|
HC SOM PCDEC GABA-B-R AB CBA
|
Facility
|
IP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915446
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$48.17 |
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Central Health Plan Commercial |
$42.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.41
|
| Rate for Payer: Galaxy Health WC |
$45.49
|
| Rate for Payer: Global Benefits Group Commercial |
$32.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.70
|
| Rate for Payer: Multiplan Commercial |
$40.14
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.49
|
|
|
HC SOM PCDEC GAD65 AB
|
Facility
|
OP
|
$104.70
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.09 |
| Max. Negotiated Rate |
$136.45 |
| Rate for Payer: Adventist Health Medi-Cal |
$23.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.36
|
| 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 |
$136.45
|
| Rate for Payer: Blue Distinction Transplant |
$62.82
|
| Rate for Payer: Blue Shield of California Commercial |
$64.70
|
| Rate for Payer: Blue Shield of California EPN |
$50.88
|
| Rate for Payer: Caremore Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$47.12
|
| Rate for Payer: Cash Price |
$47.12
|
| Rate for Payer: Central Health Plan Commercial |
$83.76
|
| Rate for Payer: Cigna of CA HMO |
$67.01
|
| Rate for Payer: Cigna of CA PPO |
$77.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.36
|
| Rate for Payer: Dignity Health Media |
$23.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.57
|
| Rate for Payer: Galaxy Health WC |
$89.00
|
| Rate for Payer: Global Benefits Group Commercial |
$62.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.23
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$78.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.57
|
| Rate for Payer: InnovAge PACE Commercial |
$35.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.83
|
| 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 |
$20.94
|
| 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 |
$78.52
|
| Rate for Payer: Networks By Design Commercial |
$68.06
|
| Rate for Payer: Prime Health Services Commercial |
$89.00
|
| 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 |
$62.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.09
|
| Rate for Payer: United Healthcare All Other HMO |
$19.09
|
| Rate for Payer: United Healthcare HMO Rider |
$19.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM PCDEC GAD65 AB
|
Facility
|
IP
|
$104.70
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$94.23 |
| Rate for Payer: Cash Price |
$47.12
|
| Rate for Payer: Central Health Plan Commercial |
$83.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.88
|
| Rate for Payer: Galaxy Health WC |
$89.00
|
| Rate for Payer: Global Benefits Group Commercial |
$62.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.94
|
| Rate for Payer: Multiplan Commercial |
$78.52
|
| Rate for Payer: Networks By Design Commercial |
$68.06
|
| Rate for Payer: Prime Health Services Commercial |
$89.00
|
|
|
HC SOM PCDEC GFAP IFA
|
Facility
|
OP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915452
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: 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 |
$32.11
|
| Rate for Payer: Blue Shield of California Commercial |
$33.08
|
| Rate for Payer: Blue Shield of California EPN |
$26.01
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Central Health Plan Commercial |
$42.82
|
| Rate for Payer: Cigna of CA HMO |
$34.25
|
| Rate for Payer: Cigna of CA PPO |
$39.60
|
| 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 |
$45.49
|
| Rate for Payer: Global Benefits Group Commercial |
$32.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.17
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.14
|
| 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 |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.70
|
| 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 |
$40.14
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.49
|
| 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 |
$32.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.11
|
| 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 PCDEC GFAP IFA
|
Facility
|
IP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915452
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$48.17 |
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Central Health Plan Commercial |
$42.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.41
|
| Rate for Payer: Galaxy Health WC |
$45.49
|
| Rate for Payer: Global Benefits Group Commercial |
$32.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.70
|
| Rate for Payer: Multiplan Commercial |
$40.14
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.49
|
|
|
HC SOM PCDEC LGI1-IGG CBA
|
Facility
|
IP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915448
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$48.17 |
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Central Health Plan Commercial |
$42.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.41
|
| Rate for Payer: Galaxy Health WC |
$45.49
|
| Rate for Payer: Global Benefits Group Commercial |
$32.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.70
|
| Rate for Payer: Multiplan Commercial |
$40.14
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.49
|
|
|
HC SOM PCDEC LGI1-IGG CBA
|
Facility
|
OP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915448
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: 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 |
$32.11
|
| Rate for Payer: Blue Shield of California Commercial |
$33.08
|
| Rate for Payer: Blue Shield of California EPN |
