|
HC SODIUM CH
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900912186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
|
|
HC SODIUM CH
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900912186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.35
|
| Rate for Payer: Blue Shield of California Commercial |
$51.51
|
| Rate for Payer: Blue Shield of California EPN |
$34.03
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cigna of CA HMO |
$49.28
|
| Rate for Payer: Cigna of CA PPO |
$56.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.49
|
| Rate for Payer: EPIC Health Plan Senior |
$4.81
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.45
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
HC SODIUM FLUORIDE F-18 UP TO 30
|
Facility
|
IP
|
$1,869.00
|
|
|
Service Code
|
CPT A9580
|
| Hospital Charge Code |
909301573
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$373.80 |
| Max. Negotiated Rate |
$1,588.65 |
| Rate for Payer: Adventist Health Commercial |
$373.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,379.32
|
| Rate for Payer: Blue Shield of California EPN |
$908.33
|
| Rate for Payer: Cash Price |
$841.05
|
| Rate for Payer: Cigna of CA HMO |
$1,308.30
|
| Rate for Payer: Cigna of CA PPO |
$1,308.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.60
|
| Rate for Payer: EPIC Health Plan Senior |
$747.60
|
| Rate for Payer: Galaxy Health WC |
$1,588.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,121.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,246.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$712.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,156.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.56
|
| Rate for Payer: Multiplan Commercial |
$1,495.20
|
| Rate for Payer: Networks By Design Commercial |
$934.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,588.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$701.44
|
| Rate for Payer: United Healthcare All Other HMO |
$682.75
|
| Rate for Payer: United Healthcare HMO Rider |
$667.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$612.10
|
|
|
HC SODIUM FLUORIDE F-18 UP TO 30
|
Facility
|
OP
|
$1,869.00
|
|
|
Service Code
|
CPT A9580
|
| Hospital Charge Code |
909301573
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$373.80 |
| Max. Negotiated Rate |
$1,588.65 |
| Rate for Payer: Adventist Health Commercial |
$373.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,588.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,027.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,401.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,147.75
|
| Rate for Payer: Cash Price |
$841.05
|
| Rate for Payer: Cigna of CA HMO |
$1,308.30
|
| Rate for Payer: Cigna of CA PPO |
$1,308.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,588.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,588.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,588.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.60
|
| Rate for Payer: EPIC Health Plan Senior |
$747.60
|
| Rate for Payer: Galaxy Health WC |
$1,588.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,121.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,246.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,156.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,308.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,308.30
|
| Rate for Payer: Multiplan Commercial |
$1,495.20
|
| Rate for Payer: Networks By Design Commercial |
$934.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,588.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,121.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,121.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$701.44
|
| Rate for Payer: United Healthcare All Other HMO |
$682.75
|
| Rate for Payer: United Healthcare HMO Rider |
$667.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$612.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,588.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,588.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,588.65
|
|
|
HC SODIUM STOOL
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
900910418
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.80 |
| Max. Negotiated Rate |
$152.15 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Cash Price |
$80.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.60
|
| Rate for Payer: EPIC Health Plan Senior |
$71.60
|
| Rate for Payer: Galaxy Health WC |
$152.15
|
| Rate for Payer: Global Benefits Group Commercial |
$107.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.96
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: Networks By Design Commercial |
$116.35
|
| Rate for Payer: Prime Health Services Commercial |
$152.15
|
|
|
HC SODIUM STOOL
|
Facility
|
OP
|
$20.31
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
900910418
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$47.81 |
| Rate for Payer: Adventist Health Commercial |
$4.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.81
|
| Rate for Payer: Blue Shield of California Commercial |
$13.59
|
| Rate for Payer: Blue Shield of California EPN |
$8.98
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: Cigna of CA HMO |
$13.00
|
| Rate for Payer: Cigna of CA PPO |
$15.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.86
|
| Rate for Payer: Galaxy Health WC |
$17.26
|
| Rate for Payer: Global Benefits Group Commercial |
$12.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.51
|
| Rate for Payer: Multiplan Commercial |
$16.25
|
| Rate for Payer: Networks By Design Commercial |
$13.20
|
| Rate for Payer: Prime Health Services Commercial |
$17.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.93
|
| Rate for Payer: United Healthcare All Other HMO |
$3.93
|
| Rate for Payer: United Healthcare HMO Rider |
$3.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4.86
|
|
|
HC SODIUM URINE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
