|
HC SOM ENS AGNA-1
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915388
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$121.95 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| 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 |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.95
|
| Rate for Payer: Blue Shield of California Commercial |
$21.46
|
| Rate for Payer: Blue Shield of California EPN |
$13.52
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Central Health Plan Commercial |
$27.25
|
| Rate for Payer: Cigna of CA HMO |
$21.80
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
| 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 |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS AMPA-R AB CBA
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915390
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$121.95 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| 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 |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.95
|
| Rate for Payer: Blue Shield of California Commercial |
$21.46
|
| Rate for Payer: Blue Shield of California EPN |
$13.52
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Central Health Plan Commercial |
$27.25
|
| Rate for Payer: Cigna of CA HMO |
$21.80
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
| 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 |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS AMPA-R AB CBA
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915390
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$30.65 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Central Health Plan Commercial |
$27.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Senior |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
|
|
HC SOM ENS AMPHYIPHYSIN AB
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915387
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$30.65 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Central Health Plan Commercial |
$27.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Senior |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
|
|
HC SOM ENS AMPHYIPHYSIN AB
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915387
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$121.95 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| 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 |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.95
|
| Rate for Payer: Blue Shield of California Commercial |
$21.46
|
| Rate for Payer: Blue Shield of California EPN |
$13.52
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Central Health Plan Commercial |
$27.25
|
| Rate for Payer: Cigna of CA HMO |
$21.80
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
| 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 |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS ANNA-1
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915384
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$121.95 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| 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 |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.95
|
| Rate for Payer: Blue Shield of California Commercial |
$21.46
|
| Rate for Payer: Blue Shield of California EPN |
$13.52
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Central Health Plan Commercial |
$27.25
|
| Rate for Payer: Cigna of CA HMO |
$21.80
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
| 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 |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS ANNA-1
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915384
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$30.65 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Central Health Plan Commercial |
$27.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Senior |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
|
|
HC SOM ENS ANNA-2
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915385
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$121.95 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| 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 |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.95
|
| Rate for Payer: Blue Shield of California Commercial |
$21.46
|
| Rate for Payer: Blue Shield of California EPN |
$13.52
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Central Health Plan Commercial |
$27.25
|
| Rate for Payer: Cigna of CA HMO |
$21.80
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
| 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 |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS ANNA-2
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915385
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$30.65 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Central Health Plan Commercial |
$27.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Senior |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
|
|
HC SOM ENS ANNA-3
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915382
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$30.65 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Central Health Plan Commercial |
$27.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Senior |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
|
|
HC SOM ENS ANNA-3
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915382
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$121.95 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| 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 |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.95
|
| Rate for Payer: Blue Shield of California Commercial |
$21.46
|
| Rate for Payer: Blue Shield of California EPN |
$13.52
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Central Health Plan Commercial |
$27.25
|
| Rate for Payer: Cigna of CA HMO |
$21.80
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
| 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 |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS CASPR2-IGG CBA
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915393
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$121.95 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| 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 |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.95
|
| Rate for Payer: Blue Shield of California Commercial |
$21.46
|
| Rate for Payer: Blue Shield of California EPN |
$13.52
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Central Health Plan Commercial |
$27.25
|
| Rate for Payer: Cigna of CA HMO |
$21.80
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
| 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 |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS CASPR2-IGG CBA
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915393
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$30.65 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Central Health Plan Commercial |
$27.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Senior |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
|
|
HC SOM ENS CRMP-5-IGG
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915395
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$121.95 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| 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 |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.95
|
| Rate for Payer: Blue Shield of California Commercial |
$21.46
|
| Rate for Payer: Blue Shield of California EPN |
$13.52
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Central Health Plan Commercial |
$27.25
|
| Rate for Payer: Cigna of CA HMO |
$21.80
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
