|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 3
|
Facility
|
OP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915334
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$51.60 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.60
|
| Rate for Payer: Blue Shield of California Commercial |
$12.82
|
| Rate for Payer: Blue Shield of California EPN |
$8.47
|
| Rate for Payer: Cash Price |
$10.54
|
| Rate for Payer: Cash Price |
$10.54
|
| Rate for Payer: Cigna of CA HMO |
$12.27
|
| Rate for Payer: Cigna of CA PPO |
$14.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Senior |
$7.82
|
| Rate for Payer: Galaxy Health WC |
$16.29
|
| Rate for Payer: Global Benefits Group Commercial |
$11.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$15.34
|
| Rate for Payer: Networks By Design Commercial |
$12.46
|
| Rate for Payer: Prime Health Services Commercial |
$16.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.34
|
| Rate for Payer: United Healthcare All Other HMO |
$6.34
|
| Rate for Payer: United Healthcare HMO Rider |
$6.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 3
|
Facility
|
IP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915334
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$16.29 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Cash Price |
$10.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.67
|
| Rate for Payer: EPIC Health Plan Senior |
$7.67
|
| Rate for Payer: Galaxy Health WC |
$16.29
|
| Rate for Payer: Global Benefits Group Commercial |
$11.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$15.34
|
| Rate for Payer: Networks By Design Commercial |
$12.46
|
| Rate for Payer: Prime Health Services Commercial |
$16.29
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 4
|
Facility
|
IP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$16.29 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Cash Price |
$10.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.67
|
| Rate for Payer: EPIC Health Plan Senior |
$7.67
|
| Rate for Payer: Galaxy Health WC |
$16.29
|
| Rate for Payer: Global Benefits Group Commercial |
$11.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$15.34
|
| Rate for Payer: Networks By Design Commercial |
$12.46
|
| Rate for Payer: Prime Health Services Commercial |
$16.29
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 4
|
Facility
|
OP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$51.60 |
| Rate for Payer: EPIC Health Plan Senior |
$7.82
|
| Rate for Payer: Galaxy Health WC |
$16.29
|
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.60
|
| Rate for Payer: Blue Shield of California Commercial |
$12.82
|
| Rate for Payer: Blue Shield of California EPN |
$8.47
|
| Rate for Payer: Cash Price |
$10.54
|
| Rate for Payer: Cash Price |
$10.54
|
| Rate for Payer: Cigna of CA HMO |
$12.27
|
| Rate for Payer: Cigna of CA PPO |
$14.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: Global Benefits Group Commercial |
$11.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$15.34
|
| Rate for Payer: Networks By Design Commercial |
$12.46
|
| Rate for Payer: Prime Health Services Commercial |
$16.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.34
|
| Rate for Payer: United Healthcare All Other HMO |
$6.34
|
| Rate for Payer: United Healthcare HMO Rider |
$6.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 5
|
Facility
|
IP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$16.29 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Cash Price |
$10.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.67
|
| Rate for Payer: EPIC Health Plan Senior |
$7.67
|
| Rate for Payer: Galaxy Health WC |
$16.29
|
| Rate for Payer: Global Benefits Group Commercial |
$11.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$15.34
|
| Rate for Payer: Networks By Design Commercial |
$12.46
|
| Rate for Payer: Prime Health Services Commercial |
$16.29
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 5
|
Facility
|
OP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$51.60 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.60
|
| Rate for Payer: Blue Shield of California Commercial |
$12.82
|
| Rate for Payer: Blue Shield of California EPN |
$8.47
|
| Rate for Payer: Cash Price |
$10.54
|
| Rate for Payer: Cash Price |
$10.54
|
| Rate for Payer: Cigna of CA HMO |
$12.27
|
| Rate for Payer: Cigna of CA PPO |
$14.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Senior |
$7.82
|
| Rate for Payer: Galaxy Health WC |
$16.29
|
| Rate for Payer: Global Benefits Group Commercial |
$11.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$15.34
|
| Rate for Payer: Networks By Design Commercial |
$12.46
|
| Rate for Payer: Prime Health Services Commercial |
$16.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.34
|
| Rate for Payer: United Healthcare All Other HMO |
$6.34
|
| Rate for Payer: United Healthcare HMO Rider |
$6.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 6
|
Facility
|
IP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$16.29 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Cash Price |
$10.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.67
|
| Rate for Payer: EPIC Health Plan Senior |
$7.67
|
| Rate for Payer: Galaxy Health WC |
$16.29
|
| Rate for Payer: Global Benefits Group Commercial |
$11.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$15.34
|
| Rate for Payer: Networks By Design Commercial |
$12.46
|
| Rate for Payer: Prime Health Services Commercial |
$16.29
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 6
|
Facility
|
OP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$51.60 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.60
|
| Rate for Payer: Blue Shield of California Commercial |