900910270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
|
|
HC SODIUM URINE
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
900910270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$48.01 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.01
|
| Rate for Payer: Blue Shield of California Commercial |
$20.07
|
| Rate for Payer: Blue Shield of California EPN |
$13.26
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.83
|
| Rate for Payer: EPIC Health Plan Senior |
$5.06
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.78
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.09
|
| Rate for Payer: United Healthcare All Other HMO |
$4.09
|
| Rate for Payer: United Healthcare HMO Rider |
$4.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.57
|
| Rate for Payer: Vantage Medical Group Senior |
$5.06
|
|
|
HC SOF 60735 MYCOP IGG 86738
|
Facility
|
OP
|
$65.04
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900914877
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$130.27 |
| Rate for Payer: Adventist Health Commercial |
$13.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.27
|
| Rate for Payer: Blue Shield of California Commercial |
$43.51
|
| Rate for Payer: Blue Shield of California EPN |
$28.75
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Cigna of CA HMO |
$41.63
|
| Rate for Payer: Cigna of CA PPO |
$48.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.87
|
| Rate for Payer: EPIC Health Plan Senior |
$13.24
|
| Rate for Payer: Galaxy Health WC |
$55.28
|
| Rate for Payer: Global Benefits Group Commercial |
$39.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$52.03
|
| Rate for Payer: Networks By Design Commercial |
$42.28
|
| Rate for Payer: Prime Health Services Commercial |
$55.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.73
|
| Rate for Payer: United Healthcare All Other HMO |
$10.73
|
| Rate for Payer: United Healthcare HMO Rider |
$10.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC SOF 60735 MYCOP IGG 86738
|
Facility
|
IP
|
$65.04
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900914877
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$55.28 |
| Rate for Payer: Adventist Health Commercial |
$13.01
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.02
|
| Rate for Payer: EPIC Health Plan Senior |
$26.02
|
| Rate for Payer: Galaxy Health WC |
$55.28
|
| Rate for Payer: Global Benefits Group Commercial |
$39.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.61
|
| Rate for Payer: Multiplan Commercial |
$52.03
|
| Rate for Payer: Networks By Design Commercial |
$42.28
|
| Rate for Payer: Prime Health Services Commercial |
$55.28
|
|
|
HC SOF 60735 MYCOP IGM 86738
|
Facility
|
IP
|
$65.04
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900914878
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$55.28 |
| Rate for Payer: Adventist Health Commercial |
$13.01
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.02
|
| Rate for Payer: EPIC Health Plan Senior |
$26.02
|
| Rate for Payer: Galaxy Health WC |
$55.28
|
| Rate for Payer: Global Benefits Group Commercial |
$39.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.61
|
| Rate for Payer: Multiplan Commercial |
$52.03
|
| Rate for Payer: Networks By Design Commercial |
$42.28
|
| Rate for Payer: Prime Health Services Commercial |
$55.28
|
|
|
HC SOF 60735 MYCOP IGM 86738
|
Facility
|
OP
|
$65.04
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900914878
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$130.27 |
| Rate for Payer: Adventist Health Commercial |
$13.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.27
|
| Rate for Payer: Blue Shield of California Commercial |
$43.51
|
| Rate for Payer: Blue Shield of California EPN |
$28.75
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Cigna of CA HMO |
$41.63
|
| Rate for Payer: Cigna of CA PPO |
$48.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.87
|
| Rate for Payer: EPIC Health Plan Senior |
$13.24
|
| Rate for Payer: Galaxy Health WC |
$55.28
|
| Rate for Payer: Global Benefits Group Commercial |
$39.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$52.03
|
| Rate for Payer: Networks By Design Commercial |
$42.28
|
| Rate for Payer: Prime Health Services Commercial |
$55.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.73
|
| Rate for Payer: United Healthcare All Other HMO |
$10.73
|
| Rate for Payer: United Healthcare HMO Rider |
$10.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC SOF ADENOVIRUS DNA QUANT PCR
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912932
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$69.80 |
| Max. Negotiated Rate |
$296.65 |
| Rate for Payer: Adventist Health Commercial |
$69.80
|
| Rate for Payer: Cash Price |
$157.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.60
|
| Rate for Payer: EPIC Health Plan Senior |
$139.60
|
| Rate for Payer: Galaxy Health WC |
$296.65
|
| Rate for Payer: Global Benefits Group Commercial |
$209.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.76
|
| Rate for Payer: Multiplan Commercial |
$279.20
|
| Rate for Payer: Networks By Design Commercial |
$226.85
|
| Rate for Payer: Prime Health Services Commercial |
$296.65
|
|
|
HC SOF ADENOVIRUS DNA QUANT PCR
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912932
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$296.65 |
| Rate for Payer: Adventist Health Commercial |
$69.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$228.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.55
|
| Rate for Payer: Blue Shield of California Commercial |
$233.48
|
| Rate for Payer: Blue Shield of California EPN |
$154.26
|
| Rate for Payer: Cash Price |
$157.05
|
| Rate for Payer: Cash Price |
$157.05
|
| Rate for Payer: Cigna of CA HMO |
$223.36
|
| Rate for Payer: Cigna of CA PPO |
$258.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.83
|
