|
HC BATT CHRG 6 VOLT OTTO BOCK OR
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT L7362
|
| Hospital Charge Code |
915357362
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cigna of CA HMO |
$311.50
|
| Rate for Payer: Cigna of CA PPO |
$311.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$275.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.80
|
| Rate for Payer: Multiplan Commercial |
$356.00
|
| Rate for Payer: Networks By Design Commercial |
$222.50
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.01
|
| Rate for Payer: United Healthcare All Other HMO |
$162.56
|
| Rate for Payer: United Healthcare HMO Rider |
$159.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.74
|
|
|
HC BATT CHRG 6 VOLT OTTO BOCK OR
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT L7362
|
| Hospital Charge Code |
905357362
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$378.25 |
| Rate for Payer: Adventist Health Commercial |
$182.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$244.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$333.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.74
|
| Rate for Payer: Blue Shield of California Commercial |
$328.41
|
| Rate for Payer: Blue Shield of California EPN |
$216.27
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cigna of CA HMO |
$311.50
|
| Rate for Payer: Cigna of CA PPO |
$311.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$378.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$378.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$196.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$275.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$311.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$311.50
|
| Rate for Payer: Multiplan Commercial |
$356.00
|
| Rate for Payer: Networks By Design Commercial |
$222.50
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$267.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$267.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.01
|
| Rate for Payer: United Healthcare All Other HMO |
$162.56
|
| Rate for Payer: United Healthcare HMO Rider |
$159.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$378.25
|
| Rate for Payer: Vantage Medical Group Senior |
$378.25
|
|
|
HC BATTERY 12 VOLT UTAH OR EQUAL
|
Facility
|
OP
|
$1,517.00
|
|
|
Service Code
|
CPT L7364
|
| Hospital Charge Code |
905357364
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$359.57 |
| Max. Negotiated Rate |
$1,289.45 |
| Rate for Payer: Adventist Health Commercial |
$621.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,289.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$834.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$878.65
|
| Rate for Payer: Blue Shield of California Commercial |
$1,119.55
|
| Rate for Payer: Blue Shield of California EPN |
$737.26
|
| Rate for Payer: Cash Price |
$682.65
|
| Rate for Payer: Cash Price |
$682.65
|
| Rate for Payer: Cigna of CA HMO |
$1,061.90
|
| Rate for Payer: Cigna of CA PPO |
$1,061.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,289.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,289.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,289.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.80
|
| Rate for Payer: EPIC Health Plan Senior |
$606.80
|
| Rate for Payer: Galaxy Health WC |
$1,289.45
|
| Rate for Payer: Global Benefits Group Commercial |
$910.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$359.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,011.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$939.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,061.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,061.90
|
| Rate for Payer: Multiplan Commercial |
$1,213.60
|
| Rate for Payer: Networks By Design Commercial |
$758.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,289.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$910.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$910.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$569.33
|
| Rate for Payer: United Healthcare All Other HMO |
$554.16
|
| Rate for Payer: United Healthcare HMO Rider |
$542.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$496.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,289.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,289.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,289.45
|
|
|
HC BATTERY 12 VOLT UTAH OR EQUAL
|
Facility
|
IP
|
$1,517.00
|
|
|
Service Code
|
CPT L7364
|
| Hospital Charge Code |
905357364
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$303.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$303.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$682.65
|
| Rate for Payer: Cash Price |
$682.65
|
| Rate for Payer: Cigna of CA HMO |
$1,061.90
|
| Rate for Payer: Cigna of CA PPO |
$1,061.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.80
|
| Rate for Payer: EPIC Health Plan Senior |
$606.80
|
| Rate for Payer: Galaxy Health WC |
$1,289.45
|
| Rate for Payer: Global Benefits Group Commercial |
$910.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,011.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$939.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.08
|
| Rate for Payer: Multiplan Commercial |
$1,213.60
|
| Rate for Payer: Networks By Design Commercial |
$758.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,289.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$569.33
|
| Rate for Payer: United Healthcare All Other HMO |
$554.16
|
| Rate for Payer: United Healthcare HMO Rider |
$542.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$496.82
|
|
|
HC BATTERY 12 VOLT UTAH OR EQUAL
|
Facility
|
OP
|
$1,517.00
|
|
|
Service Code
|
CPT L7364
|
| Hospital Charge Code |
915357364
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$359.57 |
| Max. Negotiated Rate |
$1,289.45 |
| Rate for Payer: Adventist Health Commercial |
$621.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,289.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$834.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$878.65
|
| Rate for Payer: Blue Shield of California Commercial |
$1,119.55
|
| Rate for Payer: Blue Shield of California EPN |
$737.26
|
| Rate for Payer: Cash Price |
$682.65
|
| Rate for Payer: Cash Price |
$682.65
|
| Rate for Payer: Cigna of CA HMO |
$1,061.90
|
| Rate for Payer: Cigna of CA PPO |
$1,061.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,289.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,289.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,289.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.80
|
| Rate for Payer: EPIC Health Plan Senior |
$606.80
|
