|
HC LAB REF TISSUE CULTURE LYMPHOCYTE NON
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900910686
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$85.85 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.40
|
| Rate for Payer: EPIC Health Plan Senior |
$40.40
|
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$64.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.24
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
|
|
HC LAB REF TISSUE CULTURE NEO BLOOD/BONE
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900912791
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$172.55 |
| Rate for Payer: Adventist Health Commercial |
$40.60
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$142.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.20
|
| Rate for Payer: EPIC Health Plan Senior |
$81.20
|
| Rate for Payer: Galaxy Health WC |
$172.55
|
| Rate for Payer: Global Benefits Group Commercial |
$121.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$128.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$119.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.72
|
| Rate for Payer: Multiplan Commercial |
$162.40
|
| Rate for Payer: Networks By Design Commercial |
$131.95
|
| Rate for Payer: Prime Health Services Commercial |
$172.55
|
|
|
HC LAB REF TISSUE CULTURE NEO BLOOD/BONE
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900912791
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$1,106.75 |
| Rate for Payer: Adventist Health Commercial |
$40.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,050.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,106.75
|
| Rate for Payer: Blue Shield of California Commercial |
$141.49
|
| Rate for Payer: Blue Shield of California Commercial |
$93.58
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: Cigna of CA HMO |
$129.92
|
| Rate for Payer: Cigna of CA PPO |
$150.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$143.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$142.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.19
|
| Rate for Payer: EPIC Health Plan Senior |
$158.12
|
| Rate for Payer: Galaxy Health WC |
$172.55
|
| Rate for Payer: Global Benefits Group Commercial |
$121.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$235.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$167.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$143.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$128.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$201.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$192.62
|
| Rate for Payer: Multiplan Commercial |
$162.40
|
| Rate for Payer: Networks By Design Commercial |
$131.95
|
| Rate for Payer: Prime Health Services Commercial |
$172.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$121.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$121.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.44
|
| Rate for Payer: United Healthcare All Other HMO |
$116.44
|
| Rate for Payer: United Healthcare HMO Rider |
$116.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$143.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Vantage Medical Group Senior |
$143.75
|
|
|
HC LAB REF TISSUE CULTURE NEO SOLID TUMOR
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900912792
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$47.40 |
| Max. Negotiated Rate |
$1,473.44 |
| Rate for Payer: Adventist Health Commercial |
$47.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,226.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,473.44
|
| Rate for Payer: Blue Shield of California Commercial |
$109.26
|
| Rate for Payer: Blue Shield of California Commercial |
$165.19
|
| Rate for Payer: Cash Price |
$106.65
|
| Rate for Payer: Cash Price |
$106.65
|
| Rate for Payer: Cigna of CA HMO |
$151.68
|
| Rate for Payer: Cigna of CA PPO |
$175.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$147.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$165.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.41
|
| Rate for Payer: EPIC Health Plan Senior |
$162.27
|
| Rate for Payer: Galaxy Health WC |
$201.45
|
| Rate for Payer: Global Benefits Group Commercial |
$142.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$241.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$220.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$147.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$150.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$249.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$197.68
|
| Rate for Payer: Multiplan Commercial |
$189.60
|
| Rate for Payer: Networks By Design Commercial |
$154.05
|
| Rate for Payer: Prime Health Services Commercial |
$201.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$142.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$142.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$119.49
|
| Rate for Payer: United Healthcare All Other HMO |
$119.49
|
| Rate for Payer: United Healthcare HMO Rider |
$119.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$147.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Vantage Medical Group Senior |
$147.52
|
|
|
HC LAB REF TISSUE CULTURE NEO SOLID TUMOR
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900912792
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$47.40 |
| Max. Negotiated Rate |
$201.45 |
| Rate for Payer: Adventist Health Commercial |
$47.40
|
| Rate for Payer: Cash Price |
$106.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$165.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.80
|
| Rate for Payer: EPIC Health Plan Senior |
$94.80
|
| Rate for Payer: Galaxy Health WC |
$201.45
|
| Rate for Payer: Global Benefits Group Commercial |
$142.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$150.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$139.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.88
|
| Rate for Payer: Multiplan Commercial |
$189.60
|
| Rate for Payer: Networks By Design Commercial |
$154.05
|
| Rate for Payer: Prime Health Services Commercial |
$201.45
|
