|
|
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 LGI1 IGG CBA
|
Facility
|
IP
|
$48.65
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915494
|
|
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 MGLUR1 AB IFA
|
Facility
|
IP
|
$48.66
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915497
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$43.79 |
| Rate for Payer: Adventist Health Commercial |
$9.73
|
| Rate for Payer: Cash Price |
$48.66
|
| Rate for Payer: Central Health Plan Commercial |
$38.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.46
|
| Rate for Payer: EPIC Health Plan Senior |
$19.46
|
| Rate for Payer: Galaxy Health WC |
$41.36
|
| Rate for Payer: Global Benefits Group Commercial |
$29.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.12
|
| 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 |
$31.63
|
| Rate for Payer: Prime Health Services Commercial |
$41.36
|
|
|
HC SOM PCDES MGLUR1 AB IFA
|
Facility
|
OP
|
$48.66
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915497
|
|
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 |
$29.54
|
| Rate for Payer: Blue Shield of California EPN |
$19.32
|
| Rate for Payer: Cash Price |
$48.66
|
| Rate for Payer: Cash Price |
$48.66
|
| Rate for Payer: Central Health Plan Commercial |
$38.93
|
| Rate for Payer: Cigna of CA HMO |
$31.14
|
| Rate for Payer: Cigna of CA PPO |
$36.01
|
| 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 |
$41.36
|
| Rate for Payer: Global Benefits Group Commercial |
$29.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.79
|
| 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 |
$32.46
|
| 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 |
$31.63
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$41.36
|
| 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 |
$29.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.20
|
| 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 MOG FACS
|
Facility
|
OP
|
$152.33
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
900915496
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.01 |
| Max. Negotiated Rate |
$137.10 |
| Rate for Payer: Adventist Health Commercial |
$30.47
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$92.51
|
| 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 |
$92.46
|
| Rate for Payer: Blue Shield of California EPN |
$60.48
|
| Rate for Payer: Cash Price |
$152.33
|
| Rate for Payer: Cash Price |
$152.33
|
| Rate for Payer: Central Health Plan Commercial |
$121.86
|
| Rate for Payer: Cigna of CA HMO |
$97.49
|
| Rate for Payer: Cigna of CA PPO |
$112.72
|
| 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 |
$129.48
|
| Rate for Payer: Global Benefits Group Commercial |
$91.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$137.10
|
| 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 |
$101.60
|
| 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 |
$30.47
|
| 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 |
$114.25
|
| Rate for Payer: Networks By Design Commercial |
$99.01
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.73
|
| Rate for Payer: Prime Health Services Commercial |
$129.48
|
| 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 |
$91.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC SOM PCDES MOG FACS
|
Facility
|
IP
|
$152.33
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
900915496
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.47 |
| Max. Negotiated Rate |
$137.10 |
| Rate for Payer: Adventist Health Commercial |
$30.47
|
| Rate for Payer: Cash Price |
$152.33
|
| Rate for Payer: Central Health Plan Commercial |
$121.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.93
|
| Rate for Payer: EPIC Health Plan Senior |
$60.93
|
| Rate for Payer: Galaxy Health WC |
$129.48
|
| Rate for Payer: Global Benefits Group Commercial |
$91.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$137.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.47
|
| Rate for Payer: Multiplan Commercial |
$114.25
|
| Rate for Payer: Networks By Design Commercial |
$99.01
|
| Rate for Payer: Prime Health Services Commercial |
$129.48
|
|
|
HC SOM PCDES NEUROCONDRIN IFA
|
Facility
|
IP
|
$48.65
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915500
|
|
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 NEUROCONDRIN IFA
|
Facility
|
OP
|
$48.65
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915500
|
|
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 NMDA-R AB CBA
|
Facility
|
OP
|
$48.65
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915490
|
|
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 NMDA-R AB CBA
|
Facility
|
IP
|
$48.65
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915490
|
|
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 NMO/AQP4 FACS
|
Facility
|
IP
|
$152.34
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915493
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.47 |
| Max. Negotiated Rate |
$137.11 |
| Rate for Payer: Adventist Health Commercial |
$30.47
|
| Rate for Payer: Cash Price |
$152.34
|
| Rate for Payer: Central Health Plan Commercial |
$121.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.94
|
| Rate for Payer: EPIC Health Plan Senior |
