|
HC GLUCOSE TEST STRIP
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
908600850
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Adventist Health Commercial |
$38.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.19
|
| Rate for Payer: Blue Shield of California Commercial |
$127.11
|
| Rate for Payer: Blue Shield of California EPN |
$83.98
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna of CA HMO |
$121.60
|
| Rate for Payer: Cigna of CA PPO |
$140.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5.04
|
| Rate for Payer: Galaxy Health WC |
$161.50
|
| Rate for Payer: Global Benefits Group Commercial |
$114.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.75
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: Networks By Design Commercial |
$123.50
|
| Rate for Payer: Prime Health Services Commercial |
$161.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.09
|
| Rate for Payer: United Healthcare All Other HMO |
$4.09
|
| Rate for Payer: United Healthcare HMO Rider |
$4.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.54
|
| Rate for Payer: Vantage Medical Group Senior |
$5.04
|
|
|
HC GLUCOSE TEST STRIP
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
908600850
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Adventist Health Commercial |
$38.00
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.00
|
| Rate for Payer: EPIC Health Plan Senior |
$76.00
|
| Rate for Payer: Galaxy Health WC |
$161.50
|
| Rate for Payer: Global Benefits Group Commercial |
$114.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.60
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: Networks By Design Commercial |
$123.50
|
| Rate for Payer: Prime Health Services Commercial |
$161.50
|
|
|
HC GLUCOSE TOLERANCE TEST 2 HR
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
900910208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$127.14 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.14
|
| Rate for Payer: Blue Shield of California Commercial |
$78.94
|
| Rate for Payer: Blue Shield of California EPN |
$52.16
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna of CA HMO |
$75.52
|
| Rate for Payer: Cigna of CA PPO |
$87.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.37
|
| Rate for Payer: EPIC Health Plan Senior |
$12.87
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: Networks By Design Commercial |
$76.70
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC GLUCOSE TOLERANCE TEST 2 HR
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
900910208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.20 |
| Max. Negotiated Rate |
$192.10 |
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.40
|
| Rate for Payer: EPIC Health Plan Senior |
$90.40
|
| Rate for Payer: Galaxy Health WC |
$192.10
|
| Rate for Payer: Global Benefits Group Commercial |
$135.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.24
|
| Rate for Payer: Multiplan Commercial |
$180.80
|
| Rate for Payer: Networks By Design Commercial |
$146.90
|
| Rate for Payer: Prime Health Services Commercial |
$192.10
|
|
|
HC GLUCOSE TOLERANCE TEST 3 HR
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
900910308
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$127.14 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.14
|
| Rate for Payer: Blue Shield of California Commercial |
$78.94
|
| Rate for Payer: Blue Shield of California EPN |
$52.16
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna of CA HMO |
$75.52
|
| Rate for Payer: Cigna of CA PPO |
$87.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.37
|
| Rate for Payer: EPIC Health Plan Senior |
$12.87
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: Networks By Design Commercial |
$76.70
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC GLUCOSE TOLERANCE TEST 3 HR
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
900910308
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.20 |
| Max. Negotiated Rate |
$192.10 |
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.40
|
| Rate for Payer: EPIC Health Plan Senior |
$90.40
|
| Rate for Payer: Galaxy Health WC |
$192.10
|
| Rate for Payer: Global Benefits Group Commercial |
$135.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.24
|
| Rate for Payer: Multiplan Commercial |
$180.80
|
| Rate for Payer: Networks By Design Commercial |
$146.90
|
| Rate for Payer: Prime Health Services Commercial |
$192.10
|
|
|
HC GLUCOSE URINE
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
900910311
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$38.70 |
| 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 |
$5.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.70
|
| 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 |
$5.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Senior |
$3.93
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.27
|
| 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 |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Senior |
$3.93
|
|
|
HC GLUCOSE URINE
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
900910311
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
|
|
HC GLUTEAL PAD EA ADD. LE
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT L2650
|
| Hospital Charge Code |
915352650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$225.25 |
| Rate for Payer: Adventist Health Commercial |
$108.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.49
|
| Rate for Payer: Blue Shield of California Commercial |
$195.57
|
| Rate for Payer: Blue Shield of California EPN |
$128.79
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.25
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.54
|
| 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: Molina Healthcare of CA Medi-Cal |
$185.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
HC GLUTEAL PAD EA ADD. LE
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT L2650
|
| Hospital Charge Code |
915352650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| 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 |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
|
|
HC GLUTEAL PAD EA ADD. LE
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT L2650
|
| Hospital Charge Code |
905352650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| 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 |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
|
|
HC GLUTEAL PAD EA ADD. LE
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT L2650
|
| Hospital Charge Code |
905352650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$225.25 |
| Rate for Payer: Adventist Health Commercial |
$108.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.49
|
| Rate for Payer: Blue Shield of California Commercial |
$195.57
|
| Rate for Payer: Blue Shield of California EPN |
