|
HC SOM PCDEC AMPA-R AB CBA
|
Facility
|
OP
|
$45.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915486
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$121.95 |
| Rate for Payer: Adventist Health Commercial |
$9.01
|
| 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 |
$28.39
|
| Rate for Payer: Blue Shield of California EPN |
$17.89
|
| Rate for Payer: Cash Price |
$45.06
|
| Rate for Payer: Cash Price |
$45.06
|
| Rate for Payer: Central Health Plan Commercial |
$36.05
|
| Rate for Payer: Cigna of CA HMO |
$28.84
|
| Rate for Payer: Cigna of CA PPO |
$33.34
|
| 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 |
$31.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$38.30
|
| Rate for Payer: Global Benefits Group Commercial |
$27.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.55
|
| 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 |
$28.61
|
| 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 |
$9.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$33.80
|
| Rate for Payer: Networks By Design Commercial |
$29.29
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$38.30
|
| 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 |
$27.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDEC ANNA1
|
Facility
|
OP
|
$45.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915442
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$121.95 |
| Rate for Payer: Adventist Health Commercial |
$9.01
|
| 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 |
$28.39
|
| Rate for Payer: Blue Shield of California EPN |
$17.89
|
| Rate for Payer: Cash Price |
$45.06
|
| Rate for Payer: Cash Price |
$45.06
|
| Rate for Payer: Central Health Plan Commercial |
$36.05
|
| Rate for Payer: Cigna of CA HMO |
$28.84
|
| Rate for Payer: Cigna of CA PPO |
$33.34
|
| 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 |
$31.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$38.30
|
| Rate for Payer: Global Benefits Group Commercial |
$27.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.55
|
| 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 |
$28.61
|
| 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 |
$9.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$33.80
|
| Rate for Payer: Networks By Design Commercial |
$29.29
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$38.30
|
| 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 |
$27.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDEC ANNA1
|
Facility
|
IP
|
$45.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915442
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$40.55 |
| Rate for Payer: Adventist Health Commercial |
$9.01
|
| Rate for Payer: Cash Price |
$45.06
|
| Rate for Payer: Central Health Plan Commercial |
$36.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.02
|
| Rate for Payer: EPIC Health Plan Senior |
$18.02
|
| Rate for Payer: Galaxy Health WC |
$38.30
|
| Rate for Payer: Global Benefits Group Commercial |
$27.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.01
|
| Rate for Payer: Multiplan Commercial |
$33.80
|
| Rate for Payer: Networks By Design Commercial |
$29.29
|
| Rate for Payer: Prime Health Services Commercial |
$38.30
|
|
|
HC SOM PCDEC CASPR2-IGG
|
Facility
|
IP
|
$45.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915449
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$40.56 |
| Rate for Payer: Adventist Health Commercial |
$9.01
|
| Rate for Payer: Cash Price |
$45.07
|
| Rate for Payer: Central Health Plan Commercial |
$36.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.03
|
| Rate for Payer: EPIC Health Plan Senior |
$18.03
|
| Rate for Payer: Galaxy Health WC |
$38.31
|
| Rate for Payer: Global Benefits Group Commercial |
$27.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.01
|
| Rate for Payer: Multiplan Commercial |
$33.80
|
| Rate for Payer: Networks By Design Commercial |
$29.30
|
| Rate for Payer: Prime Health Services Commercial |
$38.31
|
|
|
HC SOM PCDEC CASPR2-IGG
|
Facility
|
OP
|
$45.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915449
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$121.95 |
| Rate for Payer: Adventist Health Commercial |
$9.01
|
| 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 |
$28.39
|
| Rate for Payer: Blue Shield of California EPN |
$17.89
|
| Rate for Payer: Cash Price |
$45.07
|
| Rate for Payer: Cash Price |
$45.07
|
| Rate for Payer: Central Health Plan Commercial |
$36.06
|
| Rate for Payer: Cigna of CA HMO |
$28.84
|
| Rate for Payer: Cigna of CA PPO |
$33.35
|
| 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 |
$31.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$38.31
|
| Rate for Payer: Global Benefits Group Commercial |
$27.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.56
|
| 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 |
$28.62
|
| 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 |
$9.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$33.80
|
| Rate for Payer: Networks By Design Commercial |