| Rate for Payer: Galaxy Health WC |
$1,289.45
|
| Rate for Payer: Global Benefits Group Commercial |
$910.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$359.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,011.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$939.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,061.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,061.90
|
| Rate for Payer: Multiplan Commercial |
$1,213.60
|
| Rate for Payer: Networks By Design Commercial |
$758.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,289.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$910.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$910.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$569.33
|
| Rate for Payer: United Healthcare All Other HMO |
$554.16
|
| Rate for Payer: United Healthcare HMO Rider |
$542.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$496.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,289.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,289.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,289.45
|
|
|
HC BATTERY 12 VOLT UTAH OR EQUAL
|
Facility
|
IP
|
$1,517.00
|
|
|
Service Code
|
CPT L7364
|
| Hospital Charge Code |
915357364
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$303.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$303.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$682.65
|
| Rate for Payer: Cash Price |
$682.65
|
| Rate for Payer: Cigna of CA HMO |
$1,061.90
|
| Rate for Payer: Cigna of CA PPO |
$1,061.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.80
|
| Rate for Payer: EPIC Health Plan Senior |
$606.80
|
| Rate for Payer: Galaxy Health WC |
$1,289.45
|
| Rate for Payer: Global Benefits Group Commercial |
$910.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,011.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$939.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.08
|
| Rate for Payer: Multiplan Commercial |
$1,213.60
|
| Rate for Payer: Networks By Design Commercial |
$758.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,289.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$569.33
|
| Rate for Payer: United Healthcare All Other HMO |
$554.16
|
| Rate for Payer: United Healthcare HMO Rider |
$542.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$496.82
|
|
|
HC BCEDP CASE MANAGEMENT FEE
|
Facility
|
IP
|
$45.00
|
|
| Hospital Charge Code |
909099998
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Senior |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
|
|
HC BCEDP CASE MANAGEMENT FEE
|
Facility
|
OP
|
$45.00
|
|
| Hospital Charge Code |
909099998
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.63
|
| Rate for Payer: Blue Shield of California Commercial |
$27.54
|
| Rate for Payer: Blue Shield of California EPN |
$18.18
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Senior |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.50
|
| Rate for Payer: United Healthcare All Other HMO |
$22.50
|
| Rate for Payer: United Healthcare HMO Rider |
$22.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.25
|
| Rate for Payer: Vantage Medical Group Senior |
$38.25
|
|
|
HC B-CELL LYMPH FISH DNA PROBE SO
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914114
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$1,675.72 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,675.72
|
| Rate for Payer: Blue Shield of California Commercial |
$57.53
|
| Rate for Payer: Blue Shield of California EPN |
$38.01
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna of CA HMO |
$55.04
|
| Rate for Payer: Cigna of CA PPO |
$63.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.92
|
| Rate for Payer: EPIC Health Plan Senior |
$21.42
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.35
|
| Rate for Payer: United Healthcare All Other HMO |
$17.35
|
| Rate for Payer: United Healthcare HMO Rider |
$17.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC B-CELL LYMPH FISH DNA PROBE SO
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914114
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$73.10 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.40
|
| Rate for Payer: EPIC Health Plan Senior |
$34.40
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
|
|
HC B-CELL LYMPH FISH INTRPHAS IN
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914115
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$2,585.40 |
| 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 |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,585.40
|
| 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 |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| 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 |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.11
|
| Rate for Payer: EPIC Health Plan Senior |
$51.19
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$53.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.59
|
| 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 |
$41.46
|
| Rate for Payer: United Healthcare All Other HMO |
$41.46
|
| Rate for Payer: United Healthcare HMO Rider |
$41.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC B-CELL LYMPH FISH INTRPHAS IN
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914115
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$158.10 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Cash Price |
$83.70
|
| 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 BC-GN NUCLEIC ACID ID CULTURE
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912467
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$197.90 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.90
|
| Rate for Payer: Blue Shield of California Commercial |
$28.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.56
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.07
|
| Rate for Payer: EPIC Health Plan Senior |
$20.05
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.87
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.25
|
| Rate for Payer: United Healthcare All Other HMO |
$16.25
|
| Rate for Payer: United Healthcare HMO Rider |
$16.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
HC BC-GN NUCLEIC ACID ID CULTURE
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912467
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$146.20 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Senior |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
|
|
HC BC-GP NUCLEIC ACID ID CULTURE
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$197.90 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.90
|
| Rate for Payer: Blue Shield of California Commercial |