$128.79
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.25
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.54
|
| 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: Molina Healthcare of CA Medi-Cal |
$185.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
HC GRAFT COMPOSITE EAR OR NASAL
|
Facility
|
OP
|
$4,978.00
|
|
|
Service Code
|
CPT 15760
|
| Hospital Charge Code |
900515760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$801.46 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$995.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,240.10
|
| Rate for Payer: Cash Price |
$2,240.10
|
| Rate for Payer: Cash Price |
$2,240.10
|
| Rate for Payer: Cigna of CA HMO |
$3,185.92
|
| Rate for Payer: Cigna of CA PPO |
$3,683.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$4,231.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,986.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,320.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$801.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,194.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,928.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| Rate for Payer: Multiplan Commercial |
$3,982.40
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$3,235.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,231.30
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,986.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,489.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,489.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,489.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,489.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC GRAFT COMPOSITE EAR OR NASAL
|
Facility
|
IP
|
$4,978.00
|
|
|
Service Code
|
CPT 15760
|
| Hospital Charge Code |
900515760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$995.60 |
| Max. Negotiated Rate |
$4,231.30 |
| Rate for Payer: Adventist Health Commercial |
$995.60
|
| Rate for Payer: Cash Price |
$2,240.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,991.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,991.20
|
| Rate for Payer: Galaxy Health WC |
$4,231.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,986.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,320.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,896.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,081.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,194.72
|
| Rate for Payer: Multiplan Commercial |
$3,982.40
|
| Rate for Payer: Networks By Design Commercial |
$3,235.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,231.30
|
|
|
HC GRAFT DERMA-FAT-FASCIA
|
Facility
|
OP
|
$4,133.00
|
|
|
Service Code
|
CPT 15770
|
| Hospital Charge Code |
900501750
|
|
Hospital Revenue Code
|
451
|
| Min. Negotiated Rate |
$826.60 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$826.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,977.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,116.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,651.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$1,859.85
|
| Rate for Payer: Cash Price |
$1,859.85
|
| Rate for Payer: Cash Price |
$1,859.85
|
| Rate for Payer: Cigna of CA HMO |
$2,645.12
|
| Rate for Payer: Cigna of CA PPO |
$3,058.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,977.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,116.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,651.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,279.70
|
| Rate for Payer: EPIC Health Plan Senior |
$4,651.63
|
| Rate for Payer: Galaxy Health WC |
$3,513.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,479.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,628.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,651.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,756.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$848.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,651.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,861.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,233.18
|
| Rate for Payer: Multiplan Commercial |
$3,306.40
|
| Rate for Payer: Multiplan WC |
$7,411.53
|
| Rate for Payer: Networks By Design Commercial |
$2,686.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,513.05
|
| Rate for Payer: Prime Health Services WC |
$7,335.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,479.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,479.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,066.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,066.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,066.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,066.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,651.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,977.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,116.79
|
| Rate for Payer: Vantage Medical Group Senior |
$4,651.63
|
|
|
HC GRAFT DERMA-FAT-FASCIA
|
Facility
|
IP
|
$4,133.00
|
|
|
Service Code
|
CPT 15770
|
| Hospital Charge Code |
900501750
|
|
Hospital Revenue Code
|
451
|
| Min. Negotiated Rate |
$826.60 |
| Max. Negotiated Rate |
$3,513.05 |
| Rate for Payer: Adventist Health Commercial |
$826.60
|
| Rate for Payer: Cash Price |
$1,859.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,653.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,653.20
|
| Rate for Payer: Galaxy Health WC |
$3,513.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,479.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,756.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,574.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,558.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.92
|
| Rate for Payer: Multiplan Commercial |
$3,306.40
|
| Rate for Payer: Networks By Design Commercial |
$2,686.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,513.05
|
|
|
HC GRAFT, IM, CONDUIT
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
CPT 93564
|
| Hospital Charge Code |
906820070
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$595.00 |
| Rate for Payer: Adventist Health Commercial |
$140.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Senior |
$280.00
|
| Rate for Payer: Galaxy Health WC |
$595.00
|
| Rate for Payer: Global Benefits Group Commercial |
$420.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$466.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$433.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$560.00
|
| Rate for Payer: Networks By Design Commercial |
$455.00
|
| Rate for Payer: Prime Health Services Commercial |
$595.00
|
|
|
HC GRAFT, IM, CONDUIT
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
CPT 93564
|
| Hospital Charge Code |
906811413
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.00
|