| 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 |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS CRMP-5-IGG
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915395
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$30.65 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Central Health Plan Commercial |
$27.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Senior |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
|
|
HC SOM ENS DPPX AB IFA
|
Facility
|
IP
|
$52.49
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915396
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$47.24 |
| Rate for Payer: Adventist Health Commercial |
$10.50
|
| Rate for Payer: Cash Price |
$52.49
|
| Rate for Payer: Central Health Plan Commercial |
$41.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.00
|
| Rate for Payer: EPIC Health Plan Senior |
$21.00
|
| Rate for Payer: Galaxy Health WC |
$44.62
|
| Rate for Payer: Global Benefits Group Commercial |
$31.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$39.37
|
| Rate for Payer: Networks By Design Commercial |
$34.12
|
| Rate for Payer: Prime Health Services Commercial |
$44.62
|
|
|
HC SOM ENS DPPX AB IFA
|
Facility
|
OP
|
$52.49
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915396
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$121.95 |
| Rate for Payer: Adventist Health Commercial |
$10.50
|
| 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 |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.95
|
| Rate for Payer: Blue Shield of California Commercial |
$33.07
|
| Rate for Payer: Blue Shield of California EPN |
$20.84
|
| Rate for Payer: Cash Price |
$52.49
|
| Rate for Payer: Cash Price |
$52.49
|
| Rate for Payer: Central Health Plan Commercial |
$41.99
|
| Rate for Payer: Cigna of CA HMO |
$33.59
|
| Rate for Payer: Cigna of CA PPO |
$38.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$44.62
|
| Rate for Payer: Global Benefits Group Commercial |
$31.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.24
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$39.37
|
| Rate for Payer: Networks By Design Commercial |
$34.12
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$44.62
|
| 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 |
$31.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS DPPX CBA
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915472
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$121.95 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| 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 |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.95
|
| Rate for Payer: Blue Shield of California Commercial |
$21.46
|
| Rate for Payer: Blue Shield of California EPN |
$13.52
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Central Health Plan Commercial |
$27.25
|
| Rate for Payer: Cigna of CA HMO |
$21.80
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
| 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 |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS DPPX CBA
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915472
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$30.65 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Central Health Plan Commercial |
$27.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Senior |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
|
|
HC SOM ENS GABA-B-R AB CBA
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915391
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$30.65 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Central Health Plan Commercial |
$27.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Senior |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
|
|
HC SOM ENS GABA-B-R AB CBA
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915391
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$121.95 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| 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 |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.95
|
| Rate for Payer: Blue Shield of California Commercial |
$21.46
|
| Rate for Payer: Blue Shield of California EPN |
$13.52
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Central Health Plan Commercial |
$27.25
|
| Rate for Payer: Cigna of CA HMO |
$21.80
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
| 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 |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS GAD65 AB
|
Facility
|
OP
|
$66.62
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915380
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$155.52 |
| Rate for Payer: Adventist Health Commercial |
$13.32
|
| 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 |
$35.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.52
|
| Rate for Payer: Blue Shield of California Commercial |
$41.97
|
| Rate for Payer: Blue Shield of California EPN |
$26.45
|
| Rate for Payer: Cash Price |
$66.62
|
| Rate for Payer: Cash Price |
$66.62
|
| Rate for Payer: Central Health Plan Commercial |
$53.30
|
| Rate for Payer: Cigna of CA HMO |
$42.64
|
| Rate for Payer: Cigna of CA PPO |
$49.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.89
|
| Rate for Payer: EPIC Health Plan Senior |
$25.93
|
| Rate for Payer: Galaxy Health WC |
$56.63
|
| Rate for Payer: Global Benefits Group Commercial |
$39.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31.58
|
| Rate for Payer: Multiplan Commercial |
$49.97
|
| Rate for Payer: Networks By Design Commercial |
$43.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23.57
|
| Rate for Payer: Prime Health Services Commercial |
$56.63
|
| 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 |
$39.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.09
|
| Rate for Payer: United Healthcare All Other HMO |
$19.09
|
| Rate for Payer: United Healthcare HMO Rider |
$19.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$23.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM ENS GAD65 AB
|
Facility
|
IP
|
$66.62
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915380
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$59.96 |
| Rate for Payer: Adventist Health Commercial |
$13.32
|
| Rate for Payer: Cash Price |
$66.62
|
| Rate for Payer: Central Health Plan Commercial |
$53.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.65
|
| Rate for Payer: EPIC Health Plan Senior |
$26.65
|
| Rate for Payer: Galaxy Health WC |
$56.63
|
| Rate for Payer: Global Benefits Group Commercial |
$39.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.32
|
| Rate for Payer: Multiplan Commercial |
$49.97
|
| Rate for Payer: Networks By Design Commercial |
$43.30
|
| Rate for Payer: Prime Health Services Commercial |
$56.63
|
|
|
HC SOM ENS GFAP IFA
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915397
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$30.65 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Central Health Plan Commercial |
$27.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Senior |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
|
|
HC SOM ENS GFAP IFA
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915397
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$121.95 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| 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 |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.95
|
| Rate for Payer: Blue Shield of California Commercial |
$21.46
|
| Rate for Payer: Blue Shield of California EPN |
$13.52
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Central Health Plan Commercial |
$27.25
|
| Rate for Payer: Cigna of CA HMO |
$21.80
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
| 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 |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