$26.01
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Central Health Plan Commercial |
$42.82
|
| Rate for Payer: Cigna of CA HMO |
$34.25
|
| Rate for Payer: Cigna of CA PPO |
$39.60
|
| 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 |
$45.49
|
| Rate for Payer: Global Benefits Group Commercial |
$32.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.17
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.14
|
| 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 |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.70
|
| 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 |
$40.14
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.49
|
| 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 |
$32.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.11
|
| 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 PCDEC MGLUR1 AB IFA
|
Facility
|
OP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915450
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: 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 |
$32.11
|
| Rate for Payer: Blue Shield of California Commercial |
$33.08
|
| Rate for Payer: Blue Shield of California EPN |
$26.01
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Central Health Plan Commercial |
$42.82
|
| Rate for Payer: Cigna of CA HMO |
$34.25
|
| Rate for Payer: Cigna of CA PPO |
$39.60
|
| 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 |
$45.49
|
| Rate for Payer: Global Benefits Group Commercial |
$32.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.17
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.14
|
| 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 |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.70
|
| 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 |
$40.14
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.49
|
| 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 |
$32.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.11
|
| 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 PCDEC MGLUR1 AB IFA
|
Facility
|
IP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915450
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$48.17 |
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Central Health Plan Commercial |
$42.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.41
|
| Rate for Payer: Galaxy Health WC |
$45.49
|
| Rate for Payer: Global Benefits Group Commercial |
$32.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.70
|
| Rate for Payer: Multiplan Commercial |
$40.14
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.49
|
|
|
HC SOM PCDEC NMDA-R AB CBA
|
Facility
|
OP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: 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 |
$32.11
|
| Rate for Payer: Blue Shield of California Commercial |
$33.08
|
| Rate for Payer: Blue Shield of California EPN |
$26.01
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Central Health Plan Commercial |
$42.82
|
| Rate for Payer: Cigna of CA HMO |
$34.25
|
| Rate for Payer: Cigna of CA PPO |
$39.60
|
| 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 |
$45.49
|
| Rate for Payer: Global Benefits Group Commercial |
$32.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.17
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.14
|
| 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 |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.70
|
| 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 |
$40.14
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.49
|
| 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 |
$32.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.11
|
| 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 PCDEC NMDA-R AB CBA
|
Facility
|
IP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$48.17 |
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Central Health Plan Commercial |
$42.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.41
|
| Rate for Payer: Galaxy Health WC |
$45.49
|
| Rate for Payer: Global Benefits Group Commercial |
$32.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.70
|
| Rate for Payer: Multiplan Commercial |
$40.14
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.49
|
|
|
HC SOM PCDEC NMO/AQP4 FACS
|
Facility
|
OP
|
$167.59
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915447
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$150.83 |
| Rate for Payer: Adventist Health Medi-Cal |
$37.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.60
|
| 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 |
$30.11
|
| Rate for Payer: Blue Distinction Transplant |
$100.55
|
| Rate for Payer: Blue Shield of California Commercial |
$103.57
|
| Rate for Payer: Blue Shield of California EPN |
$81.45
|
| Rate for Payer: Caremore Medicare Advantage |
$37.73
|
| Rate for Payer: Cash Price |
$75.42
|
| Rate for Payer: Cash Price |
$75.42
|
| Rate for Payer: Central Health Plan Commercial |
$134.07
|
| Rate for Payer: Cigna of CA HMO |
$107.26
|
| Rate for Payer: Cigna of CA PPO |
$124.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.60
|
| Rate for Payer: Dignity Health Media |
$37.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.73
|
| Rate for Payer: Galaxy Health WC |
$142.45
|
| Rate for Payer: Global Benefits Group Commercial |
$100.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$150.83
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$125.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$62.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: InnovAge PACE Commercial |
$56.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$111.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.52
