|
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 |
$356.23 |
| Rate for Payer: Adventist Health Commercial |
$69.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$356.23
|
| 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 |
$267.05
|
| Rate for Payer: Blue Shield of California Commercial |
$160.89
|
| Rate for Payer: Blue Shield of California Commercial |
$243.25
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$244.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: Galaxy Health WC |
$296.65
|
| Rate for Payer: Global Benefits Group Commercial |
$209.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$221.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| 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: Galaxy Health WC |
$296.65
|
| Rate for Payer: Adventist Health Commercial |
$69.80
|
| Rate for Payer: Cash Price |
$157.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$244.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.60
|
| Rate for Payer: EPIC Health Plan Senior |
$139.60
|
| Rate for Payer: Global Benefits Group Commercial |
$209.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$221.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$205.91
|
| 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 |
$142.59 |
| Rate for Payer: Adventist Health Commercial |
$10.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.76
|
| 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 |
$142.59
|
| Rate for Payer: Blue Shield of California Commercial |
$25.04
|
| Rate for Payer: Blue Shield of California Commercial |
$37.85
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.36
|
| Rate for Payer: EPIC Health Plan Senior |
$14.90
|
| Rate for Payer: Galaxy Health WC |
$46.16
|
| Rate for Payer: Global Benefits Group Commercial |
$32.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$34.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.97
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.02
|
| 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 Foundation Hospitals Commercial/Self Funded |
$34.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.04
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.02
|
| 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 Foundation Hospitals Commercial/Self Funded |
$34.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.04
|
| 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 |
$142.59 |
| Rate for Payer: Adventist Health Commercial |
$10.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.76
|
| 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 |
$142.59
|
| Rate for Payer: Blue Shield of California Commercial |
$25.04
|
| Rate for Payer: Blue Shield of California Commercial |
$37.85
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.36
|
| Rate for Payer: EPIC Health Plan Senior |
$14.90
|
| Rate for Payer: Galaxy Health WC |
$46.16
|
| Rate for Payer: Global Benefits Group Commercial |
$32.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$34.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.97
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$208.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$189.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$175.82
|
| 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 |
$350.50 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| 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 |
$350.50
|
| Rate for Payer: Blue Shield of California Commercial |
$137.38
|
| Rate for Payer: Blue Shield of California Commercial |
$207.71
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$208.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$189.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| 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
|
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 |
$196.12
|
| Rate for Payer: Blue Shield of California Commercial |
$249.16
|
| Rate for Payer: Blue Shield of California Commercial |
$164.27
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$117.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.16
|
| 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
|
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 |
$196.12
|
| Rate for Payer: Blue Shield of California Commercial |
$249.16
|
| Rate for Payer: Blue Shield of California Commercial |
$164.27
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$117.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.16
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$64.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$205.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.16
|
| 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 |
$210.60
|
| 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
|
IP
|
$324.00
|
|
|
Service Code
|
CPT L2820
|
| Hospital Charge Code |
915352820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$64.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$205.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.16
|
| 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 |
$210.60
|
| 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 |
$196.12
|
| Rate for Payer: Blue Shield of California Commercial |
$249.16
|
| Rate for Payer: Blue Shield of California Commercial |
$164.27
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.16
|
| 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 |
$196.12
|
| Rate for Payer: Blue Shield of California Commercial |
$249.16
|
| Rate for Payer: Blue Shield of California Commercial |
$164.27
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.16
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$64.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$205.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.16
|
| 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 |
$210.60
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$64.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$205.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.16
|
| 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 |
$210.60
|
| 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 PALATE
|
Facility
|
OP
|
$1,187.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.93 |
| Max. Negotiated Rate |
$1,008.95 |
| Rate for Payer: Adventist Health Commercial |
$237.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$324.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$761.70
|
| Rate for Payer: Blue Shield of California Commercial |
$757.31
|
| Rate for Payer: Blue Shield of California Commercial |
$499.73
|
| Rate for Payer: Cash Price |
$534.15
|
| Rate for Payer: Cash Price |
$534.15
|
| 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 |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$830.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| 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/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$753.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| 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 |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
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 |
$534.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$830.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$753.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$700.33
|
| 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 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: 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: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$647.50
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$587.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$545.75
