|
HC TOMOGRAPHY COMPLEX MOTION BODY SEC
|
Facility
|
OP
|
$728.00
|
|
|
Service Code
|
CPT 76101
|
| Hospital Charge Code |
909001156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$145.60 |
| Max. Negotiated Rate |
$618.80 |
| Rate for Payer: Adventist Health Commercial |
$145.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$477.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$618.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$400.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$546.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$402.04
|
| Rate for Payer: Blue Shield of California Commercial |
$445.54
|
| Rate for Payer: Blue Shield of California EPN |
$294.11
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cigna of CA HMO |
$465.92
|
| Rate for Payer: Cigna of CA PPO |
$538.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$618.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$618.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$618.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.20
|
| Rate for Payer: EPIC Health Plan Senior |
$291.20
|
| Rate for Payer: Galaxy Health WC |
$618.80
|
| Rate for Payer: Global Benefits Group Commercial |
$436.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$485.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$277.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$450.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$509.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$509.60
|
| Rate for Payer: Multiplan Commercial |
$582.40
|
| Rate for Payer: Networks By Design Commercial |
$473.20
|
| Rate for Payer: Prime Health Services Commercial |
$618.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$436.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$436.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$364.00
|
| Rate for Payer: United Healthcare All Other HMO |
$364.00
|
| Rate for Payer: United Healthcare HMO Rider |
$364.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$364.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$618.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$618.80
|
| Rate for Payer: Vantage Medical Group Senior |
$618.80
|
|
|
HC TOMOGRAPHY SINGLE PLANE BODY SEC
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
CPT 76100
|
| Hospital Charge Code |
909001551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.94 |
| Max. Negotiated Rate |
$638.35 |
| Rate for Payer: Adventist Health Commercial |
$150.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$492.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$355.36
|
| Rate for Payer: Blue Shield of California Commercial |
$459.61
|
| Rate for Payer: Blue Shield of California EPN |
$303.40
|
| Rate for Payer: Cash Price |
$337.95
|
| Rate for Payer: Cash Price |
$337.95
|
| Rate for Payer: Cigna of CA HMO |
$480.64
|
| Rate for Payer: Cigna of CA PPO |
$555.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$638.35
|
| Rate for Payer: Global Benefits Group Commercial |
$450.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$95.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$500.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$600.80
|
| Rate for Payer: Networks By Design Commercial |
$488.15
|
| Rate for Payer: Prime Health Services Commercial |
$638.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$450.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$450.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC TOMOGRAPHY SINGLE PLANE BODY SEC
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
CPT 76100
|
| Hospital Charge Code |
909001551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$150.20 |
| Max. Negotiated Rate |
$638.35 |
| Rate for Payer: Adventist Health Commercial |
$150.20
|
| Rate for Payer: Cash Price |
$337.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.40
|
| Rate for Payer: EPIC Health Plan Senior |
$300.40
|
| Rate for Payer: Galaxy Health WC |
$638.35
|
| Rate for Payer: Global Benefits Group Commercial |
$450.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$500.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$286.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$464.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.24
|
| Rate for Payer: Multiplan Commercial |
$600.80
|
| Rate for Payer: Networks By Design Commercial |
$488.15
|
| Rate for Payer: Prime Health Services Commercial |
$638.35
|
|
|
HC TORSION CONTROL ANKLE JOINT ADDITION LE
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT L2375
|
| Hospital Charge Code |
915352375
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$48.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Cigna of CA HMO |
$170.10
|
| Rate for Payer: Cigna of CA PPO |
$170.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.20
|
| Rate for Payer: EPIC Health Plan Senior |
$97.20
|
| Rate for Payer: Galaxy Health WC |
$206.55
|
| Rate for Payer: Global Benefits Group Commercial |
$145.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.32
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: Networks By Design Commercial |
$121.50
|
| Rate for Payer: Prime Health Services Commercial |
$206.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Other HMO |
$88.77
|
| Rate for Payer: United Healthcare HMO Rider |
$86.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.58
|
|
|
HC TORSION CONTROL ANKLE JOINT ADDITION LE
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT L2375
|
| Hospital Charge Code |
905352375
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$48.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Cigna of CA HMO |
$170.10
|
| Rate for Payer: Cigna of CA PPO |
$170.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.20
|
| Rate for Payer: EPIC Health Plan Senior |
$97.20
|
| Rate for Payer: Galaxy Health WC |
$206.55
|
| Rate for Payer: Global Benefits Group Commercial |
$145.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.32
