|
HC SYPHILIS NON TREP QUANT
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
900913672
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
|
|
HC SYPHILIS TOTAL
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913674
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$54.40 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Senior |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
|
|
HC SYPHILIS TOTAL
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913674
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$231.08 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.08
|
| Rate for Payer: Blue Shield of California Commercial |
$42.82
|
| Rate for Payer: Blue Shield of California EPN |
$28.29
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SYPHILLIS IGG
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
900913561
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$158.10 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.40
|
| Rate for Payer: EPIC Health Plan Senior |
$74.40
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.64
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
|
|
HC SYPHILLIS IGG
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
900913561
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$171.36 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.36
|
| Rate for Payer: Blue Shield of California Commercial |
$124.43
|
| Rate for Payer: Blue Shield of California EPN |
$82.21
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cigna of CA HMO |
$119.04
|
| Rate for Payer: Cigna of CA PPO |
$137.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.87
|
| Rate for Payer: EPIC Health Plan Senior |
$13.24
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.73
|
| Rate for Payer: United Healthcare All Other HMO |
$10.73
|
| Rate for Payer: United Healthcare HMO Rider |
$10.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC SYPHILLIS IGG INDIVIDUAL
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
900913563
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$158.10 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.40
|
| Rate for Payer: EPIC Health Plan Senior |
$74.40
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.64
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
|
|
HC SYPHILLIS IGG INDIVIDUAL
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
900913563
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$171.36 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.36
|
| Rate for Payer: Blue Shield of California Commercial |
$124.43
|
| Rate for Payer: Blue Shield of California EPN |
$82.21
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cigna of CA HMO |
$119.04
|
| Rate for Payer: Cigna of CA PPO |
$137.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.87
|
| Rate for Payer: EPIC Health Plan Senior |
$13.24
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.73
|
| Rate for Payer: United Healthcare All Other HMO |
$10.73
|
| Rate for Payer: United Healthcare HMO Rider |
$10.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC SYPHILLIS TEST RPR
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
900910892
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.16
|
| Rate for Payer: Blue Shield of California Commercial |
$121.76
|
| Rate for Payer: Blue Shield of California EPN |
$80.44
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cigna of CA HMO |
$116.48
|
| Rate for Payer: Cigna of CA PPO |
$134.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Networks By Design Commercial |
$118.30
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC SYPHILLIS TEST RPR
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
900910892
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.68
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Networks By Design Commercial |
$118.30
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
|
|
HC SYPHILLIS TEST RPR INDIVIDUAL
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
900912331
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.68
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Networks By Design Commercial |
$118.30
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
|
|
HC SYPHILLIS TEST RPR INDIVIDUAL
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
900912331
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.16
|
| Rate for Payer: Blue Shield of California Commercial |
$121.76
|
| Rate for Payer: Blue Shield of California EPN |
$80.44
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cigna of CA HMO |
$116.48
|
| Rate for Payer: Cigna of CA PPO |
$134.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Networks By Design Commercial |
$118.30
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC SYPHILLIS TEST VDRL/ CSF
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
900910861
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.68
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Networks By Design Commercial |
$118.30
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
|
|
HC SYPHILLIS TEST VDRL/ CSF
