|
HC SOM PARANEOPL EVAL AGNA1
|
Facility
|
IP
|
$30.36
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914652
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$27.32 |
| Rate for Payer: Cash Price |
$13.66
|
| Rate for Payer: Central Health Plan Commercial |
$24.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.14
|
| Rate for Payer: Galaxy Health WC |
$25.81
|
| Rate for Payer: Global Benefits Group Commercial |
$18.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: Multiplan Commercial |
$22.77
|
| Rate for Payer: Networks By Design Commercial |
$19.73
|
| Rate for Payer: Prime Health Services Commercial |
$25.81
|
|
|
HC SOM PARANEOPL EVAL AMPH AB
|
Facility
|
IP
|
$30.37
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914656
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$27.33 |
| Rate for Payer: Cash Price |
$13.67
|
| Rate for Payer: Central Health Plan Commercial |
$24.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.15
|
| Rate for Payer: Galaxy Health WC |
$25.81
|
| Rate for Payer: Global Benefits Group Commercial |
$18.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: Multiplan Commercial |
$22.78
|
| Rate for Payer: Networks By Design Commercial |
$19.74
|
| Rate for Payer: Prime Health Services Commercial |
$25.81
|
|
|
HC SOM PARANEOPL EVAL AMPH AB
|
Facility
|
OP
|
$30.37
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914656
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.08
|
| 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 |
$106.99
|
| Rate for Payer: Blue Distinction Transplant |
$18.22
|
| Rate for Payer: Blue Shield of California Commercial |
$18.77
|
| Rate for Payer: Blue Shield of California EPN |
$14.76
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$13.67
|
| Rate for Payer: Cash Price |
$13.67
|
| Rate for Payer: Central Health Plan Commercial |
$24.30
|
| Rate for Payer: Cigna of CA HMO |
$19.44
|
| Rate for Payer: Cigna of CA PPO |
$22.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Media |
$12.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$25.81
|
| Rate for Payer: Global Benefits Group Commercial |
$18.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.33
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.26
|
| 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 |
$6.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$22.78
|
| Rate for Payer: Networks By Design Commercial |
$19.74
|
| Rate for Payer: Prime Health Services Commercial |
$25.81
|
| 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 |
$18.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PARANEOPL EVAL ANNA1
|
Facility
|
IP
|
$30.37
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914649
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$27.33 |
| Rate for Payer: Cash Price |
$13.67
|
| Rate for Payer: Central Health Plan Commercial |
$24.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.15
|
| Rate for Payer: Galaxy Health WC |
$25.81
|
| Rate for Payer: Global Benefits Group Commercial |
$18.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: Multiplan Commercial |
$22.78
|
| Rate for Payer: Networks By Design Commercial |
$19.74
|
| Rate for Payer: Prime Health Services Commercial |
$25.81
|
|
|
HC SOM PARANEOPL EVAL ANNA1
|
Facility
|
OP
|
$30.37
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914649
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.08
|
| 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 |
$106.99
|
| Rate for Payer: Blue Distinction Transplant |
$18.22
|
| Rate for Payer: Blue Shield of California Commercial |
$18.77
|
| Rate for Payer: Blue Shield of California EPN |
$14.76
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$13.67
|
| Rate for Payer: Cash Price |
$13.67
|
| Rate for Payer: Central Health Plan Commercial |
$24.30
|
| Rate for Payer: Cigna of CA HMO |
$19.44
|
| Rate for Payer: Cigna of CA PPO |
$22.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Media |
$12.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$25.81
|
| Rate for Payer: Global Benefits Group Commercial |
$18.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.33
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.26
|
| 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 |
$6.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$22.78
|
| Rate for Payer: Networks By Design Commercial |
$19.74
|
| Rate for Payer: Prime Health Services Commercial |
$25.81
|
| 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 |
$18.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PARANEOPL EVAL ANNA2
|
Facility
|
OP
|
$30.36
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914650
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.08
|
| 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 |
$106.99
|
| Rate for Payer: Blue Distinction Transplant |