$29.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$38.31
|
| 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 |
$27.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDEC DPPX AB IFA
|
Facility
|
OP
|
$45.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$121.95 |
| Rate for Payer: Adventist Health Commercial |
$9.01
|
| 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 |
$28.39
|
| Rate for Payer: Blue Shield of California EPN |
$17.89
|
| Rate for Payer: Cash Price |
$45.07
|
| Rate for Payer: Cash Price |
$45.07
|
| Rate for Payer: Central Health Plan Commercial |
$36.06
|
| Rate for Payer: Cigna of CA HMO |
$28.84
|
| Rate for Payer: Cigna of CA PPO |
$33.35
|
| 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 |
$31.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$38.31
|
| Rate for Payer: Global Benefits Group Commercial |
$27.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.56
|
| 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 |
$28.62
|
| 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 |
$9.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$33.80
|
| Rate for Payer: Networks By Design Commercial |
$29.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$38.31
|
| 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 |
$27.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDEC DPPX AB IFA
|
Facility
|
IP
|
$45.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$40.56 |
| Rate for Payer: Adventist Health Commercial |
$9.01
|
| Rate for Payer: Cash Price |
$45.07
|
| Rate for Payer: Central Health Plan Commercial |
$36.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.03
|
| Rate for Payer: EPIC Health Plan Senior |
$18.03
|
| Rate for Payer: Galaxy Health WC |
$38.31
|
| Rate for Payer: Global Benefits Group Commercial |
$27.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.01
|
| Rate for Payer: Multiplan Commercial |
$33.80
|
| Rate for Payer: Networks By Design Commercial |
$29.30
|
| Rate for Payer: Prime Health Services Commercial |
$38.31
|
|
|
HC SOM PCDEC GABA-B-R AB CBA
|
Facility
|
OP
|
$45.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915446
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$121.95 |
| Rate for Payer: Adventist Health Commercial |
$9.01
|
| 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 |
$28.39
|
| Rate for Payer: Blue Shield of California EPN |
$17.89
|
| Rate for Payer: Cash Price |
$45.07
|
| Rate for Payer: Cash Price |
$45.07
|
| Rate for Payer: Central Health Plan Commercial |
$36.06
|
| Rate for Payer: Cigna of CA HMO |
$28.84
|
| Rate for Payer: Cigna of CA PPO |
$33.35
|
| 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 |
$31.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$38.31
|
| Rate for Payer: Global Benefits Group Commercial |
$27.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.56
|
| 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 |
$28.62
|
| 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 |
$9.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$33.80
|
| Rate for Payer: Networks By Design Commercial |
$29.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$38.31
|
| 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 |
$27.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDEC GABA-B-R AB CBA
|
Facility
|
IP
|
$45.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915446
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$40.56 |
| Rate for Payer: Adventist Health Commercial |
$9.01
|
| Rate for Payer: Cash Price |
$45.07
|
| Rate for Payer: Central Health Plan Commercial |
$36.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.03
|
| Rate for Payer: EPIC Health Plan Senior |
$18.03
|
| Rate for Payer: Galaxy Health WC |
$38.31
|
| Rate for Payer: Global Benefits Group Commercial |
$27.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.01
|
| Rate for Payer: Multiplan Commercial |
$33.80
|
| Rate for Payer: Networks By Design Commercial |
$29.30
|
| Rate for Payer: Prime Health Services Commercial |
$38.31
|
|
|
HC SOM PCDEC GAD65 AB
|
Facility
|
OP
|
$88.16
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.63 |
| Max. Negotiated Rate |
$155.52 |
| Rate for Payer: Adventist Health Commercial |
$17.63
|
| 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 |
$55.54
|
| Rate for Payer: Blue Shield of California EPN |
$35.00
|
| Rate for Payer: Cash Price |
$88.16
|
| Rate for Payer: Cash Price |
$88.16
|
| Rate for Payer: Central Health Plan Commercial |
$70.53
|
| Rate for Payer: Cigna of CA HMO |
$56.42
|
| Rate for Payer: Cigna of CA PPO |
$65.24
|
| 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 |
$61.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.89
|
| Rate for Payer: EPIC Health Plan Senior |
$25.93
|
| Rate for Payer: Galaxy Health WC |
$74.94
|
| Rate for Payer: Global Benefits Group Commercial |
$52.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.34
|
| 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 |
$55.98
|
| 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 |
$17.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31.58
