|
HC SODIUM URINE
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
900910270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.59
|
| 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 |
$66.90
|
| Rate for Payer: Blue Shield of California EPN |
$44.20
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna of CA HMO |
$64.00
|
| Rate for Payer: Cigna of CA PPO |
$74.00
|
| 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 |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| 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 |
$66.70
|
| 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 |
$24.00
|
| 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 |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| 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
|
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 |
$35.77
|
| 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 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 |
$35.77
|
| Rate for Payer: Cash Price |
$35.77
|
| 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 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: EPIC Health Plan Senior |
$13.24
|
| Rate for Payer: Galaxy Health WC |
$55.28
|
| 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 |
$35.77
|
| Rate for Payer: Cash Price |
$35.77
|
| 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: 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 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 |
$35.77
|
| 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 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 |
$191.95
|
| Rate for Payer: Cash Price |
$191.95
|
| 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 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 |
$191.95
|
| 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 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 |
$29.87
|
| Rate for Payer: Cash Price |
$29.87
|
| 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 |
$29.87
|
| 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: Galaxy Health WC |
$46.16
|
| 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 |
$29.87
|
| Rate for Payer: Cash Price |
$29.87
|
| 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: 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 |
$29.87
|
| 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 |
$163.90
|
| 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: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| 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 |
$163.90
|
| Rate for Payer: Cash Price |
$163.90
|
| 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: 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 |
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 |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| 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 |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| 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 |
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 |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| 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 |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| 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 |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| 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 KAFO SECTION
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT L2830
|
| Hospital Charge Code |
915352830
|
|
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 |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| 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 KAFO SECTION
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT L2830
|
| Hospital Charge Code |
905352830
|
|
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 |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| 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 |
$126.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.34
|
| 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
|
OP
|
$324.00
|
|
|
Service Code
|
CPT L2830
|
| Hospital Charge Code |
915352830
|
|
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 |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| 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 |
$126.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.34
|
| 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 PALATE
|
Facility
|
IP
|
$1,187.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$237.40 |
| Max. Negotiated Rate |
$1,008.95 |
| Rate for Payer: Adventist Health Commercial |
$237.40
|
| Rate for Payer: Cash Price |
$652.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$474.80
|
| Rate for Payer: EPIC Health Plan Senior |
$474.80
|
| Rate for Payer: Galaxy Health WC |
$1,008.95
|
| Rate for Payer: Global Benefits Group Commercial |
$712.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$791.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$734.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.88
|
| Rate for Payer: Multiplan Commercial |
$949.60
|
| Rate for Payer: Networks By Design Commercial |
$771.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,008.95
|
|
|
HC SOFT PALATE
|
Facility
|
OP
|
$1,187.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$1,008.95 |
| Rate for Payer: Adventist Health Commercial |
$237.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$778.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$728.94
|
| Rate for Payer: Blue Shield of California Commercial |
$726.44
|
| Rate for Payer: Blue Shield of California EPN |
$479.55
|
| Rate for Payer: Cash Price |
$652.85
|
| Rate for Payer: Cash Price |
$652.85
|
| Rate for Payer: Cigna of CA HMO |
$759.68
|
| Rate for Payer: Cigna of CA PPO |
$878.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$1,008.95
|
| Rate for Payer: Global Benefits Group Commercial |
$712.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$791.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$949.60
|
| Rate for Payer: Networks By Design Commercial |
$771.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,008.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$712.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$712.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC SOGDX 230 GCH1 81479
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914803
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$185.00 |
| Max. Negotiated Rate |
$786.25 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$606.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$786.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$508.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$568.04
|
| Rate for Payer: Blue Shield of California Commercial |
$618.83
|
| Rate for Payer: Blue Shield of California EPN |
$408.85
|
| Rate for Payer: Cash Price |
$508.75
|
| Rate for Payer: Cigna of CA HMO |
$592.00
|
| Rate for Payer: Cigna of CA PPO |
$684.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$786.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$786.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$786.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.00
|
| Rate for Payer: EPIC Health Plan Senior |
$370.00
|
| Rate for Payer: Galaxy Health WC |
$786.25
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$616.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$572.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$647.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$647.50
|
| Rate for Payer: Multiplan Commercial |
$740.00
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$555.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$555.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$462.50
|
| Rate for Payer: United Healthcare All Other HMO |
$462.50
|
| Rate for Payer: United Healthcare HMO Rider |
$462.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$462.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$786.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$786.25
|
| Rate for Payer: Vantage Medical Group Senior |
$786.25
|
|
|
HC SOGDX 230 GCH1 81479
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914803
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$185.00 |
| Max. Negotiated Rate |
$786.25 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Cash Price |
$508.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.00
|
| Rate for Payer: EPIC Health Plan Senior |
$370.00
|
| Rate for Payer: Galaxy Health WC |
$786.25
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$616.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$572.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.00
|
| Rate for Payer: Multiplan Commercial |
$740.00
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
|