$12.82
|
| Rate for Payer: Blue Shield of California EPN |
$8.47
|
| Rate for Payer: Cash Price |
$10.54
|
| Rate for Payer: Cash Price |
$10.54
|
| Rate for Payer: Cigna of CA HMO |
$12.27
|
| Rate for Payer: Cigna of CA PPO |
$14.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Senior |
$7.82
|
| Rate for Payer: Galaxy Health WC |
$16.29
|
| Rate for Payer: Global Benefits Group Commercial |
$11.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$15.34
|
| Rate for Payer: Networks By Design Commercial |
$12.46
|
| Rate for Payer: Prime Health Services Commercial |
$16.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.34
|
| Rate for Payer: United Healthcare All Other HMO |
$6.34
|
| Rate for Payer: United Healthcare HMO Rider |
$6.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 7
|
Facility
|
IP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915338
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$16.29 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Cash Price |
$10.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.67
|
| Rate for Payer: EPIC Health Plan Senior |
$7.67
|
| Rate for Payer: Galaxy Health WC |
$16.29
|
| Rate for Payer: Global Benefits Group Commercial |
$11.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$15.34
|
| Rate for Payer: Networks By Design Commercial |
$12.46
|
| Rate for Payer: Prime Health Services Commercial |
$16.29
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 7
|
Facility
|
OP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915338
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$51.60 |
| Rate for Payer: EPIC Health Plan Senior |
$7.82
|
| Rate for Payer: Galaxy Health WC |
$16.29
|
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.60
|
| Rate for Payer: Blue Shield of California Commercial |
$12.82
|
| Rate for Payer: Blue Shield of California EPN |
$8.47
|
| Rate for Payer: Cash Price |
$10.54
|
| Rate for Payer: Cash Price |
$10.54
|
| Rate for Payer: Cigna of CA HMO |
$12.27
|
| Rate for Payer: Cigna of CA PPO |
$14.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: Global Benefits Group Commercial |
$11.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$15.34
|
| Rate for Payer: Networks By Design Commercial |
$12.46
|
| Rate for Payer: Prime Health Services Commercial |
$16.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.34
|
| Rate for Payer: United Healthcare All Other HMO |
$6.34
|
| Rate for Payer: United Healthcare HMO Rider |
$6.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 8
|
Facility
|
IP
|
$19.21
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915339
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$16.33 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Cash Price |
$10.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: Galaxy Health WC |
$16.33
|
| Rate for Payer: Global Benefits Group Commercial |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.61
|
| Rate for Payer: Multiplan Commercial |
$15.37
|
| Rate for Payer: Networks By Design Commercial |
$12.49
|
| Rate for Payer: Prime Health Services Commercial |
$16.33
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 8
|
Facility
|
OP
|
$19.21
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915339
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$51.60 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.60
|
| Rate for Payer: Blue Shield of California Commercial |
$12.85
|
| Rate for Payer: Blue Shield of California EPN |
$8.49
|
| Rate for Payer: Cash Price |
$10.57
|
| Rate for Payer: Cash Price |
$10.57
|
| Rate for Payer: Cigna of CA HMO |
$12.29
|
| Rate for Payer: Cigna of CA PPO |
$14.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Senior |
$7.82
|
| Rate for Payer: Galaxy Health WC |
$16.33
|
| Rate for Payer: Global Benefits Group Commercial |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$15.37
|
| Rate for Payer: Networks By Design Commercial |
$12.49
|
| Rate for Payer: Prime Health Services Commercial |
$16.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.34
|
| Rate for Payer: United Healthcare All Other HMO |
$6.34
|
| Rate for Payer: United Healthcare HMO Rider |
$6.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
HC SPCL TRT PROC LG SGL RAD DOSE
|
Facility
|
OP
|
$3,581.00
|
|
|
Service Code
|
CPT 77470
|
| Hospital Charge Code |
909100313
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$195.28 |
| Max. Negotiated Rate |
$3,043.85 |
| Rate for Payer: Adventist Health Commercial |
$716.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,348.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$808.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,743.07
|
| Rate for Payer: Blue Shield of California Commercial |
$2,191.57
|
| Rate for Payer: Blue Shield of California EPN |
$1,446.72
|
| Rate for Payer: Cash Price |
$1,969.55
|
| Rate for Payer: Cash Price |
$1,969.55
|
| Rate for Payer: Cash Price |
$1,969.55
|
| Rate for Payer: Cigna of CA HMO |
$2,291.84
|
| Rate for Payer: Cigna of CA PPO |
$2,649.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$808.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$735.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$992.25
|
| Rate for Payer: EPIC Health Plan Senior |
$735.00
|
| Rate for Payer: Galaxy Health WC |
$3,043.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,148.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,205.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$195.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$735.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,388.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$859.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$926.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$984.90