|
|
HC LAB REF TISSUE CULTURE SKIN/SOLID TISS
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900912790
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$30.20 |
| Max. Negotiated Rate |
$128.35 |
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.40
|
| Rate for Payer: EPIC Health Plan Senior |
$60.40
|
| Rate for Payer: Galaxy Health WC |
$128.35
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.24
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: Networks By Design Commercial |
$98.15
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
|
|
HC LAB REF TISSUE CULTURE SKIN/SOLID TISS
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900912790
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$30.20 |
| Max. Negotiated Rate |
$1,233.08 |
| Rate for Payer: United Healthcare HMO Rider |
$113.99
|
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,170.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,233.08
|
| Rate for Payer: Blue Shield of California Commercial |
$105.25
|
| Rate for Payer: Blue Shield of California Commercial |
$69.61
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cigna of CA HMO |
$96.64
|
| Rate for Payer: Cigna of CA PPO |
$111.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$140.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.20
|
| Rate for Payer: EPIC Health Plan Senior |
$154.80
|
| Rate for Payer: Galaxy Health WC |
$128.35
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$230.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$210.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$140.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$237.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$197.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$177.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$188.58
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: Networks By Design Commercial |
$98.15
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.99
|
| Rate for Payer: United Healthcare All Other HMO |
$113.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$140.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
|
|
HC LAB REF TISSUE INSITU INTERP & REPORT
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
900910703
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$780.38 |
| Rate for Payer: EPIC Health Plan Senior |
$241.03
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$780.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.86
|
| Rate for Payer: Blue Shield of California Commercial |
$24.89
|
| Rate for Payer: Blue Shield of California Commercial |
$37.64
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.55
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$359.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$147.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$166.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$276.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$293.62
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$219.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC LAB REF TISSUE INSITU INTERP & REPORT
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
900910703
|
|
Hospital Revenue Code
|
310
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.86
|
| 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 LAB REF TRYPSINOGEN
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900910733
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$139.46 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.46
|
| Rate for Payer: Blue Shield of California Commercial |
$32.27
|
| Rate for Payer: Blue Shield of California Commercial |
$48.79
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.36
|
| Rate for Payer: EPIC Health Plan Senior |
$20.24
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC LAB REF TRYPSINOGEN
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900910733
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$59.50 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
|
|
HC LAB REF VARICELLA-ZOSTER AB ACIF CSF
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911362
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.50
|
| Rate for Payer: Blue Shield of California Commercial |
$19.82
|
| Rate for Payer: Blue Shield of California Commercial |
$29.97
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cigna of CA HMO |
$27.52
|
| Rate for Payer: Cigna of CA PPO |
$31.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$34.40
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC LAB REF VARICELLA-ZOSTER AB ACIF CSF
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911362
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$36.55 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.20
|
| Rate for Payer: EPIC Health Plan Senior |
$17.20
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.32
|
| Rate for Payer: Multiplan Commercial |
$34.40
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
|
|
HC LAB REF VITAMIN D 1 25-DIHYDROXY
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
900911098
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC LAB REF VITAMIN D 1 25-DIHYDROXY
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
900911098
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: EPIC Health Plan Senior |
$42.35
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$320.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$309.09
|
| Rate for Payer: Blue Shield of California Commercial |
$11.06
|
| Rate for Payer: Blue Shield of California Commercial |
$16.73
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.52
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$63.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$55.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.59
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.18
|
| Rate for Payer: United Healthcare All Other HMO |
$31.18
|
| Rate for Payer: United Healthcare HMO Rider |
$31.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$38.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.35
|