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
900910861
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.16
|
| Rate for Payer: Blue Shield of California Commercial |
$121.76
|
| Rate for Payer: Blue Shield of California EPN |
$80.44
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cigna of CA HMO |
$116.48
|
| Rate for Payer: Cigna of CA PPO |
$134.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Networks By Design Commercial |
$118.30
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC SYSTEM NASAL TUBE RTNR 12-14FR
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901698433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC SYSTEM NASAL TUBE RTNR 12-14FR
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901698433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$380.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$356.18
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
|
|
HC SYSTEM NASAL TUBE RTNR 16-18FR
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901698599
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC SYSTEM NASAL TUBE RTNR 16-18FR
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901698599
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$380.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$356.18
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC SYSTEM NASAL TUBE RTNR 8-10FR
|
Facility
|
IP
|
$613.18
|
|
| Hospital Charge Code |
901698432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.64 |
| Max. Negotiated Rate |
$521.20 |
| Rate for Payer: Adventist Health Commercial |
$122.64
|
| Rate for Payer: Cash Price |
$337.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.27
|
| Rate for Payer: EPIC Health Plan Senior |
$245.27
|
| Rate for Payer: Galaxy Health WC |
$521.20
|
| Rate for Payer: Global Benefits Group Commercial |
$367.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$408.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.16
|
| Rate for Payer: Multiplan Commercial |
$490.54
|
| Rate for Payer: Networks By Design Commercial |
$398.57
|
| Rate for Payer: Prime Health Services Commercial |
$521.20
|
|
|
HC SYSTEM NASAL TUBE RTNR 8-10FR
|
Facility
|
OP
|
$613.18
|
|
| Hospital Charge Code |
901698432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.64 |
| Max. Negotiated Rate |
$521.20 |
| Rate for Payer: Adventist Health Commercial |
$122.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$402.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$521.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$459.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$376.55
|
| Rate for Payer: Cash Price |
$337.25
|
| Rate for Payer: Cigna of CA HMO |
$392.44
|
| Rate for Payer: Cigna of CA PPO |
$453.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$521.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$521.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$521.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.27
|
| Rate for Payer: EPIC Health Plan Senior |
$245.27
|
| Rate for Payer: Galaxy Health WC |
$521.20
|
| Rate for Payer: Global Benefits Group Commercial |
$367.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$408.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$429.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$429.23
|
| Rate for Payer: Multiplan Commercial |
$490.54
|
| Rate for Payer: Networks By Design Commercial |
$398.57
|
| Rate for Payer: Prime Health Services Commercial |
$521.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$367.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$367.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$306.59
|
| Rate for Payer: United Healthcare All Other HMO |
$306.59
|
| Rate for Payer: United Healthcare HMO Rider |
$306.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$306.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$521.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$521.20
|
| Rate for Payer: Vantage Medical Group Senior |
$521.20
|
|
|
HC SYTM TORTLEAIR HEAD REPOSITIONING LRG 41-46CM
|
Facility
|
OP
|
$176.75
|
|
| Hospital Charge Code |
901607217
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.35 |
| Max. Negotiated Rate |
$150.24 |
| Rate for Payer: Adventist Health Commercial |
$35.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$150.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$132.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.54
|
| Rate for Payer: Cash Price |
$97.21
|
| Rate for Payer: Cigna of CA HMO |
$113.12
|
| Rate for Payer: Cigna of CA PPO |
$130.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$150.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.70
|
| Rate for Payer: EPIC Health Plan Senior |
$70.70
|
| Rate for Payer: Galaxy Health WC |
$150.24
|
| Rate for Payer: Global Benefits Group Commercial |
$106.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$109.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$123.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$123.72
|
| Rate for Payer: Multiplan Commercial |
$141.40
|
| Rate for Payer: Networks By Design Commercial |
$114.89