|
| Rate for Payer: Multiplan Commercial |
$66.12
|
| Rate for Payer: Networks By Design Commercial |
$57.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23.57
|
| Rate for Payer: Prime Health Services Commercial |
$74.94
|
| 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 |
$52.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.09
|
| Rate for Payer: United Healthcare All Other HMO |
$19.09
|
| Rate for Payer: United Healthcare HMO Rider |
$19.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$23.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM PCDEC GAD65 AB
|
Facility
|
IP
|
$88.16
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.63 |
| Max. Negotiated Rate |
$79.34 |
| Rate for Payer: Adventist Health Commercial |
$17.63
|
| Rate for Payer: Cash Price |
$88.16
|
| Rate for Payer: Central Health Plan Commercial |
$70.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.26
|
| Rate for Payer: EPIC Health Plan Senior |
$35.26
|
| Rate for Payer: Galaxy Health WC |
$74.94
|
| Rate for Payer: Global Benefits Group Commercial |
$52.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.63
|
| Rate for Payer: Multiplan Commercial |
$66.12
|
| Rate for Payer: Networks By Design Commercial |
$57.30
|
| Rate for Payer: Prime Health Services Commercial |
$74.94
|
|
|
HC SOM PCDEC GFAP IFA
|
Facility
|
IP
|
$45.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915452
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$40.56 |
| Rate for Payer: Adventist Health Commercial |
$9.01
|
| Rate for Payer: Cash Price |
$45.07
|
| Rate for Payer: Central Health Plan Commercial |
$36.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.03
|
| Rate for Payer: EPIC Health Plan Senior |
$18.03
|
| Rate for Payer: Galaxy Health WC |
$38.31
|
| Rate for Payer: Global Benefits Group Commercial |
$27.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.01
|
| Rate for Payer: Multiplan Commercial |
$33.80
|
| Rate for Payer: Networks By Design Commercial |
$29.30
|
| Rate for Payer: Prime Health Services Commercial |
$38.31
|
|
|
HC SOM PCDEC GFAP IFA
|
Facility
|
OP
|
$45.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915452
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$121.95 |
| Rate for Payer: Adventist Health Commercial |
$9.01
|
| 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 |
$28.39
|
| Rate for Payer: Blue Shield of California EPN |
$17.89
|
| Rate for Payer: Cash Price |
$45.07
|
| Rate for Payer: Cash Price |
$45.07
|
| Rate for Payer: Central Health Plan Commercial |
$36.06
|
| Rate for Payer: Cigna of CA HMO |
$28.84
|
| Rate for Payer: Cigna of CA PPO |
$33.35
|
| 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 |
$31.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$38.31
|
| Rate for Payer: Global Benefits Group Commercial |
$27.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.56
|
| 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 |
$28.62
|
| 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 |
$9.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$33.80
|
| Rate for Payer: Networks By Design Commercial |
$29.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$38.31
|
| 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 |
$27.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDEC LGI1-IGG CBA
|
Facility
|
IP
|
$45.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915448
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$40.56 |
| Rate for Payer: Adventist Health Commercial |
$9.01
|
| Rate for Payer: Cash Price |
$45.07
|
| Rate for Payer: Central Health Plan Commercial |
$36.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.03
|
| Rate for Payer: EPIC Health Plan Senior |
$18.03
|
| Rate for Payer: Galaxy Health WC |
$38.31
|
| Rate for Payer: Global Benefits Group Commercial |
$27.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.01
|
| Rate for Payer: Multiplan Commercial |
$33.80
|
| Rate for Payer: Networks By Design Commercial |
$29.30
|
| Rate for Payer: Prime Health Services Commercial |
$38.31
|
|
|
HC SOM PCDEC LGI1-IGG CBA
|
Facility
|
OP
|
$45.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915448
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$121.95 |
| Rate for Payer: Adventist Health Commercial |
$9.01
|
| 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 |
$28.39
|
| Rate for Payer: Blue Shield of California EPN |
$17.89
|
| Rate for Payer: Cash Price |
$45.07
|
| Rate for Payer: Cash Price |
$45.07
|
| Rate for Payer: Central Health Plan Commercial |
$36.06
|
| Rate for Payer: Cigna of CA HMO |
$28.84
|
| Rate for Payer: Cigna of CA PPO |
$33.35
|
| 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 |
$31.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$38.31
|
| Rate for Payer: Global Benefits Group Commercial |
$27.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.56
|
| 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 |
$28.62
|
| 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 |
$9.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$33.80