|
| Rate for Payer: Multiplan Commercial |
$2,864.80
|
| Rate for Payer: Networks By Design Commercial |
$2,327.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,043.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,148.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$735.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$808.50
|
| Rate for Payer: Vantage Medical Group Senior |
$735.00
|
|
|
HC SPCL TRT PROC LG SGL RAD DOSE
|
Facility
|
IP
|
$3,581.00
|
|
|
Service Code
|
CPT 77470
|
| Hospital Charge Code |
909100313
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$716.20 |
| Max. Negotiated Rate |
$3,043.85 |
| Rate for Payer: Adventist Health Commercial |
$716.20
|
| Rate for Payer: Cash Price |
$1,969.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,432.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,432.40
|
| Rate for Payer: Galaxy Health WC |
$3,043.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,148.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,388.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,364.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,216.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$859.44
|
| Rate for Payer: Multiplan Commercial |
$2,864.80
|
| Rate for Payer: Networks By Design Commercial |
$2,327.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,043.85
|
|
|
HC SPEC DOSIMETRY-TLD MICRO
|
Facility
|
OP
|
$886.00
|
|
|
Service Code
|
CPT 77331
|
| Hospital Charge Code |
904810814
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$89.71 |
| Max. Negotiated Rate |
$1,759.00 |
| Rate for Payer: Adventist Health Commercial |
$177.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$581.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$253.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$185.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.83
|
| Rate for Payer: Blue Shield of California Commercial |
$542.23
|
| Rate for Payer: Blue Shield of California EPN |
$357.94
|
| Rate for Payer: Cash Price |
$487.30
|
| Rate for Payer: Cash Price |
$487.30
|
| Rate for Payer: Cash Price |
$487.30
|
| Rate for Payer: Cigna of CA HMO |
$567.04
|
| Rate for Payer: Cigna of CA PPO |
$655.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$253.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$185.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$168.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.75
|
| Rate for Payer: EPIC Health Plan Senior |
$168.70
|
| Rate for Payer: Galaxy Health WC |
$753.10
|
| Rate for Payer: Global Benefits Group Commercial |
$531.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$276.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$89.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$168.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$590.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$212.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$226.06
|
| Rate for Payer: Multiplan Commercial |
$708.80
|
| Rate for Payer: Networks By Design Commercial |
$575.90
|
| Rate for Payer: Prime Health Services Commercial |
$753.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$531.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$168.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$253.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$185.57
|
| Rate for Payer: Vantage Medical Group Senior |
$168.70
|
|
|
HC SPEC DOSIMETRY-TLD MICRO
|
Facility
|
IP
|
$886.00
|
|
|
Service Code
|
CPT 77331
|
| Hospital Charge Code |
904810814
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$177.20 |
| Max. Negotiated Rate |
$753.10 |
| Rate for Payer: Adventist Health Commercial |
$177.20
|
| Rate for Payer: Cash Price |
$487.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$354.40
|
| Rate for Payer: EPIC Health Plan Senior |
$354.40
|
| Rate for Payer: Galaxy Health WC |
$753.10
|
| Rate for Payer: Global Benefits Group Commercial |
$531.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$590.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$337.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$548.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.64
|
| Rate for Payer: Multiplan Commercial |
$708.80
|
| Rate for Payer: Networks By Design Commercial |
$575.90
|
| Rate for Payer: Prime Health Services Commercial |
$753.10
|
|
|
HC SPEC GRAVITY HEMATOLOGY
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900910178
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: Adventist Health Commercial |
$16.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Senior |
$32.00
|
| Rate for Payer: Galaxy Health WC |
$68.00
|
| Rate for Payer: Global Benefits Group Commercial |
$48.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: Networks By Design Commercial |
$52.00
|
| Rate for Payer: Prime Health Services Commercial |
$68.00
|
|
|
HC SPEC GRAVITY HEMATOLOGY
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900910178
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: Adventist Health Commercial |
$16.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.47
|
| Rate for Payer: Blue Shield of California Commercial |
$53.52
|
| Rate for Payer: Blue Shield of California EPN |
$35.36
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna of CA HMO |
$51.20
|
| Rate for Payer: Cigna of CA PPO |
$59.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.70
|
| Rate for Payer: EPIC Health Plan Senior |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$68.00
|
| Rate for Payer: Global Benefits Group Commercial |
$48.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.66