$60.94
|
| Rate for Payer: Galaxy Health WC |
$129.49
|
| Rate for Payer: Global Benefits Group Commercial |
$91.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$137.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.47
|
| Rate for Payer: Multiplan Commercial |
$114.25
|
| Rate for Payer: Networks By Design Commercial |
$99.02
|
| Rate for Payer: Prime Health Services Commercial |
$129.49
|
|
|
HC SOM PCDES NMO/AQP4 FACS
|
Facility
|
OP
|
$152.34
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915493
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.01 |
| Max. Negotiated Rate |
$137.11 |
| Rate for Payer: Adventist Health Commercial |
$30.47
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$92.52
|
| 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 |
$92.47
|
| Rate for Payer: Blue Shield of California EPN |
$60.48
|
| Rate for Payer: Cash Price |
$152.34
|
| Rate for Payer: Cash Price |
$152.34
|
| Rate for Payer: Central Health Plan Commercial |
$121.87
|
| Rate for Payer: Cigna of CA HMO |
$97.50
|
| Rate for Payer: Cigna of CA PPO |
$112.73
|
| 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 |
$129.49
|
| Rate for Payer: Global Benefits Group Commercial |
$91.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$137.11
|
| 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 |
$101.61
|
| 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 |
$30.47
|
| 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 |
$114.25
|
| Rate for Payer: Networks By Design Commercial |
$99.02
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.73
|
| Rate for Payer: Prime Health Services Commercial |
$129.49
|
| 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 |
$91.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC SOM PCDES PCA-TR
|
Facility
|
IP
|
$48.66
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915488
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$43.79 |
| Rate for Payer: Adventist Health Commercial |
$9.73
|
| Rate for Payer: Cash Price |
$48.66
|
| Rate for Payer: Central Health Plan Commercial |
$38.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.46
|
| Rate for Payer: EPIC Health Plan Senior |
$19.46
|
| Rate for Payer: Galaxy Health WC |
$41.36
|
| Rate for Payer: Global Benefits Group Commercial |
$29.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.12
|
| 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 |
$31.63
|
| Rate for Payer: Prime Health Services Commercial |
$41.36
|
|
|
HC SOM PCDES PCA-TR
|
Facility
|
OP
|
$48.66
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915488
|
|
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 |
$29.54
|
| Rate for Payer: Blue Shield of California EPN |
$19.32
|
| Rate for Payer: Cash Price |
$48.66
|
| Rate for Payer: Cash Price |
$48.66
|
| Rate for Payer: Central Health Plan Commercial |
$38.93
|
| Rate for Payer: Cigna of CA HMO |
$31.14
|
| Rate for Payer: Cigna of CA PPO |
$36.01
|
| 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 |
$41.36
|
| Rate for Payer: Global Benefits Group Commercial |
$29.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.79
|
| 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 |
$32.46
|
| 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 |
$31.63
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$41.36
|
| 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 |
$29.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.20
|
| 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 PENICILLIN G IGE
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912843
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Central Health Plan Commercial |
$3.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: EPIC Health Plan Senior |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$4.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.56
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.04
|
|
|
HC SOM PENICILLIN G IGE
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912843
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.34
|
| Rate for Payer: Blue Shield of California Commercial |
$2.88
|
| Rate for Payer: Blue Shield of California EPN |
$1.89
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Central Health Plan Commercial |
$3.80
|
| Rate for Payer: Cigna of CA HMO |
$3.04
|
| Rate for Payer: Cigna of CA PPO |
$3.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$4.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: InnovAge PACE Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$3.56
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.22
|
| Rate for Payer: Prime Health Services Commercial |
$4.04
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Riverside University Health System MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SOM PENICILLIN V IGE
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912842
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Central Health Plan Commercial |
$3.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: EPIC Health Plan Senior |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$4.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.56
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.04
|
|