|
| 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 |
$125.69
|
| Rate for Payer: Networks By Design Commercial |
$108.93
|
| Rate for Payer: Prime Health Services Commercial |
$142.45
|
| 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 |
$100.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.55
|
| 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 |
$56.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC SOM PCDEC NMO/AQP4 FACS
|
Facility
|
IP
|
$167.59
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915447
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.52 |
| Max. Negotiated Rate |
$150.83 |
| Rate for Payer: Cash Price |
$75.42
|
| Rate for Payer: Central Health Plan Commercial |
$134.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.04
|
| Rate for Payer: Galaxy Health WC |
$142.45
|
| Rate for Payer: Global Benefits Group Commercial |
$100.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$150.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$111.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.52
|
| Rate for Payer: Multiplan Commercial |
$125.69
|
| Rate for Payer: Networks By Design Commercial |
$108.93
|
| Rate for Payer: Prime Health Services Commercial |
$142.45
|
|
|
HC SOM PCDEC PCA-TR
|
Facility
|
IP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915443
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$48.17 |
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Central Health Plan Commercial |
$42.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.41
|
| Rate for Payer: Galaxy Health WC |
$45.49
|
| Rate for Payer: Global Benefits Group Commercial |
$32.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.70
|
| Rate for Payer: Multiplan Commercial |
$40.14
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.49
|
|
|
HC SOM PCDEC PCA-TR
|
Facility
|
OP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915443
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: 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 |
$32.11
|
| Rate for Payer: Blue Shield of California Commercial |
$33.08
|
| Rate for Payer: Blue Shield of California EPN |
$26.01
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Central Health Plan Commercial |
$42.82
|
| Rate for Payer: Cigna of CA HMO |
$34.25
|
| Rate for Payer: Cigna of CA PPO |
$39.60
|
| 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 |
$45.49
|
| Rate for Payer: Global Benefits Group Commercial |
$32.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.17
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.14
|
| 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 |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.70
|
| 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 |
$40.14
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.49
|
| 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 |
$32.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.11
|
| 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 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: Cash Price |
$2.14
|
| Rate for Payer: Central Health Plan Commercial |
$3.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 |
$140.27 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.29
|
| 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 |
$140.27
|
| Rate for Payer: Blue Distinction Transplant |
$2.85
|
| Rate for Payer: Blue Shield of California Commercial |
$2.94
|
| Rate for Payer: Blue Shield of California EPN |
$2.31
|
| Rate for Payer: Caremore Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cash Price |
$2.14
|
| 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 Media |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$3.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.61
|
| 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: 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: 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: Cash Price |
$2.14
|
| Rate for Payer: Central Health Plan Commercial |
$3.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 V IGE
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912842
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$140.27 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.29
|
| 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 |
$140.27
|
| Rate for Payer: Blue Distinction Transplant |
$2.85
|
| Rate for Payer: Blue Shield of California Commercial |
$2.94
|
| Rate for Payer: Blue Shield of California EPN |
$2.31
|
| Rate for Payer: Caremore Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cash Price |
$2.14
|
| 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 Media |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$3.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.61
|
| 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: 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: 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 PERNIC ANEM CASC B12
|
Facility
|
OP
|
$79.28
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
900914690
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$133.76 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.76
|
| Rate for Payer: Blue Distinction Transplant |
$47.57
|
| Rate for Payer: Blue Shield of California Commercial |
$49.00
|
| Rate for Payer: Blue Shield of California EPN |
$38.53
|
| Rate for Payer: Caremore Medicare Advantage |
$15.08
|
| Rate for Payer: Cash Price |
$35.68
|
| Rate for Payer: Cash Price |
$35.68
|
| Rate for Payer: Central Health Plan Commercial |
$63.42
|
| Rate for Payer: Cigna of CA HMO |
$50.74
|
| Rate for Payer: Cigna of CA PPO |
$58.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.62