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: Networks By Design Commercial |
$121.50
|
| Rate for Payer: Prime Health Services Commercial |
$206.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Other HMO |
$88.77
|
| Rate for Payer: United Healthcare HMO Rider |
$86.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.58
|
|
|
HC TORSION CONTROL ANKLE JOINT ADDITION LE
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT L2375
|
| Hospital Charge Code |
905352375
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.32 |
| Max. Negotiated Rate |
$206.55 |
| Rate for Payer: Adventist Health Commercial |
$99.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$182.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.75
|
| Rate for Payer: Blue Shield of California Commercial |
$179.33
|
| Rate for Payer: Blue Shield of California EPN |
$118.10
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Cigna of CA HMO |
$170.10
|
| Rate for Payer: Cigna of CA PPO |
$170.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$206.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$206.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.20
|
| Rate for Payer: EPIC Health Plan Senior |
$97.20
|
| Rate for Payer: Galaxy Health WC |
$206.55
|
| Rate for Payer: Global Benefits Group Commercial |
$145.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$117.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.10
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: Networks By Design Commercial |
$121.50
|
| Rate for Payer: Prime Health Services Commercial |
$206.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Other HMO |
$88.77
|
| Rate for Payer: United Healthcare HMO Rider |
$86.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$206.55
|
| Rate for Payer: Vantage Medical Group Senior |
$206.55
|
|
|
HC TORSION CONTROL ANKLE JOINT ADDITION LE
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT L2375
|
| Hospital Charge Code |
915352375
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.32 |
| Max. Negotiated Rate |
$206.55 |
| Rate for Payer: Adventist Health Commercial |
$99.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$182.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.75
|
| Rate for Payer: Blue Shield of California Commercial |
$179.33
|
| Rate for Payer: Blue Shield of California EPN |
$118.10
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Cigna of CA HMO |
$170.10
|
| Rate for Payer: Cigna of CA PPO |
$170.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$206.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$206.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.20
|
| Rate for Payer: EPIC Health Plan Senior |
$97.20
|
| Rate for Payer: Galaxy Health WC |
$206.55
|
| Rate for Payer: Global Benefits Group Commercial |
$145.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$117.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.10
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: Networks By Design Commercial |
$121.50
|
| Rate for Payer: Prime Health Services Commercial |
$206.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Other HMO |
$88.77
|
| Rate for Payer: United Healthcare HMO Rider |
$86.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$206.55
|
| Rate for Payer: Vantage Medical Group Senior |
$206.55
|
|
|
HC TORSION CONTROL KNEE JOINT ADDITION LE
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT L2380
|
| Hospital Charge Code |
905352380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$100.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
|
|
HC TORSION CONTROL KNEE JOINT ADDITION LE
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT L2380
|
| Hospital Charge Code |
915352380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.84
|
| Rate for Payer: Blue Shield of California Commercial |
$147.60
|
| Rate for Payer: Blue Shield of California EPN |
$97.20
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$170.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$139.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$100.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
|
|
HC TORSION CONTROL KNEE JOINT ADDITION LE
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT L2380
|
| Hospital Charge Code |
915352380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$100.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
|
|
HC TORSION CONTROL KNEE JOINT ADDITION LE
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT L2380
|
| Hospital Charge Code |
905352380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.84
|
| Rate for Payer: Blue Shield of California Commercial |
$147.60
|
| Rate for Payer: Blue Shield of California EPN |
$97.20
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$170.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$139.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$100.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
|
|
HC TORSION MECHANISM KNEE/ANKLE
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT L2861
|
| Hospital Charge Code |
905352861
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna of CA HMO |
$280.00
|
| Rate for Payer: Cigna of CA PPO |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$320.00
|
| Rate for Payer: Networks By Design Commercial |
$200.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.12
|
| Rate for Payer: United Healthcare All Other HMO |
$146.12
|
| Rate for Payer: United Healthcare HMO Rider |
$142.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.00
|
|
|
HC TORSION MECHANISM KNEE/ANKLE
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT L2861
|
| Hospital Charge Code |
905352861
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.68
|
| Rate for Payer: Blue Shield of California Commercial |
$295.20
|
| Rate for Payer: Blue Shield of California EPN |
$194.40
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna of CA HMO |