|
| Rate for Payer: Networks By Design Commercial |
$29.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$38.31
|
| 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 |
$27.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDEC MGLUR1 AB IFA
|
Facility
|
OP
|
$45.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915450
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$121.95 |
| Rate for Payer: Adventist Health Commercial |
$9.01
|
| 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 |
$28.39
|
| Rate for Payer: Blue Shield of California EPN |
$17.89
|
| Rate for Payer: Cash Price |
$45.07
|
| Rate for Payer: Cash Price |
$45.07
|
| Rate for Payer: Central Health Plan Commercial |
$36.06
|
| Rate for Payer: Cigna of CA HMO |
$28.84
|
| Rate for Payer: Cigna of CA PPO |
$33.35
|
| 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 |
$31.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$38.31
|
| Rate for Payer: Global Benefits Group Commercial |
$27.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.56
|
| 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 |
$28.62
|
| 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 |
$9.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$33.80
|
| Rate for Payer: Networks By Design Commercial |
$29.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$38.31
|
| 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 |
$27.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDEC MGLUR1 AB IFA
|
Facility
|
IP
|
$45.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915450
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$40.56 |
| Rate for Payer: Adventist Health Commercial |
$9.01
|
| Rate for Payer: Cash Price |
$45.07
|
| Rate for Payer: Central Health Plan Commercial |
$36.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.03
|
| Rate for Payer: EPIC Health Plan Senior |
$18.03
|
| Rate for Payer: Galaxy Health WC |
$38.31
|
| Rate for Payer: Global Benefits Group Commercial |
$27.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.01
|
| Rate for Payer: Multiplan Commercial |
$33.80
|
| Rate for Payer: Networks By Design Commercial |
$29.30
|
| Rate for Payer: Prime Health Services Commercial |
$38.31
|
|
|
HC SOM PCDEC NMDA-R AB CBA
|
Facility
|
IP
|
$45.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$40.55 |
| Rate for Payer: Adventist Health Commercial |
$9.01
|
| Rate for Payer: Cash Price |
$45.06
|
| Rate for Payer: Central Health Plan Commercial |
$36.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.02
|
| Rate for Payer: EPIC Health Plan Senior |
$18.02
|
| Rate for Payer: Galaxy Health WC |
$38.30
|
| Rate for Payer: Global Benefits Group Commercial |
$27.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.01
|
| Rate for Payer: Multiplan Commercial |
$33.80
|
| Rate for Payer: Networks By Design Commercial |
$29.29
|
| Rate for Payer: Prime Health Services Commercial |
$38.30
|
|
|
HC SOM PCDEC NMDA-R AB CBA
|
Facility
|
OP
|
$45.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$121.95 |
| Rate for Payer: Adventist Health Commercial |
$9.01
|
| 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 |
$28.39
|
| Rate for Payer: Blue Shield of California EPN |
$17.89
|
| Rate for Payer: Cash Price |
$45.06
|
| Rate for Payer: Cash Price |
$45.06
|
| Rate for Payer: Central Health Plan Commercial |
$36.05
|
| Rate for Payer: Cigna of CA HMO |
$28.84
|
| Rate for Payer: Cigna of CA PPO |
$33.34
|
| 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 |
$31.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$38.30
|
| Rate for Payer: Global Benefits Group Commercial |
$27.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.55
|
| 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 |
$28.61
|
| 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 |
$9.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$33.80
|
| Rate for Payer: Networks By Design Commercial |
$29.29
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$38.30
|
| 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 |
$27.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDEC NMO/AQP4 FACS
|
Facility
|
IP
|
$141.11
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915447
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.22 |
| Max. Negotiated Rate |
$127.00 |
| Rate for Payer: Adventist Health Commercial |
$28.22
|
| Rate for Payer: Cash Price |
$141.11
|
| Rate for Payer: Central Health Plan Commercial |
$112.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.44
|
| Rate for Payer: EPIC Health Plan Senior |
$56.44
|
| Rate for Payer: Galaxy Health WC |
$119.94
|
| Rate for Payer: Global Benefits Group Commercial |
$84.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$89.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.22
|
| Rate for Payer: Multiplan Commercial |
$105.83
|
| Rate for Payer: Networks By Design Commercial |
$91.72
|
| Rate for Payer: Prime Health Services Commercial |
$119.94
|
|
|
HC SOM PCDEC NMO/AQP4 FACS
|
Facility
|
OP
|
$141.11
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915447