$18.22
|
| Rate for Payer: Blue Shield of California Commercial |
$18.76
|
| Rate for Payer: Blue Shield of California EPN |
$14.75
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$13.66
|
| Rate for Payer: Cash Price |
$13.66
|
| Rate for Payer: Central Health Plan Commercial |
$24.29
|
| Rate for Payer: Cigna of CA HMO |
$19.43
|
| Rate for Payer: Cigna of CA PPO |
$22.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Media |
$12.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$25.81
|
| Rate for Payer: Global Benefits Group Commercial |
$18.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22.77
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.25
|
| 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 |
$6.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$22.77
|
| Rate for Payer: Networks By Design Commercial |
$19.73
|
| Rate for Payer: Prime Health Services Commercial |
$25.81
|
| 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 |
$18.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PARANEOPL EVAL ANNA2
|
Facility
|
IP
|
$30.36
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914650
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$27.32 |
| Rate for Payer: Cash Price |
$13.66
|
| Rate for Payer: Central Health Plan Commercial |
$24.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.14
|
| Rate for Payer: Galaxy Health WC |
$25.81
|
| Rate for Payer: Global Benefits Group Commercial |
$18.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: Multiplan Commercial |
$22.77
|
| Rate for Payer: Networks By Design Commercial |
$19.73
|
| Rate for Payer: Prime Health Services Commercial |
$25.81
|
|
|
HC SOM PARANEOPL EVAL ANNA3
|
Facility
|
IP
|
$30.36
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$27.32 |
| Rate for Payer: Cash Price |
$13.66
|
| Rate for Payer: Central Health Plan Commercial |
$24.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.14
|
| Rate for Payer: Galaxy Health WC |
$25.81
|
| Rate for Payer: Global Benefits Group Commercial |
$18.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: Multiplan Commercial |
$22.77
|
| Rate for Payer: Networks By Design Commercial |
$19.73
|
| Rate for Payer: Prime Health Services Commercial |
$25.81
|
|
|
HC SOM PARANEOPL EVAL ANNA3
|
Facility
|
OP
|
$30.36
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.08
|
| 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 |
$106.99
|
| Rate for Payer: Blue Distinction Transplant |
$18.22
|
| Rate for Payer: Blue Shield of California Commercial |
$18.76
|
| Rate for Payer: Blue Shield of California EPN |
$14.75
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$13.66
|
| Rate for Payer: Cash Price |
$13.66
|
| Rate for Payer: Central Health Plan Commercial |
$24.29
|
| Rate for Payer: Cigna of CA HMO |
$19.43
|
| Rate for Payer: Cigna of CA PPO |
$22.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Media |
$12.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$25.81
|
| Rate for Payer: Global Benefits Group Commercial |
$18.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22.77
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.25
|
| 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 |
$6.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$22.77
|
| Rate for Payer: Networks By Design Commercial |
$19.73
|
| Rate for Payer: Prime Health Services Commercial |
$25.81
|
| 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 |
$18.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PARANEOPL EVAL CRMP5 AB
|
Facility
|
OP
|
$30.37
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914657
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.08
|
| 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 |
$106.99
|
| Rate for Payer: Blue Distinction Transplant |
$18.22
|
| Rate for Payer: Blue Shield of California Commercial |
$18.77
|
| Rate for Payer: Blue Shield of California EPN |
$14.76
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$13.67
|
| Rate for Payer: Cash Price |
$13.67
|
| Rate for Payer: Central Health Plan Commercial |
$24.30
|
| Rate for Payer: Cigna of CA HMO |
$19.44
|
| Rate for Payer: Cigna of CA PPO |
$22.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Media |
$12.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$25.81
|
| Rate for Payer: Global Benefits Group Commercial |
$18.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.33
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.26
|
| 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 |
$6.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$22.78
|
| Rate for Payer: Networks By Design Commercial |
$19.74
|
| Rate for Payer: Prime Health Services Commercial |
$25.81
|
| 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 |