$280.00
|
| Rate for Payer: Cigna of CA PPO |
$280.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$340.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$280.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.00
|
| Rate for Payer: Multiplan Commercial |
$320.00
|
| Rate for Payer: Networks By Design Commercial |
$200.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.12
|
| Rate for Payer: United Healthcare All Other HMO |
$146.12
|
| Rate for Payer: United Healthcare HMO Rider |
$142.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.00
|
| Rate for Payer: Vantage Medical Group Senior |
$340.00
|
|
|
HC TORSION MECHANISM WRIST ELBOW
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT L3891
|
| Hospital Charge Code |
905353891
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.68
|
| Rate for Payer: Blue Shield of California Commercial |
$295.20
|
| Rate for Payer: Blue Shield of California EPN |
$194.40
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna of CA HMO |
$280.00
|
| Rate for Payer: Cigna of CA PPO |
$280.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$340.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$280.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.00
|
| Rate for Payer: Multiplan Commercial |
$320.00
|
| Rate for Payer: Networks By Design Commercial |
$200.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.12
|
| Rate for Payer: United Healthcare All Other HMO |
$146.12
|
| Rate for Payer: United Healthcare HMO Rider |
$142.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.00
|
| Rate for Payer: Vantage Medical Group Senior |
$340.00
|
|
|
HC TORSION MECHANISM WRIST ELBOW
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT L3891
|
| Hospital Charge Code |
905353891
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna of CA HMO |
$280.00
|
| Rate for Payer: Cigna of CA PPO |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$320.00
|
| Rate for Payer: Networks By Design Commercial |
$200.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.12
|
| Rate for Payer: United Healthcare All Other HMO |
$146.12
|
| Rate for Payer: United Healthcare HMO Rider |
$142.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.00
|
|
|
HC TOTAL BODY THYROID SCAN
|
Facility
|
IP
|
$4,186.00
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
909301317
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$837.20 |
| Max. Negotiated Rate |
$3,558.10 |
| Rate for Payer: Adventist Health Commercial |
$837.20
|
| Rate for Payer: Cash Price |
$1,883.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,674.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,674.40
|
| Rate for Payer: Galaxy Health WC |
$3,558.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,511.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,792.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,594.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,591.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,004.64
|
| Rate for Payer: Multiplan Commercial |
$3,348.80
|
| Rate for Payer: Networks By Design Commercial |
$2,720.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,558.10
|
|
|
HC TOTAL BODY THYROID SCAN
|
Facility
|
OP
|
$4,186.00
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
909301317
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$218.06 |
| Max. Negotiated Rate |
$3,558.10 |
| Rate for Payer: Adventist Health Commercial |
$837.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,745.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,570.62
|
| Rate for Payer: Blue Shield of California Commercial |
$2,561.83
|
| Rate for Payer: Blue Shield of California EPN |
$1,691.14
|
| Rate for Payer: Cash Price |
$1,883.70
|
| Rate for Payer: Cash Price |
$1,883.70
|
| Rate for Payer: Cigna of CA HMO |
$2,679.04
|
| Rate for Payer: Cigna of CA PPO |
$3,097.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.31
|
| Rate for Payer: EPIC Health Plan Senior |
$683.93
|
| Rate for Payer: Galaxy Health WC |
$3,558.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,511.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,121.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$218.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,792.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$683.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,004.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$861.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$916.47
|
| Rate for Payer: Multiplan Commercial |
$3,348.80
|
| Rate for Payer: Networks By Design Commercial |
$2,720.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,558.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,511.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,511.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$717.15
|
| Rate for Payer: United Healthcare All Other HMO |
$717.15
|
| Rate for Payer: United Healthcare HMO Rider |
$717.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$717.15
|
| Rate for Payer: Upland Medical Group Pediatric |
$683.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
HC TOTAL LUNG LAVAGE UNILATERAL
|
Facility
|
OP
|
$1,381.00
|
|
|
Service Code
|
CPT 32997
|
| Hospital Charge Code |
900803550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.20 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$276.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$905.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,173.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$759.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,035.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Cigna of CA HMO |
$883.84
|
| Rate for Payer: Cigna of CA PPO |
$1,021.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,173.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,173.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,173.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$552.40