|
| Rate for Payer: Dignity Health Media |
$15.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.08
|
| Rate for Payer: Galaxy Health WC |
$67.39
|
| Rate for Payer: Global Benefits Group Commercial |
$47.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.35
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$59.46
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.08
|
| Rate for Payer: InnovAge PACE Commercial |
$22.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.21
|
| Rate for Payer: Multiplan Commercial |
$59.46
|
| Rate for Payer: Networks By Design Commercial |
$51.53
|
| Rate for Payer: Prime Health Services Commercial |
$67.39
|
| Rate for Payer: Prime Health Services Medicare |
$15.98
|
| Rate for Payer: Riverside University Health System MISP |
$16.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.21
|
| Rate for Payer: United Healthcare All Other HMO |
$12.21
|
| Rate for Payer: United Healthcare HMO Rider |
$12.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Vantage Medical Group Senior |
$15.08
|
|
|
HC SOM PERNIC ANEM CASC B12
|
Facility
|
IP
|
$79.28
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
900914690
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.86 |
| Max. Negotiated Rate |
$71.35 |
| Rate for Payer: Cash Price |
$35.68
|
| Rate for Payer: Central Health Plan Commercial |
$63.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.71
|
| Rate for Payer: Galaxy Health WC |
$67.39
|
| Rate for Payer: Global Benefits Group Commercial |
$47.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.86
|
| Rate for Payer: Multiplan Commercial |
$59.46
|
| Rate for Payer: Networks By Design Commercial |
$51.53
|
| Rate for Payer: Prime Health Services Commercial |
$67.39
|
|
|
HC SOM PHENCYCLIDINE CONFIRM, U
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900912920
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Central Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.20
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
| Rate for Payer: Networks By Design Commercial |
$39.65
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
|
|
HC SOM PHENCYCLIDINE CONFIRM, U
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900912920
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$114.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.52
|
| Rate for Payer: Blue Distinction Transplant |
$36.60
|
| Rate for Payer: Blue Shield of California Commercial |
$37.70
|
| Rate for Payer: Blue Shield of California EPN |
$29.65
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Central Health Plan Commercial |
$48.80
|
| Rate for Payer: Cigna of CA HMO |
$39.04
|
| Rate for Payer: Cigna of CA PPO |
$45.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.85
|
| Rate for Payer: Dignity Health Media |
$51.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$45.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.20
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
| Rate for Payer: Networks By Design Commercial |
$39.65
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
| Rate for Payer: Riverside University Health System MISP |
$24.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.27
|
| Rate for Payer: United Healthcare All Other HMO |
$30.27
|
| Rate for Payer: United Healthcare HMO Rider |
$30.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.85
|
| Rate for Payer: Vantage Medical Group Senior |
$51.85
|
|
|
HC SOM PHENOBARBITAL LEVEL
|
Facility
|
IP
|
$23.99
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
900912658
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.59 |
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.39
|
| Rate for Payer: Global Benefits Group Commercial |
$14.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$17.99
|
| Rate for Payer: Networks By Design Commercial |
$15.59
|
| Rate for Payer: Prime Health Services Commercial |
$20.39
|
|
|
HC SOM PHENOBARBITAL LEVEL
|
Facility
|
OP
|
$23.99
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
900912658
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$101.44 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$83.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.44
|
| Rate for Payer: Blue Distinction Transplant |
$14.39
|
| Rate for Payer: Blue Shield of California Commercial |
$14.83
|
| Rate for Payer: Blue Shield of California EPN |
$11.66
|
| Rate for Payer: Caremore Medicare Advantage |
$15.30
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.19
|
| Rate for Payer: Cigna of CA HMO |
$15.35
|
| Rate for Payer: Cigna of CA PPO |
$17.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.95
|
| Rate for Payer: Dignity Health Media |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.66
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$20.39
|
| Rate for Payer: Global Benefits Group Commercial |
$14.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.59
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$17.99
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.30
|
| Rate for Payer: InnovAge PACE Commercial |
$22.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.50
|
| Rate for Payer: Multiplan Commercial |
$17.99
|
| Rate for Payer: Networks By Design Commercial |
$15.59
|
| Rate for Payer: Prime Health Services Commercial |
$20.39
|
| Rate for Payer: Prime Health Services Medicare |
$16.22
|
| Rate for Payer: Riverside University Health System MISP |
$16.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.39
|
| Rate for Payer: United Healthcare All Other HMO |
$12.39
|
| Rate for Payer: United Healthcare HMO Rider |
$12.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