$18.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PARANEOPL EVAL CRMP5 AB
|
Facility
|
IP
|
$30.37
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914657
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$27.33 |
| Rate for Payer: Cash Price |
$13.67
|
| Rate for Payer: Central Health Plan Commercial |
$24.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.15
|
| Rate for Payer: Galaxy Health WC |
$25.81
|
| Rate for Payer: Global Benefits Group Commercial |
$18.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: Multiplan Commercial |
$22.78
|
| Rate for Payer: Networks By Design Commercial |
$19.74
|
| Rate for Payer: Prime Health Services Commercial |
$25.81
|
|
|
HC SOM PARANEOPL EVAL NEU AB
|
Facility
|
OP
|
$46.36
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914661
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$119.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.90
|
| Rate for Payer: Blue Distinction Transplant |
$27.82
|
| Rate for Payer: Blue Shield of California Commercial |
$28.65
|
| Rate for Payer: Blue Shield of California EPN |
$22.53
|
| Rate for Payer: Caremore Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$20.86
|
| Rate for Payer: Cash Price |
$20.86
|
| Rate for Payer: Central Health Plan Commercial |
$37.09
|
| Rate for Payer: Cigna of CA HMO |
$29.67
|
| Rate for Payer: Cigna of CA PPO |
$34.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Media |
$18.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$39.41
|
| Rate for Payer: Global Benefits Group Commercial |
$27.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.72
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$34.77
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: InnovAge PACE Commercial |
$27.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$34.77
|
| Rate for Payer: Networks By Design Commercial |
$30.13
|
| Rate for Payer: Prime Health Services Commercial |
$39.41
|
| Rate for Payer: Prime Health Services Medicare |
$19.50
|
| Rate for Payer: Riverside University Health System MISP |
$20.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM PARANEOPL EVAL NEU AB
|
Facility
|
IP
|
$46.36
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914661
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$41.72 |
| Rate for Payer: Cash Price |
$20.86
|
| Rate for Payer: Central Health Plan Commercial |
$37.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.54
|
| Rate for Payer: Galaxy Health WC |
$39.41
|
| Rate for Payer: Global Benefits Group Commercial |
$27.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.27
|
| Rate for Payer: Multiplan Commercial |
$34.77
|
| Rate for Payer: Networks By Design Commercial |
$30.13
|
| Rate for Payer: Prime Health Services Commercial |
$39.41
|
|
|
HC SOM PARANEOPL EVAL NTYPE AB
|
Facility
|
OP
|
$32.31
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914659
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$119.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.90
|
| Rate for Payer: Blue Distinction Transplant |
$19.39
|
| Rate for Payer: Blue Shield of California Commercial |
$19.97
|
| Rate for Payer: Blue Shield of California EPN |
$15.70
|
| Rate for Payer: Caremore Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$14.54
|
| Rate for Payer: Cash Price |
$14.54
|
| Rate for Payer: Central Health Plan Commercial |
$25.85
|
| Rate for Payer: Cigna of CA HMO |
$20.68
|
| Rate for Payer: Cigna of CA PPO |
$23.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Media |
$18.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$27.46
|
| Rate for Payer: Global Benefits Group Commercial |
$19.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.08
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$24.23
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: InnovAge PACE Commercial |
$27.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$24.23
|
| Rate for Payer: Networks By Design Commercial |
$21.00
|
| Rate for Payer: Prime Health Services Commercial |
$27.46
|
| Rate for Payer: Prime Health Services Medicare |
$19.50
|
| Rate for Payer: Riverside University Health System MISP |
$20.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM PARANEOPL EVAL NTYPE AB
|
Facility
|
IP
|
$32.31
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914659
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$29.08 |
| Rate for Payer: Cash Price |
$14.54
|
| Rate for Payer: Central Health Plan Commercial |
$25.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.92
|
| Rate for Payer: Galaxy Health WC |
$27.46
|
| Rate for Payer: Global Benefits Group Commercial |
$19.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.46
|
| Rate for Payer: Multiplan Commercial |
$24.23
|
| Rate for Payer: Networks By Design Commercial |
$21.00
|
| Rate for Payer: Prime Health Services Commercial |