| Rate for Payer: Vantage Medical Group Senior |
$38.50
|
|
|
HC LAB REF VZV AB IMMUNITY SCREEN
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900912872
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.13
|
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.00
|
| Rate for Payer: Blue Shield of California Commercial |
$40.11
|
| Rate for Payer: Blue Shield of California Commercial |
$60.64
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cigna of CA HMO |
$55.68
|
| Rate for Payer: Cigna of CA PPO |
$64.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.25
|
| Rate for Payer: EPIC Health Plan Senior |
$14.17
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC LAB REF VZV AB IMMUNITY SCREEN
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900912872
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$73.95 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.80
|
| Rate for Payer: EPIC Health Plan Senior |
$34.80
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.88
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
|
|
HC LAB REF WHITE BEAN IGE
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912545
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5.20
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$10.40
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
|
|
HC LAB REF WHITE BEAN IGE
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912545
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$163.16 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.16
|
| Rate for Payer: Blue Shield of California Commercial |
$5.99
|
| Rate for Payer: Blue Shield of California Commercial |
$9.06
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$9.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.61
|
| Rate for Payer: EPIC Health Plan Senior |
$5.74
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$10.40
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC LACER WT BEARING MOLDED KAFO
|
Facility
|
OP
|
$834.00
|
|
|
Service Code
|
CPT L2540
|
| Hospital Charge Code |
905352540
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$200.16 |
| Max. Negotiated Rate |
$708.90 |
| Rate for Payer: Adventist Health Commercial |
$341.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$708.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$625.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$504.82
|
| Rate for Payer: Blue Shield of California Commercial |
$641.35
|
| Rate for Payer: Blue Shield of California Commercial |
$422.84
|
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Cigna of CA HMO |
$583.80
|
| Rate for Payer: Cigna of CA PPO |
$583.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$708.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$708.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$708.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$583.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.60
|
| Rate for Payer: EPIC Health Plan Senior |
$333.60
|
| Rate for Payer: Galaxy Health WC |
$708.90
|
| Rate for Payer: Global Benefits Group Commercial |
$500.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$407.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$529.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$460.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$492.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$583.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$583.80
|
| Rate for Payer: Multiplan Commercial |
$667.20
|
| Rate for Payer: Networks By Design Commercial |
$417.00
|
| Rate for Payer: Prime Health Services Commercial |
$708.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$500.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$500.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$313.00
|
| Rate for Payer: United Healthcare All Other HMO |
$304.66
|
| Rate for Payer: United Healthcare HMO Rider |
$298.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$273.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$708.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$708.90
|
| Rate for Payer: Vantage Medical Group Senior |
$708.90
|
|
|
HC LACER WT BEARING MOLDED KAFO
|
Facility
|
IP
|
$834.00
|
|
|
Service Code
|
CPT L2540
|
| Hospital Charge Code |
915352540
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$166.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$166.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Cigna of CA HMO |
$583.80
|
| Rate for Payer: Cigna of CA PPO |
$583.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$583.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.60
|
| Rate for Payer: EPIC Health Plan Senior |
$333.60
|
| Rate for Payer: Galaxy Health WC |
$708.90
|
| Rate for Payer: Global Benefits Group Commercial |
$500.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$529.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$492.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.16
|
| Rate for Payer: Multiplan Commercial |
$667.20
|
| Rate for Payer: Networks By Design Commercial |
$542.10
|
| Rate for Payer: Prime Health Services Commercial |
$708.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$313.00
|
| Rate for Payer: United Healthcare All Other HMO |
$304.66
|
| Rate for Payer: United Healthcare HMO Rider |
$298.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$273.13
|
|
|
HC LACER WT BEARING MOLDED KAFO
|
Facility
|
OP
|
$834.00
|
|
|
Service Code
|
CPT L2540
|
| Hospital Charge Code |
915352540
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$200.16 |
| Max. Negotiated Rate |
$708.90 |
| Rate for Payer: Adventist Health Commercial |
$341.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$708.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$625.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$504.82
|
| Rate for Payer: Blue Shield of California Commercial |
$641.35
|
| Rate for Payer: Blue Shield of California Commercial |
$422.84
|
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Cigna of CA HMO |
$583.80
|
| Rate for Payer: Cigna of CA PPO |