$28.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.56
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.07
|
| Rate for Payer: EPIC Health Plan Senior |
$20.05
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.87
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.25
|
| Rate for Payer: United Healthcare All Other HMO |
$16.25
|
| Rate for Payer: United Healthcare HMO Rider |
$16.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
HC BC-GP NUCLEIC ACID ID CULTURE
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$146.20 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Senior |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
|
|
HC BCID2
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 87154
|
| Hospital Charge Code |
900913011
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$605.79 |
| Rate for Payer: Adventist Health Commercial |
$44.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$144.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$327.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$218.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$605.79
|
| Rate for Payer: Blue Shield of California Commercial |
$147.18
|
| Rate for Payer: Blue Shield of California EPN |
$97.24
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna of CA HMO |
$140.80
|
| Rate for Payer: Cigna of CA PPO |
$162.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$327.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$218.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.38
|
| Rate for Payer: EPIC Health Plan Senior |
$218.06
|
| Rate for Payer: Galaxy Health WC |
$187.00
|
| Rate for Payer: Global Benefits Group Commercial |
$132.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$366.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$218.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$146.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$414.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$218.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$292.20
|
| Rate for Payer: Multiplan Commercial |
$176.00
|
| Rate for Payer: Networks By Design Commercial |
$143.00
|
| Rate for Payer: Prime Health Services Commercial |
$187.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$132.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$132.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$176.62
|
| Rate for Payer: United Healthcare All Other HMO |
$176.62
|
| Rate for Payer: United Healthcare HMO Rider |
$176.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$218.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$327.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.87
|
| Rate for Payer: Vantage Medical Group Senior |
$218.06
|
|
|
HC BCID2
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 87154
|
| Hospital Charge Code |
900913011
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$225.25 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
|
|
HC BCT LIMITED STUDY
|
Facility
|
OP
|
$888.00
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
909201971
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$177.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$545.32
|
| Rate for Payer: Blue Shield of California Commercial |
$543.46
|
| Rate for Payer: Blue Shield of California EPN |
$358.75
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cigna of CA HMO |
$568.32
|
| Rate for Payer: Cigna of CA PPO |
$657.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$754.80
|
| Rate for Payer: Global Benefits Group Commercial |
$532.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$213.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$592.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$710.40
|
| Rate for Payer: Networks By Design Commercial |
$577.20
|
| Rate for Payer: Prime Health Services Commercial |
$754.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$532.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$532.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$444.00
|
| Rate for Payer: United Healthcare All Other HMO |
$444.00
|
| Rate for Payer: United Healthcare HMO Rider |
$444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$444.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC BCT LIMITED STUDY
|
Facility
|
IP
|
$1,325.00
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
909201971
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$265.00 |
| Max. Negotiated Rate |
$1,126.25 |
| Rate for Payer: Adventist Health Commercial |
$265.00
|
| Rate for Payer: Cash Price |
$596.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.00
|
| Rate for Payer: EPIC Health Plan Senior |
$530.00
|
| Rate for Payer: Galaxy Health WC |
$1,126.25
|
| Rate for Payer: Global Benefits Group Commercial |
$795.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$883.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$504.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$820.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$318.00
|
| Rate for Payer: Multiplan Commercial |
$1,060.00
|
| Rate for Payer: Networks By Design Commercial |
$861.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,126.25
|
|
|
HC BE ENDOSK INCLUD TISSUE SHAPNG
|
Facility
|
IP
|
$4,043.00
|
|
|
Service Code
|
CPT L6400
|
| Hospital Charge Code |
905356400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$808.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$808.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cigna of CA HMO |
$2,830.10
|
| Rate for Payer: Cigna of CA PPO |
$2,830.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,617.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,617.20
|
| Rate for Payer: Galaxy Health WC |
$3,436.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,425.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,696.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,540.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,502.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.32
|
| Rate for Payer: Multiplan Commercial |
$3,234.40
|
| Rate for Payer: Networks By Design Commercial |
$2,021.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,436.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,517.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1,476.91
|
| Rate for Payer: United Healthcare HMO Rider |
$1,444.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,324.08
|
|
|
HC BE ENDOSK INCLUD TISSUE SHAPNG
|
Facility
|
OP
|
$4,043.00
|
|
|
Service Code
|
CPT L6400
|
| Hospital Charge Code |
905356400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$970.32 |
| Max. Negotiated Rate |
$3,436.55 |
| Rate for Payer: Adventist Health Commercial |