$27.46
|
|
|
HC SOM PARANEOPL EVAL PCA1
|
Facility
|
IP
|
$30.36
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914653
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$27.32 |
| Rate for Payer: Cash Price |
$13.66
|
| Rate for Payer: Central Health Plan Commercial |
$24.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.14
|
| Rate for Payer: Galaxy Health WC |
$25.81
|
| Rate for Payer: Global Benefits Group Commercial |
$18.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: Multiplan Commercial |
$22.77
|
| Rate for Payer: Networks By Design Commercial |
$19.73
|
| Rate for Payer: Prime Health Services Commercial |
$25.81
|
|
|
HC SOM PARANEOPL EVAL PCA1
|
Facility
|
OP
|
$30.36
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914653
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.08
|
| 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 |
$106.99
|
| Rate for Payer: Blue Distinction Transplant |
$18.22
|
| Rate for Payer: Blue Shield of California Commercial |
$18.76
|
| Rate for Payer: Blue Shield of California EPN |
$14.75
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$13.66
|
| Rate for Payer: Cash Price |
$13.66
|
| Rate for Payer: Central Health Plan Commercial |
$24.29
|
| Rate for Payer: Cigna of CA HMO |
$19.43
|
| Rate for Payer: Cigna of CA PPO |
$22.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Media |
$12.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$25.81
|
| Rate for Payer: Global Benefits Group Commercial |
$18.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22.77
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.25
|
| 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 |
$6.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$22.77
|
| Rate for Payer: Networks By Design Commercial |
$19.73
|
| Rate for Payer: Prime Health Services Commercial |
$25.81
|
| 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 |
$18.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PARANEOPL EVAL PCA2
|
Facility
|
OP
|
$30.36
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914654
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.08
|
| 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 |
$106.99
|
| Rate for Payer: Blue Distinction Transplant |
$18.22
|
| Rate for Payer: Blue Shield of California Commercial |
$18.76
|
| Rate for Payer: Blue Shield of California EPN |
$14.75
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$13.66
|
| Rate for Payer: Cash Price |
$13.66
|
| Rate for Payer: Central Health Plan Commercial |
$24.29
|
| Rate for Payer: Cigna of CA HMO |
$19.43
|
| Rate for Payer: Cigna of CA PPO |
$22.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Media |
$12.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$25.81
|
| Rate for Payer: Global Benefits Group Commercial |
$18.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22.77
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.25
|
| 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 |
$6.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$22.77
|
| Rate for Payer: Networks By Design Commercial |
$19.73
|
| Rate for Payer: Prime Health Services Commercial |
$25.81
|
| 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 |
$18.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PARANEOPL EVAL PCA2
|
Facility
|
IP
|
$30.36
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914654
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$27.32 |
| Rate for Payer: Cash Price |
$13.66
|
| Rate for Payer: Central Health Plan Commercial |
$24.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.14
|
| Rate for Payer: Galaxy Health WC |
$25.81
|
| Rate for Payer: Global Benefits Group Commercial |
$18.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: Multiplan Commercial |
$22.77
|
| Rate for Payer: Networks By Design Commercial |
$19.73
|
| Rate for Payer: Prime Health Services Commercial |
$25.81
|
|
|
HC SOM PARANEOPL EVAL PCATR
|
Facility
|
IP
|
$30.36
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$27.32 |
| Rate for Payer: Cash Price |
$13.66
|
| Rate for Payer: Central Health Plan Commercial |
$24.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.14
|
| Rate for Payer: Galaxy Health WC |
$25.81
|
| Rate for Payer: Global Benefits Group Commercial |
$18.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: Multiplan Commercial |
$22.77
|
| Rate for Payer: Networks By Design Commercial |
$19.73
|
| Rate for Payer: Prime Health Services Commercial |
$25.81
|
|
|
HC SOM PARANEOPL EVAL PCATR
|
Facility
|
OP
|
$30.36
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.08
|
| 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 |
$106.99
|
| Rate for Payer: Blue Distinction Transplant |
$18.22
|
| Rate for Payer: Blue Shield of California Commercial |
$18.76
|