$583.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$708.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$708.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$708.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$583.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.60
|
| Rate for Payer: EPIC Health Plan Senior |
$333.60
|
| Rate for Payer: Galaxy Health WC |
$708.90
|
| Rate for Payer: Global Benefits Group Commercial |
$500.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$407.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$529.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$460.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$492.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$583.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$583.80
|
| Rate for Payer: Multiplan Commercial |
$667.20
|
| Rate for Payer: Networks By Design Commercial |
$417.00
|
| Rate for Payer: Prime Health Services Commercial |
$708.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$500.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$500.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$313.00
|
| Rate for Payer: United Healthcare All Other HMO |
$304.66
|
| Rate for Payer: United Healthcare HMO Rider |
$298.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$273.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$708.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$708.90
|
| Rate for Payer: Vantage Medical Group Senior |
$708.90
|
|
|
HC LACER WT BEARING MOLDED KAFO
|
Facility
|
IP
|
$834.00
|
|
|
Service Code
|
CPT L2540
|
| Hospital Charge Code |
905352540
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$166.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$166.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Cigna of CA HMO |
$583.80
|
| Rate for Payer: Cigna of CA PPO |
$583.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$583.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.60
|
| Rate for Payer: EPIC Health Plan Senior |
$333.60
|
| Rate for Payer: Galaxy Health WC |
$708.90
|
| Rate for Payer: Global Benefits Group Commercial |
$500.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$529.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$492.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.16
|
| Rate for Payer: Multiplan Commercial |
$667.20
|
| Rate for Payer: Networks By Design Commercial |
$542.10
|
| Rate for Payer: Prime Health Services Commercial |
$708.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$313.00
|
| Rate for Payer: United Healthcare All Other HMO |
$304.66
|
| Rate for Payer: United Healthcare HMO Rider |
$298.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$273.13
|
|
|
HC LACER WT BEARING NON-MOLDED
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT L2530
|
| Hospital Charge Code |
915352530
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$116.64 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Adventist Health Commercial |
$199.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$413.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$267.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$364.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$294.18
|
| Rate for Payer: Blue Shield of California Commercial |
$373.73
|
| Rate for Payer: Blue Shield of California Commercial |
$246.40
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna of CA HMO |
$340.20
|
| Rate for Payer: Cigna of CA PPO |
$340.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$413.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$413.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$413.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$340.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.40
|
| Rate for Payer: EPIC Health Plan Senior |
$194.40
|
| Rate for Payer: Galaxy Health WC |
$413.10
|
| Rate for Payer: Global Benefits Group Commercial |
$291.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$254.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$308.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$287.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$286.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$340.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$340.20
|
| Rate for Payer: Multiplan Commercial |
$388.80
|
| Rate for Payer: Networks By Design Commercial |
$243.00
|
| Rate for Payer: Prime Health Services Commercial |
$413.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$291.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$291.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.40
|
| Rate for Payer: United Healthcare All Other HMO |
$177.54
|
| Rate for Payer: United Healthcare HMO Rider |
$173.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$413.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$413.10
|
| Rate for Payer: Vantage Medical Group Senior |
$413.10
|
|
|
HC LACER WT BEARING NON-MOLDED
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT L2530
|
| Hospital Charge Code |
915352530
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$97.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna of CA HMO |
$340.20
|
| Rate for Payer: Cigna of CA PPO |
$340.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$340.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.40
|
| Rate for Payer: EPIC Health Plan Senior |
$194.40
|
| Rate for Payer: Galaxy Health WC |
$413.10
|
| Rate for Payer: Global Benefits Group Commercial |
$291.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$308.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$286.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.64
|
| Rate for Payer: Multiplan Commercial |
$388.80
|
| Rate for Payer: Networks By Design Commercial |
$315.90
|
| Rate for Payer: Prime Health Services Commercial |
$413.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.40
|
| Rate for Payer: United Healthcare All Other HMO |
$177.54
|
| Rate for Payer: United Healthcare HMO Rider |
$173.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.16
|
|