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: Networks By Design Commercial |
$52.00
|
| Rate for Payer: Prime Health Services Commercial |
$68.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.82
|
| Rate for Payer: United Healthcare All Other HMO |
$2.82
|
| Rate for Payer: United Healthcare HMO Rider |
$2.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC SPECIAL EXT TO INSTEP SHOE ADD
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT L3570
|
| Hospital Charge Code |
915353570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Adventist Health Commercial |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.46
|
| Rate for Payer: Blue Shield of California Commercial |
$125.46
|
| Rate for Payer: Blue Shield of California EPN |
$82.62
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna of CA HMO |
$119.00
|
| Rate for Payer: Cigna of CA PPO |
$119.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$90.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$119.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.00
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.80
|
| Rate for Payer: United Healthcare All Other HMO |
$62.10
|
| Rate for Payer: United Healthcare HMO Rider |
$60.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.50
|
| Rate for Payer: Vantage Medical Group Senior |
$144.50
|
|
|
HC SPECIAL EXT TO INSTEP SHOE ADD
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT L3570
|
| Hospital Charge Code |
915353570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna of CA HMO |
$119.00
|
| Rate for Payer: Cigna of CA PPO |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.80
|
| Rate for Payer: United Healthcare All Other HMO |
$62.10
|
| Rate for Payer: United Healthcare HMO Rider |
$60.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.67
|
|
|
HC SPECIAL EXT TO INSTEP SHOE ADD
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT L3570
|
| Hospital Charge Code |
905353570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna of CA HMO |
$119.00
|
| Rate for Payer: Cigna of CA PPO |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.80
|
| Rate for Payer: United Healthcare All Other HMO |
$62.10
|
| Rate for Payer: United Healthcare HMO Rider |
$60.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.67
|
|
|
HC SPECIAL EXT TO INSTEP SHOE ADD
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT L3570
|
| Hospital Charge Code |
905353570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Adventist Health Commercial |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.46
|
| Rate for Payer: Blue Shield of California Commercial |
$125.46
|
| Rate for Payer: Blue Shield of California EPN |
$82.62
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna of CA HMO |
$119.00
|
| Rate for Payer: Cigna of CA PPO |
$119.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$90.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$119.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.00
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.80
|
| Rate for Payer: United Healthcare All Other HMO |
$62.10
|
| Rate for Payer: United Healthcare HMO Rider |
$60.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.50
|
| Rate for Payer: Vantage Medical Group Senior |
$144.50
|
|
|
HC SPECIAL STAINS, GROUP 1
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
903800029
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$452.20 |
| Rate for Payer: Adventist Health Commercial |
$106.40
|
| Rate for Payer: Cash Price |
$292.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$212.80
|
| Rate for Payer: EPIC Health Plan Senior |
$212.80
|
| Rate for Payer: Galaxy Health WC |
$452.20
|
| Rate for Payer: Global Benefits Group Commercial |
$319.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$354.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$329.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.68
|
| Rate for Payer: Multiplan Commercial |
$425.60
|
| Rate for Payer: Networks By Design Commercial |
$345.80
|
| Rate for Payer: Prime Health Services Commercial |
$452.20
|
|
|
HC SPECIAL STAINS, GROUP 1
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
903800029
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$29.39 |
| Max. Negotiated Rate |
$452.20 |
| Rate for Payer: Adventist Health Commercial |
$106.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$348.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.39
|
| Rate for Payer: Blue Shield of California Commercial |
$355.91
|
| Rate for Payer: Blue Shield of California EPN |
$235.14
|
| Rate for Payer: Cash Price |
$292.60
|
| Rate for Payer: Cash Price |
$292.60
|
| Rate for Payer: Cigna of CA HMO |
$340.48
|
| Rate for Payer: Cigna of CA PPO |
$393.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.65
|
| Rate for Payer: EPIC Health Plan Senior |
$67.89
|
| Rate for Payer: Galaxy Health WC |
$452.20
|
| Rate for Payer: Global Benefits Group Commercial |
$319.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$55.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$354.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.97
|
| Rate for Payer: Multiplan Commercial |
$425.60
|
| Rate for Payer: Networks By Design Commercial |
$345.80
|
| Rate for Payer: Prime Health Services Commercial |
$452.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$319.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$319.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
|
HC SPECIAL STAINS GROUP 1 PG
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
903800207
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Senior |
$57.60
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.56
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
|