|
| Rate for Payer: Prime Health Services Commercial |
$150.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.38
|
| Rate for Payer: United Healthcare All Other HMO |
$88.38
|
| Rate for Payer: United Healthcare HMO Rider |
$88.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$150.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.24
|
| Rate for Payer: Vantage Medical Group Senior |
$150.24
|
|
|
HC SYTM TORTLEAIR HEAD REPOSITIONING LRG 41-46CM
|
Facility
|
IP
|
$176.75
|
|
| Hospital Charge Code |
901607217
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.35 |
| Max. Negotiated Rate |
$150.24 |
| Rate for Payer: Adventist Health Commercial |
$35.35
|
| Rate for Payer: Cash Price |
$97.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.70
|
| Rate for Payer: EPIC Health Plan Senior |
$70.70
|
| Rate for Payer: Galaxy Health WC |
$150.24
|
| Rate for Payer: Global Benefits Group Commercial |
$106.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$109.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.42
|
| Rate for Payer: Multiplan Commercial |
$141.40
|
| Rate for Payer: Networks By Design Commercial |
$114.89
|
| Rate for Payer: Prime Health Services Commercial |
$150.24
|
|
|
HC SYTM TORTLEAIR HEAD REPOSITIONING MED 38-41CM
|
Facility
|
IP
|
$183.75
|
|
| Hospital Charge Code |
901607216
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$156.19 |
| Rate for Payer: Adventist Health Commercial |
$36.75
|
| Rate for Payer: Cash Price |
$101.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.50
|
| Rate for Payer: EPIC Health Plan Senior |
$73.50
|
| Rate for Payer: Galaxy Health WC |
$156.19
|
| Rate for Payer: Global Benefits Group Commercial |
$110.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.10
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$119.44
|
| Rate for Payer: Prime Health Services Commercial |
$156.19
|
|
|
HC SYTM TORTLEAIR HEAD REPOSITIONING MED 38-41CM
|
Facility
|
OP
|
$183.75
|
|
| Hospital Charge Code |
901607216
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$156.19 |
| Rate for Payer: Adventist Health Commercial |
$36.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.84
|
| Rate for Payer: Cash Price |
$101.06
|
| Rate for Payer: Cigna of CA HMO |
$117.60
|
| Rate for Payer: Cigna of CA PPO |
$135.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$156.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.50
|
| Rate for Payer: EPIC Health Plan Senior |
$73.50
|
| Rate for Payer: Galaxy Health WC |
$156.19
|
| Rate for Payer: Global Benefits Group Commercial |
$110.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$128.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$128.62
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$119.44
|
| Rate for Payer: Prime Health Services Commercial |
$156.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.88
|
| Rate for Payer: United Healthcare All Other HMO |
$91.88
|
| Rate for Payer: United Healthcare HMO Rider |
$91.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$156.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.19
|
| Rate for Payer: Vantage Medical Group Senior |
$156.19
|
|
|
HC SYTM TORTLEAIR HEAD REPOSITIONING SM 33-38CM
|
Facility
|
OP
|
$183.75
|
|
| Hospital Charge Code |
901607215
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$156.19 |
| Rate for Payer: Adventist Health Commercial |
$36.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.84
|
| Rate for Payer: Cash Price |
$101.06
|
| Rate for Payer: Cigna of CA HMO |
$117.60
|
| Rate for Payer: Cigna of CA PPO |
$135.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$156.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.50
|
| Rate for Payer: EPIC Health Plan Senior |
$73.50
|
| Rate for Payer: Galaxy Health WC |
$156.19
|
| Rate for Payer: Global Benefits Group Commercial |
$110.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$128.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$128.62
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$119.44
|
| Rate for Payer: Prime Health Services Commercial |
$156.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.88
|
| Rate for Payer: United Healthcare All Other HMO |
$91.88
|
| Rate for Payer: United Healthcare HMO Rider |
$91.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$156.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.19
|
| Rate for Payer: Vantage Medical Group Senior |
$156.19
|
|
|
HC SYTM TORTLEAIR HEAD REPOSITIONING SM 33-38CM
|
Facility
|
IP
|
$183.75
|
|
| Hospital Charge Code |
901607215
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$156.19 |
| Rate for Payer: Adventist Health Commercial |
$36.75
|
| Rate for Payer: Cash Price |
$101.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.50
|
| Rate for Payer: EPIC Health Plan Senior |
$73.50
|
| Rate for Payer: Galaxy Health WC |
$156.19
|
| Rate for Payer: Global Benefits Group Commercial |
$110.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.10
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$119.44
|
| Rate for Payer: Prime Health Services Commercial |
$156.19
|
|
