|
HC STREPTOCARD STREP A
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
900912483
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC STREPTOCARD STREP A
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
900912483
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$88.77 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.77
|
| Rate for Payer: Blue Shield of California Commercial |
$15.39
|
| Rate for Payer: Blue Shield of California EPN |
$10.17
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cigna of CA HMO |
$14.72
|
| Rate for Payer: Cigna of CA PPO |
$17.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.32
|
| Rate for Payer: EPIC Health Plan Senior |
$16.53
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.15
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.39
|
| Rate for Payer: United Healthcare All Other HMO |
$13.39
|
| Rate for Payer: United Healthcare HMO Rider |
$13.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.39
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.18
|
| Rate for Payer: Vantage Medical Group Senior |
$16.53
|
|
|
HC STREPTOCARD STREP B
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912484
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC STREPTOCARD STREP B
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912484
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$46.22 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.22
|
| Rate for Payer: Blue Shield of California Commercial |
$28.77
|
| Rate for Payer: Blue Shield of California EPN |
$19.01
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cigna of CA HMO |
$27.52
|
| Rate for Payer: Cigna of CA PPO |
$31.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$34.40
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC STREPTOCARD STREP C
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912485
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$46.22 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.22
|
| Rate for Payer: Blue Shield of California Commercial |
$28.77
|
| Rate for Payer: Blue Shield of California EPN |
$19.01
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cigna of CA HMO |
$27.52
|
| Rate for Payer: Cigna of CA PPO |
$31.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$34.40
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC STREPTOCARD STREP C
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912485
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC STREPTOCARD STREP D
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912486
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$46.22 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.22
|
| Rate for Payer: Blue Shield of California Commercial |
$28.77
|
| Rate for Payer: Blue Shield of California EPN |
$19.01
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cigna of CA HMO |
$27.52
|
| Rate for Payer: Cigna of CA PPO |
$31.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$34.40
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC STREPTOCARD STREP D
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912486
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC STREPTOCARD STREP F
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912487
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$46.22 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.22
|
| Rate for Payer: Blue Shield of California Commercial |
$28.77
|
| Rate for Payer: Blue Shield of California EPN |
$19.01
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cigna of CA HMO |
$27.52
|
| Rate for Payer: Cigna of CA PPO |
$31.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$34.40
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC STREPTOCARD STREP F
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912487
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC STREPTOCARD STREP G
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912488
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$46.22 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.22
|
| Rate for Payer: Blue Shield of California Commercial |
$28.77
|
| Rate for Payer: Blue Shield of California EPN |
$19.01
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cigna of CA HMO |
$27.52
|
| Rate for Payer: Cigna of CA PPO |
$31.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$34.40
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC STREPTOCARD STREP G
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912488
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC STREPTOZYME TEST
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 86063
|
| Hospital Charge Code |
900910870
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$76.50
|
| 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: 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 |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
|
|
HC STREPTOZYME TEST
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 86063
|
| Hospital Charge Code |
900910870
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$57.12 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.12
|
| Rate for Payer: Blue Shield of California Commercial |
$15.39
|
| Rate for Payer: Blue Shield of California EPN |
$10.17
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cigna of CA HMO |
$14.72
|
| Rate for Payer: Cigna of CA PPO |
$17.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.79
|
| Rate for Payer: EPIC Health Plan Senior |
$5.77
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.73
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.67
|
| Rate for Payer: United Healthcare All Other HMO |
$4.67
|
| Rate for Payer: United Healthcare HMO Rider |
$4.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5.77
|
|
|
HC STR POST TX CD3 ENGRAFTMENT
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
CPT 81268
|
| Hospital Charge Code |
903902026
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$2,542.98 |
| Rate for Payer: Adventist Health Commercial |
$158.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$520.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$391.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,542.98
|
| Rate for Payer: Blue Shield of California Commercial |
$531.19