| Rate for Payer: EPIC Health Plan Senior |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$296.65
|
| Rate for Payer: Global Benefits Group Commercial |
$209.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$279.20
|
| Rate for Payer: Networks By Design Commercial |
$226.85
|
| Rate for Payer: Prime Health Services Commercial |
$296.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$209.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$209.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC SOF INFLUENZA TYPE A AB
|
Facility
|
OP
|
$54.31
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900914694
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$136.45 |
| Rate for Payer: Adventist Health Commercial |
$10.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.45
|
| Rate for Payer: Blue Shield of California Commercial |
$36.33
|
| Rate for Payer: Blue Shield of California EPN |
$24.01
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Cigna of CA HMO |
$34.76
|
| Rate for Payer: Cigna of CA PPO |
$40.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.29
|
| Rate for Payer: EPIC Health Plan Senior |
$13.55
|
| Rate for Payer: Galaxy Health WC |
$46.16
|
| Rate for Payer: Global Benefits Group Commercial |
$32.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.16
|
| Rate for Payer: Multiplan Commercial |
$43.45
|
| Rate for Payer: Networks By Design Commercial |
$35.30
|
| Rate for Payer: Prime Health Services Commercial |
$46.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.98
|
| Rate for Payer: United Healthcare All Other HMO |
$10.98
|
| Rate for Payer: United Healthcare HMO Rider |
$10.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13.55
|
|
|
HC SOF INFLUENZA TYPE A AB
|
Facility
|
IP
|
$54.31
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900914694
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$46.16 |
| Rate for Payer: Adventist Health Commercial |
$10.86
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.72
|
| Rate for Payer: EPIC Health Plan Senior |
$21.72
|
| Rate for Payer: Galaxy Health WC |
$46.16
|
| Rate for Payer: Global Benefits Group Commercial |
$32.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.03
|
| Rate for Payer: Multiplan Commercial |
$43.45
|
| Rate for Payer: Networks By Design Commercial |
$35.30
|
| Rate for Payer: Prime Health Services Commercial |
$46.16
|
|
|
HC SOF INFLUENZA TYPE B AB
|
Facility
|
OP
|
$54.31
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900914695
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$136.45 |
| Rate for Payer: Adventist Health Commercial |
$10.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.45
|
| Rate for Payer: Blue Shield of California Commercial |
$36.33
|
| Rate for Payer: Blue Shield of California EPN |
$24.01
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Cigna of CA HMO |
$34.76
|
| Rate for Payer: Cigna of CA PPO |
$40.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.29
|
| Rate for Payer: EPIC Health Plan Senior |
$13.55
|
| Rate for Payer: Galaxy Health WC |
$46.16
|
| Rate for Payer: Global Benefits Group Commercial |
$32.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.16
|
| Rate for Payer: Multiplan Commercial |
$43.45
|
| Rate for Payer: Networks By Design Commercial |
$35.30
|
| Rate for Payer: Prime Health Services Commercial |
$46.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.98
|
| Rate for Payer: United Healthcare All Other HMO |
$10.98
|
| Rate for Payer: United Healthcare HMO Rider |
$10.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13.55
|
|
|
HC SOF INFLUENZA TYPE B AB
|
Facility
|
IP
|
$54.31
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900914695
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$46.16 |
| Rate for Payer: Adventist Health Commercial |
$10.86
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.72
|
| Rate for Payer: EPIC Health Plan Senior |
$21.72
|
| Rate for Payer: Galaxy Health WC |
$46.16
|
| Rate for Payer: Global Benefits Group Commercial |
$32.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.03
|
| Rate for Payer: Multiplan Commercial |
$43.45
|
| Rate for Payer: Networks By Design Commercial |
$35.30
|
| Rate for Payer: Prime Health Services Commercial |
$46.16
|
|
|
HC SOF NOROVIRUS RNA
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914720
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$253.30 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.20
|
| Rate for Payer: EPIC Health Plan Senior |
$119.20
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$184.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.52
|
| Rate for Payer: Multiplan Commercial |
$238.40
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
|
|
HC SOF NOROVIRUS RNA
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914720
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$335.41 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$195.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.41
|
| Rate for Payer: Blue Shield of California Commercial |
$199.36
|
| Rate for Payer: Blue Shield of California EPN |
$131.72
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna of CA HMO |
$190.72
|
| Rate for Payer: Cigna of CA PPO |
$220.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$238.40
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOFT INTERFACE AFO SECTION
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT L2820
|
| Hospital Charge Code |
915352820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$64.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna of CA HMO |
$226.80
|
| Rate for Payer: Cigna of CA PPO |
$226.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Senior |
$129.60
|
| Rate for Payer: Galaxy Health WC |
$275.40
|
| Rate for Payer: Global Benefits Group Commercial |
$194.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.76
|
| Rate for Payer: Multiplan Commercial |
$259.20
|