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$127.00 |
| Rate for Payer: Adventist Health Commercial |
$28.22
|
| 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 |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.32
|
| Rate for Payer: Blue Shield of California Commercial |
$88.90
|
| Rate for Payer: Blue Shield of California EPN |
$56.02
|
| Rate for Payer: Cash Price |
$141.11
|
| Rate for Payer: Cash Price |
$141.11
|
| Rate for Payer: Central Health Plan Commercial |
$112.89
|
| Rate for Payer: Cigna of CA HMO |
$90.31
|
| Rate for Payer: Cigna of CA PPO |
$104.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.25
|
| Rate for Payer: EPIC Health Plan Senior |
$41.50
|
| Rate for Payer: Galaxy Health WC |
$119.94
|
| Rate for Payer: Global Benefits Group Commercial |
$84.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$89.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$105.83
|
| Rate for Payer: Networks By Design Commercial |
$91.72
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.73
|
| Rate for Payer: Prime Health Services Commercial |
$119.94
|
| 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 |
$84.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC SOM PCDEC PCA-TR
|
Facility
|
OP
|
$45.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915443
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$121.95 |
| Rate for Payer: Adventist Health Commercial |
$9.01
|
| 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 |
$28.39
|
| Rate for Payer: Blue Shield of California EPN |
$17.89
|
| Rate for Payer: Cash Price |
$45.06
|
| Rate for Payer: Cash Price |
$45.06
|
| Rate for Payer: Central Health Plan Commercial |
$36.05
|
| Rate for Payer: Cigna of CA HMO |
$28.84
|
| Rate for Payer: Cigna of CA PPO |
$33.34
|
| 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 |
$31.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$38.30
|
| Rate for Payer: Global Benefits Group Commercial |
$27.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.55
|
| 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 |
$28.61
|
| 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 |
$9.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$33.80
|
| Rate for Payer: Networks By Design Commercial |
$29.29
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$38.30
|
| 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 |
$27.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDEC PCA-TR
|
Facility
|
IP
|
$45.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915443
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$40.55 |
| Rate for Payer: Adventist Health Commercial |
$9.01
|
| Rate for Payer: Cash Price |
$45.06
|
| Rate for Payer: Central Health Plan Commercial |
$36.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.02
|
| Rate for Payer: EPIC Health Plan Senior |
$18.02
|
| Rate for Payer: Galaxy Health WC |
$38.30
|
| Rate for Payer: Global Benefits Group Commercial |
$27.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.01
|
| Rate for Payer: Multiplan Commercial |
$33.80
|
| Rate for Payer: Networks By Design Commercial |
$29.29
|
| Rate for Payer: Prime Health Services Commercial |
$38.30
|
|
|
HC SOM PCDES AMPA-R AB CBA
|
Facility
|
IP
|
$37.72
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$33.95 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Central Health Plan Commercial |
$30.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.09
|
| Rate for Payer: EPIC Health Plan Senior |
$15.09
|
| Rate for Payer: Galaxy Health WC |
$32.06
|
| Rate for Payer: Global Benefits Group Commercial |
$22.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.54
|
| Rate for Payer: Multiplan Commercial |
$28.29
|
| Rate for Payer: Networks By Design Commercial |
$24.52
|
| Rate for Payer: Prime Health Services Commercial |
$32.06
|
|
|
HC SOM PCDES AMPA-R AB CBA
|
Facility
|
OP
|
$37.72
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$121.95 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| 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 |
$23.76
|
| Rate for Payer: Blue Shield of California EPN |
$14.97
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Central Health Plan Commercial |
$30.18
|
| Rate for Payer: Cigna of CA HMO |
$24.14
|
| Rate for Payer: Cigna of CA PPO |
$27.91
|
| 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 |
$26.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$32.06
|
| Rate for Payer: Global Benefits Group Commercial |
$22.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.95
|
| 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 |
$23.95
|
| 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 |
$7.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$28.29
|
| Rate for Payer: Networks By Design Commercial |
$24.52
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$32.06
|
| 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 |
$22.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.63
|
| 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
|
|