|
| Rate for Payer: Blue Shield of California EPN |
$350.95
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cigna of CA HMO |
$508.16
|
| Rate for Payer: Cigna of CA PPO |
$587.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$391.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.07
|
| Rate for Payer: EPIC Health Plan Senior |
$260.79
|
| Rate for Payer: Galaxy Health WC |
$674.90
|
| Rate for Payer: Global Benefits Group Commercial |
$476.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$427.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$201.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$260.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$529.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$328.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$349.46
|
| Rate for Payer: Multiplan Commercial |
$635.20
|
| Rate for Payer: Networks By Design Commercial |
$516.10
|
| Rate for Payer: Prime Health Services Commercial |
$674.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$476.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$476.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$211.24
|
| Rate for Payer: United Healthcare All Other HMO |
$211.24
|
| Rate for Payer: United Healthcare HMO Rider |
$211.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$260.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$391.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.87
|
| Rate for Payer: Vantage Medical Group Senior |
$260.79
|
|
|
HC STR POST TX CD3 ENGRAFTMENT
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
CPT 81268
|
| Hospital Charge Code |
903902026
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$674.90 |
| Rate for Payer: Adventist Health Commercial |
$158.80
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.60
|
| Rate for Payer: EPIC Health Plan Senior |
$317.60
|
| Rate for Payer: Galaxy Health WC |
$674.90
|
| Rate for Payer: Global Benefits Group Commercial |
$476.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$529.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$491.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.56
|
| Rate for Payer: Multiplan Commercial |
$635.20
|
| Rate for Payer: Networks By Design Commercial |
$516.10
|
| Rate for Payer: Prime Health Services Commercial |
$674.90
|
|
|
HC STR POST TX ENGRAFTMENT
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
CPT 81267
|
| Hospital Charge Code |
903902025
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,062.50 |
| Rate for Payer: Adventist Health Commercial |
$250.00
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$500.00
|
| Rate for Payer: Galaxy Health WC |
$1,062.50
|
| Rate for Payer: Global Benefits Group Commercial |
$750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$833.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$476.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$773.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.00
|
| Rate for Payer: Multiplan Commercial |
$1,000.00
|
| Rate for Payer: Networks By Design Commercial |
$812.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,062.50
|
|
|
HC STR POST TX ENGRAFTMENT
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
CPT 81267
|
| Hospital Charge Code |
903902025
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$168.04 |
| Max. Negotiated Rate |
$5,412.46 |
| Rate for Payer: Adventist Health Commercial |
$250.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$819.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$311.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,412.46
|
| Rate for Payer: Blue Shield of California Commercial |
$836.25
|
| Rate for Payer: Blue Shield of California EPN |
$552.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna of CA HMO |
$800.00
|
| Rate for Payer: Cigna of CA PPO |
$925.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$311.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$228.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$207.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.07
|
| Rate for Payer: EPIC Health Plan Senior |
$207.46
|
| Rate for Payer: Galaxy Health WC |
$1,062.50
|
| Rate for Payer: Global Benefits Group Commercial |
$750.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$340.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$201.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$207.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$833.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$278.00
|
| Rate for Payer: Multiplan Commercial |
$1,000.00
|
| Rate for Payer: Networks By Design Commercial |
$812.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,062.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$750.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$750.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.04
|
| Rate for Payer: United Healthcare All Other HMO |
$168.04
|
| Rate for Payer: United Healthcare HMO Rider |
$168.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$207.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$311.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$228.21
|
| Rate for Payer: Vantage Medical Group Senior |
$207.46
|
|
|
HC STR POST TX MYELOID ENGRAFTMNT
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
CPT 81268
|
| Hospital Charge Code |
903902027
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$674.90 |
| Rate for Payer: Adventist Health Commercial |
$158.80
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.60
|
| Rate for Payer: EPIC Health Plan Senior |
$317.60
|
| Rate for Payer: Galaxy Health WC |
$674.90
|
| Rate for Payer: Global Benefits Group Commercial |
$476.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$529.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$491.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.56
|
| Rate for Payer: Multiplan Commercial |
$635.20
|
| Rate for Payer: Networks By Design Commercial |
$516.10
|
| Rate for Payer: Prime Health Services Commercial |
$674.90
|
|
|
HC STR POST TX MYELOID ENGRAFTMNT
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
CPT 81268
|
| Hospital Charge Code |
903902027
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$2,542.98 |