| Rate for Payer: Networks By Design Commercial |
$162.00
|
| Rate for Payer: Prime Health Services Commercial |
$275.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.60
|
| Rate for Payer: United Healthcare All Other HMO |
$118.36
|
| Rate for Payer: United Healthcare HMO Rider |
$115.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.11
|
|
|
HC SOFT INTERFACE AFO SECTION
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT L2820
|
| Hospital Charge Code |
915352820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$77.76 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Adventist Health Commercial |
$132.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$275.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$178.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$243.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$187.66
|
| Rate for Payer: Blue Shield of California Commercial |
$239.11
|
| Rate for Payer: Blue Shield of California EPN |
$157.46
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna of CA HMO |
$226.80
|
| Rate for Payer: Cigna of CA PPO |
$226.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$275.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$275.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Senior |
$129.60
|
| Rate for Payer: Galaxy Health WC |
$275.40
|
| Rate for Payer: Global Benefits Group Commercial |
$194.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$117.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$226.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$226.80
|
| Rate for Payer: Multiplan Commercial |
$259.20
|
| Rate for Payer: Networks By Design Commercial |
$162.00
|
| Rate for Payer: Prime Health Services Commercial |
$275.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$194.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$194.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.60
|
| Rate for Payer: United Healthcare All Other HMO |
$118.36
|
| Rate for Payer: United Healthcare HMO Rider |
$115.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$275.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.40
|
| Rate for Payer: Vantage Medical Group Senior |
$275.40
|
|
|
HC SOFT INTERFACE AFO SECTION
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT L2820
|
| Hospital Charge Code |
905352820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$64.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna of CA HMO |
$226.80
|
| Rate for Payer: Cigna of CA PPO |
$226.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Senior |
$129.60
|
| Rate for Payer: Galaxy Health WC |
$275.40
|
| Rate for Payer: Global Benefits Group Commercial |
$194.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.76
|
| Rate for Payer: Multiplan Commercial |
$259.20
|
| Rate for Payer: Networks By Design Commercial |
$162.00
|
| Rate for Payer: Prime Health Services Commercial |
$275.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.60
|
| Rate for Payer: United Healthcare All Other HMO |
$118.36
|
| Rate for Payer: United Healthcare HMO Rider |
$115.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.11
|
|
|
HC SOFT INTERFACE AFO SECTION
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT L2820
|
| Hospital Charge Code |
905352820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$77.76 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Adventist Health Commercial |
$132.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$275.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$178.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$243.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$187.66
|
| Rate for Payer: Blue Shield of California Commercial |
$239.11
|
| Rate for Payer: Blue Shield of California EPN |
$157.46
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna of CA HMO |
$226.80
|
| Rate for Payer: Cigna of CA PPO |
$226.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$275.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$275.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Senior |
$129.60
|
| Rate for Payer: Galaxy Health WC |
$275.40
|
| Rate for Payer: Global Benefits Group Commercial |
$194.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$117.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$226.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$226.80
|
| Rate for Payer: Multiplan Commercial |
$259.20
|
| Rate for Payer: Networks By Design Commercial |
$162.00
|
| Rate for Payer: Prime Health Services Commercial |
$275.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$194.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$194.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.60
|
| Rate for Payer: United Healthcare All Other HMO |
$118.36
|
| Rate for Payer: United Healthcare HMO Rider |
$115.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$275.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.40
|
| Rate for Payer: Vantage Medical Group Senior |
$275.40
|
|
|
HC SOFT INTERFACE KAFO SECTION
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT L2830
|
| Hospital Charge Code |
905352830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$64.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna of CA HMO |
$226.80
|
| Rate for Payer: Cigna of CA PPO |
$226.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Senior |
$129.60
|
| Rate for Payer: Galaxy Health WC |
$275.40
|
| Rate for Payer: Global Benefits Group Commercial |
$194.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.76
|
| Rate for Payer: Multiplan Commercial |
$259.20
|
| Rate for Payer: Networks By Design Commercial |
$162.00
|
| Rate for Payer: Prime Health Services Commercial |
$275.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.60
|
| Rate for Payer: United Healthcare All Other HMO |
$118.36
|
| Rate for Payer: United Healthcare HMO Rider |
$115.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.11
|
|