| Rate for Payer: EPIC Health Plan Senior |
$288.00
|
| Rate for Payer: Galaxy Health WC |
$612.00
|
| Rate for Payer: Global Benefits Group Commercial |
$432.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$480.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$445.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.80
|
| Rate for Payer: Multiplan Commercial |
$576.00
|
| Rate for Payer: Networks By Design Commercial |
$468.00
|
| Rate for Payer: Prime Health Services Commercial |
$612.00
|
|
|
HC GRAFT, IM, CONDUIT
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 93564
|
| Hospital Charge Code |
906820070
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$80.02 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$140.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$595.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$385.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$525.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna of CA HMO |
$455.00
|
| Rate for Payer: Cigna of CA PPO |
$518.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$595.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$595.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$595.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Senior |
$280.00
|
| Rate for Payer: Galaxy Health WC |
$595.00
|
| Rate for Payer: Global Benefits Group Commercial |
$420.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$466.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$433.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$490.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$490.00
|
| Rate for Payer: Multiplan Commercial |
$560.00
|
| Rate for Payer: Networks By Design Commercial |
$455.00
|
| Rate for Payer: Prime Health Services Commercial |
$595.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$420.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$420.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$595.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$595.00
|
| Rate for Payer: Vantage Medical Group Senior |
$595.00
|
|
|
HC GRAFT, IM, CONDUIT
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
CPT 93564
|
| Hospital Charge Code |
906811413
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$80.02 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$396.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$540.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$468.00
|
| Rate for Payer: Cigna of CA PPO |
$532.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$612.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$612.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.00
|
| Rate for Payer: EPIC Health Plan Senior |
$288.00
|
| Rate for Payer: Galaxy Health WC |
$612.00
|
| Rate for Payer: Global Benefits Group Commercial |
$432.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$480.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$445.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$504.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$504.00
|
| Rate for Payer: Multiplan Commercial |
$576.00
|
| Rate for Payer: Networks By Design Commercial |
$468.00
|
| Rate for Payer: Prime Health Services Commercial |
$612.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$432.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$432.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$612.00
|
| Rate for Payer: Vantage Medical Group Senior |
$612.00
|
|
|
HC GRAM POSITIVE SENSITIVITY MIC
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900912491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$62.90 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.60
|
| Rate for Payer: EPIC Health Plan Senior |
$29.60
|
| Rate for Payer: Galaxy Health WC |
$62.90
|
| Rate for Payer: Global Benefits Group Commercial |
$44.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.76
|
| Rate for Payer: Multiplan Commercial |
$59.20
|
| Rate for Payer: Networks By Design Commercial |
$48.10
|
| Rate for Payer: Prime Health Services Commercial |
$62.90
|
|
|
HC GRAM POSITIVE SENSITIVITY MIC
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900912491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.38
|
| Rate for Payer: Blue Shield of California Commercial |
$42.82
|
| Rate for Payer: Blue Shield of California EPN |
$28.29
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.68
|
| Rate for Payer: EPIC Health Plan Senior |
$8.65
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.01
|
| Rate for Payer: United Healthcare All Other HMO |
$7.01
|
| Rate for Payer: United Healthcare HMO Rider |
$7.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
|
|
HC GRAM STAIN
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
900911705
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.44
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
|
|
HC GRAM STAIN
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
900911705
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$225.00 |
| 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 |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.16
|
| Rate for Payer: Blue Shield of California Commercial |
$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: 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 |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$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 |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC GROUP THERAPY 60 MIN
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
903100090
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$40.25 |
| Max. Negotiated Rate |
$341.70 |
| Rate for Payer: Adventist Health Commercial |
$80.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$263.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$246.87
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna of CA HMO |
$257.28
|
| Rate for Payer: Cigna of CA PPO |
$297.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.67
|
| Rate for Payer: EPIC Health Plan Senior |
$117.53
|
| Rate for Payer: Galaxy Health WC |
$341.70
|
| Rate for Payer: Global Benefits Group Commercial |
$241.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$268.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$321.60
|
| Rate for Payer: Networks By Design Commercial |
$261.30
|
| Rate for Payer: Prime Health Services Commercial |
$341.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$241.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$241.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$201.00
|
| Rate for Payer: United Healthcare All Other HMO |
$201.00
|
| Rate for Payer: United Healthcare HMO Rider |
$201.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$201.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Vantage Medical Group Senior |
$117.53
|
|