|
| 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
|
|
|
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 |
$312.85
|
| 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 |
$593.57
|
| Rate for Payer: Blue Shield of California Commercial |
$426.43
|
| Rate for Payer: Blue Shield of California Commercial |
$644.73
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$416.25
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$647.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$587.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$545.75
|
| 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 317 SIX1 81479
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914808
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$573.75 |
| Rate for Payer: Cigna of CA PPO |
$499.50
|
| Rate for Payer: Adventist Health Commercial |
$135.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$312.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$573.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$371.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$506.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$433.15
|
| Rate for Payer: Blue Shield of California Commercial |
$311.18
|
| Rate for Payer: Blue Shield of California Commercial |
$470.48
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Cigna of CA HMO |
$432.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$573.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$573.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$573.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$472.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.00
|
| Rate for Payer: EPIC Health Plan Senior |
$270.00
|
| Rate for Payer: Galaxy Health WC |
$573.75
|
| Rate for Payer: Global Benefits Group Commercial |
$405.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$428.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$398.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$472.50
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Networks By Design Commercial |
$438.75
|
| Rate for Payer: Prime Health Services Commercial |
$573.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$405.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$405.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$337.50
|
| Rate for Payer: United Healthcare All Other HMO |
$337.50
|
| Rate for Payer: United Healthcare HMO Rider |
$337.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$573.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$573.75
|
| Rate for Payer: Vantage Medical Group Senior |
$573.75
|
|
|
HC SOGDX 317 SIX1 81479
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914808
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$573.75 |
| Rate for Payer: Adventist Health Commercial |
$135.00
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$472.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.00
|
| Rate for Payer: EPIC Health Plan Senior |
$270.00
|
| Rate for Payer: Galaxy Health WC |
$573.75
|
| Rate for Payer: Global Benefits Group Commercial |
$405.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$428.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$398.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Networks By Design Commercial |
$438.75
|
| Rate for Payer: Prime Health Services Commercial |
$573.75
|
|
|
HC SOGDX 559 TP53 GENE 81405
|
Facility
|
IP
|
$1,395.00
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914849
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$279.00 |
| Max. Negotiated Rate |
$1,185.75 |
| Rate for Payer: Adventist Health Commercial |
$279.00
|
| Rate for Payer: Cash Price |
$627.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$976.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$558.00
|
| Rate for Payer: EPIC Health Plan Senior |
$558.00
|
| Rate for Payer: Galaxy Health WC |
$1,185.75
|
| Rate for Payer: Global Benefits Group Commercial |
$837.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$885.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$823.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$334.80
|
| Rate for Payer: Multiplan Commercial |
$1,116.00
|
| Rate for Payer: Networks By Design Commercial |
$906.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,185.75
|
|
|
HC SOGDX 559 TP53 GENE 81405
|
Facility
|
OP
|
$1,395.00
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914849
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$244.10 |
| Max. Negotiated Rate |
$2,432.53 |
| Rate for Payer: Cigna of CA PPO |
$1,032.30
|
| Rate for Payer: Adventist Health Commercial |
$279.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$729.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$331.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$301.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,432.53
|
| Rate for Payer: Blue Shield of California Commercial |
$643.10
|
| Rate for Payer: Blue Shield of California Commercial |
$972.32
|
| Rate for Payer: Cash Price |
$627.75
|
| Rate for Payer: Cash Price |
$627.75
|
| Rate for Payer: Cigna of CA HMO |
$892.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$452.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$331.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$301.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$976.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.23
|
| Rate for Payer: EPIC Health Plan Senior |
$331.49
|
| Rate for Payer: Galaxy Health WC |
$1,185.75
|
| Rate for Payer: Global Benefits Group Commercial |
$837.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$494.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$506.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$301.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$885.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$572.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$421.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$334.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$379.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$403.81
|
| Rate for Payer: Multiplan Commercial |
$1,116.00
|
| Rate for Payer: Networks By Design Commercial |
$906.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,185.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$837.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$837.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$244.10
|
| Rate for Payer: United Healthcare All Other HMO |
$244.10
|
| Rate for Payer: United Healthcare HMO Rider |
$244.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$244.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$301.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$331.49
|
| Rate for Payer: Vantage Medical Group Senior |
$301.35
|
|
|
HC SOHAR HERED PARAGANG PHEO A
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914679
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Adventist Health Commercial |
$240.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$840.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$480.00
|
| Rate for Payer: EPIC Health Plan Senior |
$480.00
|
| Rate for Payer: Galaxy Health WC |
$1,020.00
|
| Rate for Payer: Global Benefits Group Commercial |
$720.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$762.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$708.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.00
|
| Rate for Payer: Multiplan Commercial |
$960.00
|
| Rate for Payer: Networks By Design Commercial |
$780.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,020.00
|
|