| Rate for Payer: Adventist Health Commercial |
$158.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$520.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$391.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,542.98
|
| Rate for Payer: Blue Shield of California Commercial |
$531.19
|
| Rate for Payer: Blue Shield of California EPN |
$350.95
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cigna of CA HMO |
$508.16
|
| Rate for Payer: Cigna of CA PPO |
$587.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$391.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.07
|
| Rate for Payer: EPIC Health Plan Senior |
$260.79
|
| Rate for Payer: Galaxy Health WC |
$674.90
|
| Rate for Payer: Global Benefits Group Commercial |
$476.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$427.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$201.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$260.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$529.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$328.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$349.46
|
| Rate for Payer: Multiplan Commercial |
$635.20
|
| Rate for Payer: Networks By Design Commercial |
$516.10
|
| Rate for Payer: Prime Health Services Commercial |
$674.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$476.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$476.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$211.24
|
| Rate for Payer: United Healthcare All Other HMO |
$211.24
|
| Rate for Payer: United Healthcare HMO Rider |
$211.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$260.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$391.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.87
|
| Rate for Payer: Vantage Medical Group Senior |
$260.79
|
|
|
HC STR PRE TX ENGRAFTMENT
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT 81265
|
| Hospital Charge Code |
903902024
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$633.25 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: Networks By Design Commercial |
$484.25
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
|
|
HC STR PRE TX ENGRAFTMENT
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT 81265
|
| Hospital Charge Code |
903902024
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$2,355.99 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$488.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$349.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$256.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$233.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,355.99
|
| Rate for Payer: Blue Shield of California Commercial |
$498.40
|
| Rate for Payer: Blue Shield of California EPN |
$329.29
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cigna of CA HMO |
$476.80
|
| Rate for Payer: Cigna of CA PPO |
$551.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$349.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$256.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$233.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.64
|
| Rate for Payer: EPIC Health Plan Senior |
$233.07
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$382.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$321.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$233.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$363.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$293.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$312.31
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: Networks By Design Commercial |
$484.25
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$447.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$447.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.78
|
| Rate for Payer: United Healthcare All Other HMO |
$188.78
|
| Rate for Payer: United Healthcare HMO Rider |
$188.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$233.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$349.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$256.38
|
| Rate for Payer: Vantage Medical Group Senior |
$233.07
|
|
|
HC STUMP SOCK SINGLE PLY AK EACH
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT L8480
|
| Hospital Charge Code |
915358480
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$29.75 |
| Rate for Payer: Adventist Health Commercial |
$14.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.27
|
| Rate for Payer: Blue Shield of California Commercial |
$25.83
|
| Rate for Payer: Blue Shield of California EPN |
$17.01
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cigna of CA HMO |
$24.50
|
| Rate for Payer: Cigna of CA PPO |
$24.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$17.50
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.79
|
| Rate for Payer: United Healthcare HMO Rider |
$12.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.75
|
| Rate for Payer: Vantage Medical Group Senior |
$29.75
|
|
|
HC STUMP SOCK SINGLE PLY AK EACH
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT L8480
|
| Hospital Charge Code |
905358480
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$29.75 |
| Rate for Payer: Adventist Health Commercial |
$14.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.27
|
| Rate for Payer: Blue Shield of California Commercial |
$25.83
|
| Rate for Payer: Blue Shield of California EPN |
$17.01
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cigna of CA HMO |
$24.50
|
| Rate for Payer: Cigna of CA PPO |
$24.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$17.50
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.79
|
| Rate for Payer: United Healthcare HMO Rider |
$12.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.75
|
| Rate for Payer: Vantage Medical Group Senior |
$29.75
|
|
|
HC STUMP SOCK SINGLE PLY AK EACH
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT L8480
|
| Hospital Charge Code |
915358480
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cigna of CA HMO |
$24.50
|
| Rate for Payer: Cigna of CA PPO |
$24.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$17.50
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.79
|
| Rate for Payer: United Healthcare HMO Rider |
$12.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.46
|
|