$1,657.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,436.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,223.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,032.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,341.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2,983.73
|
| Rate for Payer: Blue Shield of California EPN |
$1,964.90
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cigna of CA HMO |
$2,830.10
|
| Rate for Payer: Cigna of CA PPO |
$2,830.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,436.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,436.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,436.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,617.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,617.20
|
| Rate for Payer: Galaxy Health WC |
$3,436.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,425.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,424.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,696.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,741.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,502.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,830.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,830.10
|
| Rate for Payer: Multiplan Commercial |
$3,234.40
|
| Rate for Payer: Networks By Design Commercial |
$2,021.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,436.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,425.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,425.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,517.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1,476.91
|
| Rate for Payer: United Healthcare HMO Rider |
$1,444.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,324.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,436.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,436.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,436.55
|
|
|
HC BE ENDOSK INCLUD TISSUE SHAPNG
|
Facility
|
IP
|
$4,043.00
|
|
|
Service Code
|
CPT L6400
|
| Hospital Charge Code |
915356400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$808.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$808.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cigna of CA HMO |
$2,830.10
|
| Rate for Payer: Cigna of CA PPO |
$2,830.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,617.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,617.20
|
| Rate for Payer: Galaxy Health WC |
$3,436.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,425.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,696.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,540.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,502.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.32
|
| Rate for Payer: Multiplan Commercial |
$3,234.40
|
| Rate for Payer: Networks By Design Commercial |
$2,021.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,436.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,517.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1,476.91
|
| Rate for Payer: United Healthcare HMO Rider |
$1,444.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,324.08
|
|
|
HC BE ENDOSK INCLUD TISSUE SHAPNG
|
Facility
|
OP
|
$4,043.00
|
|
|
Service Code
|
CPT L6400
|
| Hospital Charge Code |
915356400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$970.32 |
| Max. Negotiated Rate |
$3,436.55 |
| Rate for Payer: Adventist Health Commercial |
$1,657.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,436.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,223.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,032.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,341.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2,983.73
|
| Rate for Payer: Blue Shield of California EPN |
$1,964.90
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cigna of CA HMO |
$2,830.10
|
| Rate for Payer: Cigna of CA PPO |
$2,830.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,436.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,436.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,436.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,617.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,617.20
|
| Rate for Payer: Galaxy Health WC |
$3,436.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,425.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,424.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,696.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,741.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,502.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,830.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,830.10
|
| Rate for Payer: Multiplan Commercial |
$3,234.40
|
| Rate for Payer: Networks By Design Commercial |
$2,021.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,436.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,425.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,425.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,517.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1,476.91
|
| Rate for Payer: United Healthcare HMO Rider |
$1,444.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,324.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,436.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,436.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,436.55
|
|
|
HC BE EXTERN POWER SWITCH CONTROL
|
Facility
|
IP
|
$15,332.00
|
|
|
Service Code
|
CPT L6930
|
| Hospital Charge Code |
915356930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,066.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$3,066.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$6,899.40
|
| Rate for Payer: Cash Price |
$6,899.40
|
| Rate for Payer: Cigna of CA HMO |
$10,732.40
|
| Rate for Payer: Cigna of CA PPO |
$10,732.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,132.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,132.80
|
| Rate for Payer: Galaxy Health WC |
$13,032.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,199.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,226.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,841.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,490.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,679.68
|
| Rate for Payer: Multiplan Commercial |
$12,265.60
|
| Rate for Payer: Networks By Design Commercial |
$7,666.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,032.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,754.10
|
| Rate for Payer: United Healthcare All Other HMO |
$5,600.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,479.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,021.23
|
|