|
| Rate for Payer: EPIC Health Plan Senior |
$552.40
|
| Rate for Payer: Galaxy Health WC |
$1,173.85
|
| Rate for Payer: Global Benefits Group Commercial |
$828.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$921.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$526.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$854.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$966.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$966.70
|
| Rate for Payer: Multiplan Commercial |
$1,104.80
|
| Rate for Payer: Networks By Design Commercial |
$897.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,173.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$828.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$828.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$690.50
|
| Rate for Payer: United Healthcare All Other HMO |
$690.50
|
| Rate for Payer: United Healthcare HMO Rider |
$690.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$690.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,173.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,173.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,173.85
|
|
|
HC TOTAL LUNG LAVAGE UNILATERAL
|
Facility
|
IP
|
$1,381.00
|
|
|
Service Code
|
CPT 32997
|
| Hospital Charge Code |
900803550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.20 |
| Max. Negotiated Rate |
$1,173.85 |
| Rate for Payer: Adventist Health Commercial |
$276.20
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$552.40
|
| Rate for Payer: EPIC Health Plan Senior |
$552.40
|
| Rate for Payer: Galaxy Health WC |
$1,173.85
|
| Rate for Payer: Global Benefits Group Commercial |
$828.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$921.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$526.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$854.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.44
|
| Rate for Payer: Multiplan Commercial |
$1,104.80
|
| Rate for Payer: Networks By Design Commercial |
$897.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,173.85
|
|
|
HC TOXOPLASMA AB IGG
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
900910989
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$141.71 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.71
|
| Rate for Payer: Blue Shield of California Commercial |
$86.97
|
| Rate for Payer: Blue Shield of California EPN |
$57.46
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna of CA HMO |
$83.20
|
| Rate for Payer: Cigna of CA PPO |
$96.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.43
|
| Rate for Payer: EPIC Health Plan Senior |
$14.39
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.65
|
| Rate for Payer: United Healthcare All Other HMO |
$11.65
|
| Rate for Payer: United Healthcare HMO Rider |
$11.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC TOXOPLASMA AB IGG
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
900910989
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$236.30 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$111.20
|
| Rate for Payer: Galaxy Health WC |
$236.30
|
| Rate for Payer: Global Benefits Group Commercial |
$166.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$185.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.72
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: Networks By Design Commercial |
$180.70
|
| Rate for Payer: Prime Health Services Commercial |
$236.30
|
|
|
HC TOXOPLASMA AB IGM
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
900912320
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$236.30 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$111.20
|
| Rate for Payer: Galaxy Health WC |
$236.30
|
| Rate for Payer: Global Benefits Group Commercial |
$166.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$185.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.72
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: Networks By Design Commercial |
$180.70
|
| Rate for Payer: Prime Health Services Commercial |
$236.30
|
|
|
HC TOXOPLASMA AB IGM
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
900912320
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$147.09 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.09
|
| Rate for Payer: Blue Shield of California Commercial |
$86.97
|
| Rate for Payer: Blue Shield of California EPN |
$57.46
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna of CA HMO |
$83.20
|
| Rate for Payer: Cigna of CA PPO |
$96.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.45
|
| Rate for Payer: EPIC Health Plan Senior |
$14.41
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.31
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.67
|
| Rate for Payer: United Healthcare All Other HMO |
$11.67
|
| Rate for Payer: United Healthcare HMO Rider |
$11.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
|
|
HC TOXOPLASMA ANTIBODY IGG
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
900913667
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$113.90 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.60
|
| Rate for Payer: EPIC Health Plan Senior |
$53.60
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.16
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
|
|
HC TOXOPLASMA ANTIBODY IGG
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
900913667
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$141.71 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.71
|
| Rate for Payer: Blue Shield of California Commercial |
$65.56
|
| Rate for Payer: Blue Shield of California EPN |
$43.32
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.43
|
| Rate for Payer: EPIC Health Plan Senior |
$14.39
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.65
|
| Rate for Payer: United Healthcare All Other HMO |
$11.65
|
| Rate for Payer: United Healthcare HMO Rider |
$11.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
