|
HC CT TSPINE W W/O CONTRAST
|
Facility
|
OP
|
$3,004.00
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
909201966
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$600.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,844.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,838.45
|
| Rate for Payer: Blue Shield of California EPN |
$1,213.62
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cigna of CA HMO |
$1,922.56
|
| Rate for Payer: Cigna of CA PPO |
$2,222.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$2,553.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,802.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$324.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,003.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$2,403.20
|
| Rate for Payer: Networks By Design Commercial |
$1,952.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,553.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,802.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,802.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$855.26
|
| Rate for Payer: United Healthcare All Other HMO |
$855.26
|
| Rate for Payer: United Healthcare HMO Rider |
$855.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$855.26
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT TSPINE W W/O CONTRAST
|
Facility
|
IP
|
$5,358.00
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
909201966
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,071.60 |
| Max. Negotiated Rate |
$4,554.30 |
| Rate for Payer: Adventist Health Commercial |
$1,071.60
|
| Rate for Payer: Cash Price |
$2,411.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,143.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,143.20
|
| Rate for Payer: Galaxy Health WC |
$4,554.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,214.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,573.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,041.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,316.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,285.92
|
| Rate for Payer: Multiplan Commercial |
$4,286.40
|
| Rate for Payer: Networks By Design Commercial |
$3,482.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,554.30
|
|
|
HC CT UPPER EXT W CONT
|
Facility
|
IP
|
$4,553.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
909201955
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$910.60 |
| Max. Negotiated Rate |
$3,870.05 |
| Rate for Payer: Adventist Health Commercial |
$910.60
|
| Rate for Payer: Cash Price |
$2,048.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,821.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,821.20
|
| Rate for Payer: Galaxy Health WC |
$3,870.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,731.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,036.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,734.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,818.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,092.72
|
| Rate for Payer: Multiplan Commercial |
$3,642.40
|
| Rate for Payer: Networks By Design Commercial |
$2,959.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,870.05
|
|
|
HC CT UPPER EXT W CONT
|
Facility
|
OP
|
$2,355.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
909201955
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$330.57 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$471.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,446.21
|
| Rate for Payer: Blue Shield of California Commercial |
$1,441.26
|
| Rate for Payer: Blue Shield of California EPN |
$951.42
|
| Rate for Payer: Cash Price |
$1,059.75
|
| Rate for Payer: Cash Price |
$1,059.75
|
| Rate for Payer: Cash Price |
$1,059.75
|
| Rate for Payer: Cigna of CA HMO |
$1,507.20
|
| Rate for Payer: Cigna of CA PPO |
$1,742.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$2,001.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,413.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$330.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,570.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$1,884.00
|
| Rate for Payer: Networks By Design Commercial |
$1,530.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,001.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,413.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,413.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$769.25
|
| Rate for Payer: United Healthcare All Other HMO |
$769.25
|
| Rate for Payer: United Healthcare HMO Rider |
$769.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC CT UPPER EXT W/WO CONT
|
Facility
|
OP
|
$2,751.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
909201956
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$550.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,689.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1,683.61
|
| Rate for Payer: Blue Shield of California EPN |
$1,111.40
|
| Rate for Payer: Cash Price |
$1,237.95
|
| Rate for Payer: Cash Price |
$1,237.95
|
| Rate for Payer: Cash Price |
$1,237.95
|
| Rate for Payer: Cigna of CA HMO |
$1,760.64
|
| Rate for Payer: Cigna of CA PPO |
$2,035.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$2,338.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,650.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$415.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,834.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$2,200.80
|
| Rate for Payer: Networks By Design Commercial |
$1,788.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,338.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,650.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,650.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$855.26
|
| Rate for Payer: United Healthcare All Other HMO |
$855.26
|
| Rate for Payer: United Healthcare HMO Rider |
$855.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$855.26
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT UPPER EXT W/WO CONT
|
Facility
|
IP
|
$4,900.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
909201956
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$980.00 |
| Max. Negotiated Rate |
$4,165.00 |
| Rate for Payer: Adventist Health Commercial |
$980.00
|
| Rate for Payer: Cash Price |
$2,205.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,960.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,960.00
|
| Rate for Payer: Galaxy Health WC |
$4,165.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,940.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,268.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,866.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,033.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,176.00
|
| Rate for Payer: Multiplan Commercial |
$3,920.00
|
| Rate for Payer: Networks By Design Commercial |
$3,185.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,165.00
|
|
|
HC CT UPPR EXTR WO CONT
|
Facility
|
IP
|
$4,205.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
909201954
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$841.00 |
| Max. Negotiated Rate |
$3,574.25 |
| Rate for Payer: Adventist Health Commercial |
$841.00
|
| Rate for Payer: Cash Price |
$1,892.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,682.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,682.00
|
| Rate for Payer: Galaxy Health WC |
$3,574.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,523.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,804.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,602.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,009.20
|
| Rate for Payer: Multiplan Commercial |
$3,364.00
|
| Rate for Payer: Networks By Design Commercial |
$2,733.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,574.25
|
|
|
HC CT UPPR EXTR WO CONT
|
Facility
|
OP
|