| Rate for Payer: Blue Shield of California EPN |
$14.75
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$13.66
|
| Rate for Payer: Cash Price |
$13.66
|
| Rate for Payer: Central Health Plan Commercial |
$24.29
|
| Rate for Payer: Cigna of CA HMO |
$19.43
|
| Rate for Payer: Cigna of CA PPO |
$22.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Media |
$12.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$25.81
|
| Rate for Payer: Global Benefits Group Commercial |
$18.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22.77
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.25
|
| 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 |
$6.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$22.77
|
| Rate for Payer: Networks By Design Commercial |
$19.73
|
| Rate for Payer: Prime Health Services Commercial |
$25.81
|
| 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 |
$18.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PARANEOPL EVAL P/Q AB
|
Facility
|
OP
|
$30.37
|
|
|
Service Code
|
CPT 86596
|
| Hospital Charge Code |
900914658
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$95.96 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.08
|
| 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 |
$37.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.94
|
| Rate for Payer: Blue Distinction Transplant |
$18.22
|
| Rate for Payer: Blue Shield of California Commercial |
$18.77
|
| Rate for Payer: Blue Shield of California EPN |
$14.76
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$13.67
|
| Rate for Payer: Cash Price |
$13.67
|
| Rate for Payer: Central Health Plan Commercial |
$24.30
|
| Rate for Payer: Cigna of CA HMO |
$19.44
|
| Rate for Payer: Cigna of CA PPO |
$22.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Media |
$12.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$25.81
|
| Rate for Payer: Global Benefits Group Commercial |
$18.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.33
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$22.78
|
| Rate for Payer: Networks By Design Commercial |
$19.74
|
| Rate for Payer: Prime Health Services Commercial |
$25.81
|
| 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 |
$18.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PARANEOPL EVAL P/Q AB
|
Facility
|
IP
|
$30.37
|
|
|
Service Code
|
CPT 86596
|
| Hospital Charge Code |
900914658
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$27.33 |
| Rate for Payer: Cash Price |
$13.67
|
| Rate for Payer: Central Health Plan Commercial |
$24.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.15
|
| Rate for Payer: Galaxy Health WC |
$25.81
|
| Rate for Payer: Global Benefits Group Commercial |
$18.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: Multiplan Commercial |
$22.78
|
| Rate for Payer: Networks By Design Commercial |
$19.74
|
| Rate for Payer: Prime Health Services Commercial |
$25.81
|
|
|
HC SOM PARANEOPL EVAL STR AB
|
Facility
|
OP
|
$30.33
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900915359
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$114.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.88
|
| Rate for Payer: Blue Distinction Transplant |
$18.20
|
| Rate for Payer: Blue Shield of California Commercial |
$18.74
|
| Rate for Payer: Blue Shield of California EPN |
$14.74
|
| Rate for Payer: Caremore Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Central Health Plan Commercial |
$24.26
|
| Rate for Payer: Cigna of CA HMO |
$19.41
|
| Rate for Payer: Cigna of CA PPO |
$22.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.90
|
| Rate for Payer: Dignity Health Media |
$17.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$25.78
|
| Rate for Payer: Global Benefits Group Commercial |
$18.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: InnovAge PACE Commercial |
$25.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$22.75
|
| Rate for Payer: Networks By Design Commercial |
$19.71
|
| Rate for Payer: Prime Health Services Commercial |
$25.78
|
| Rate for Payer: Prime Health Services Medicare |
$18.31
|
| Rate for Payer: Riverside University Health System MISP |
$19.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM PARANEOPL EVAL STR AB
|
Facility
|
IP
|
$30.33
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900915359
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$27.30 |
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Central Health Plan Commercial |
$24.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.13
|
| Rate for Payer: Galaxy Health WC |
$25.78
|
| Rate for Payer: Global Benefits Group Commercial |
$18.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: Multiplan Commercial |
$22.75
|
| Rate for Payer: Networks By Design Commercial |
$19.71
|
| Rate for Payer: Prime Health Services Commercial |
$25.78
|
|