$2,360.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
909201954
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$472.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| 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 |
$1,449.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1,444.32
|
| Rate for Payer: Blue Shield of California EPN |
$953.44
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cigna of CA HMO |
$1,510.40
|
| Rate for Payer: Cigna of CA PPO |
$1,746.40
|
| 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 |
$2,006.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,416.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$266.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,574.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$566.40
|
| 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 |
$1,888.00
|
| Rate for Payer: Networks By Design Commercial |
$1,534.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,006.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,416.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,416.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.23
|
| Rate for Payer: United Healthcare All Other HMO |
$491.23
|
| Rate for Payer: United Healthcare HMO Rider |
$491.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.23
|
| 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 CUIRASS SHELL
|
Facility
|
IP
|
$2,300.00
|
|
| Hospital Charge Code |
900800900
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$1,955.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Multiplan Commercial |
$1,840.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
|
|
HC CUIRASS SHELL
|
Facility
|
OP
|
$2,300.00
|
|
| Hospital Charge Code |
900800900
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$1,955.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,508.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,725.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,412.43
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Cigna of CA HMO |
$1,472.00
|
| Rate for Payer: Cigna of CA PPO |
$1,702.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,610.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,840.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC CULTURE AEROBIC ID
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900911554
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$90.00
|
| 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 |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC CULTURE AEROBIC ID
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900911554
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.73
|
| Rate for Payer: Blue Shield of California Commercial |
$41.48
|
| Rate for Payer: Blue Shield of California EPN |
$27.40
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna of CA HMO |
$39.68
|
| Rate for Payer: Cigna of CA PPO |
$45.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$52.70
|
| Rate for Payer: Global Benefits Group Commercial |
$37.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$49.60
|
| Rate for Payer: Networks By Design Commercial |
$40.30
|
| Rate for Payer: Prime Health Services Commercial |
$52.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC CULTURE AEROBIC ID CYSTIC FIBROSIS
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$390.15 |
| Rate for Payer: Adventist Health Commercial |
$91.80
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.60
|
| Rate for Payer: EPIC Health Plan Senior |
$183.60
|
| Rate for Payer: Galaxy Health WC |
$390.15
|
| Rate for Payer: Global Benefits Group Commercial |
$275.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$284.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.16
|
| Rate for Payer: Multiplan Commercial |
$367.20
|
| Rate for Payer: Networks By Design Commercial |
$298.35
|
| Rate for Payer: Prime Health Services Commercial |
$390.15
|
|
|
HC CULTURE AEROBIC ID CYSTIC FIBROSIS
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.73
|
| Rate for Payer: Blue Shield of California Commercial |
$48.17
|
| Rate for Payer: Blue Shield of California EPN |
$31.82
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC CULTURE ANAEROBIC
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
900911501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.43
|
| Rate for Payer: Blue Shield of California Commercial |
$54.86
|
| Rate for Payer: Blue Shield of California EPN |
$36.24
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.78
|
| Rate for Payer: EPIC Health Plan Senior |
$9.47
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.69
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.67
|
| Rate for Payer: United Healthcare All Other HMO |
$7.67
|
| Rate for Payer: United Healthcare HMO Rider |
$7.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.42
|
| Rate for Payer: Vantage Medical Group Senior |
$9.47
|
|
|
HC CULTURE ANAEROBIC
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
900911501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$294.95 |
| Rate for Payer: Adventist Health Commercial |
$69.40
|
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.80
|
| Rate for Payer: EPIC Health Plan Senior |
$138.80
|
| Rate for Payer: Galaxy Health WC |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$231.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.28
|
| Rate for Payer: Multiplan Commercial |
$277.60
|
| Rate for Payer: Networks By Design Commercial |
$225.55
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
|
|
HC CULTURE ANAEROBIC IDS RAPID
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
900911553
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.42
|
| Rate for Payer: Blue Shield of California Commercial |
$48.17
|
| Rate for Payer: Blue Shield of California EPN |
$31.82
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC CULTURE ANAEROBIC IDS RAPID
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
900911553
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$90.00
|
| 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 |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC CULTURE BACTERIAL AG H INFLU
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911711
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$46.22 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.22
|
| Rate for Payer: Blue Shield of California Commercial |
$30.77
|
| Rate for Payer: Blue Shield of California EPN |
$20.33
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC CULTURE BACTERIAL AG H INFLU
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911711
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
|
|
HC CULTURE BACTERIAL AG N MENING
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911713
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$46.22 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.22
|
| Rate for Payer: Blue Shield of California Commercial |
$30.77
|
| Rate for Payer: Blue Shield of California EPN |
$20.33
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC CULTURE BACTERIAL AG N MENING
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911713
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
|
|
HC CULTURE BACTERIAL AG S PNEUM
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911712
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$46.22 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.22
|
| Rate for Payer: Blue Shield of California Commercial |
$30.77
|
| Rate for Payer: Blue Shield of California EPN |
$20.33
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC CULTURE BACTERIAL AG S PNEUM
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911712
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
|
|
HC CULTURE BACTERIAL AG STREP B
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911710
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
|
