|
HC MOD/TRAIN IN USE VOICE PROSTHE MCAL
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
907000029
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$53.76 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$91.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$190.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cigna of CA HMO |
$143.36
|
| Rate for Payer: Cigna of CA PPO |
$165.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$190.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.60
|
| Rate for Payer: EPIC Health Plan Senior |
$89.60
|
| Rate for Payer: Galaxy Health WC |
$190.40
|
| Rate for Payer: Global Benefits Group Commercial |
$134.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$87.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$138.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$156.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$156.80
|
| Rate for Payer: Multiplan Commercial |
$179.20
|
| Rate for Payer: Networks By Design Commercial |
$145.60
|
| Rate for Payer: Prime Health Services Commercial |
$190.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$190.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.40
|
| Rate for Payer: Vantage Medical Group Senior |
$190.40
|
|
|
HC MOD/TRAIN IN USE VOICE PROSTHE MCAL
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
907000029
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$190.40 |
| Rate for Payer: Adventist Health Commercial |
$44.80
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.60
|
| Rate for Payer: EPIC Health Plan Senior |
$89.60
|
| Rate for Payer: Galaxy Health WC |
$190.40
|
| Rate for Payer: Global Benefits Group Commercial |
$134.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$138.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.76
|
| Rate for Payer: Multiplan Commercial |
$179.20
|
| Rate for Payer: Networks By Design Commercial |
$145.60
|
| Rate for Payer: Prime Health Services Commercial |
$190.40
|
|
|
HC MOD VOICE/AUG DVC MCAL
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
907000027
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
|
|
HC MOD VOICE/AUG DVC MCAL
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
907000027
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$41.04 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$70.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$145.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$94.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$128.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cigna of CA HMO |
$109.44
|
| Rate for Payer: Cigna of CA PPO |
$126.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$145.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$145.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$145.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$119.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.70
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$145.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$145.35
|
| Rate for Payer: Vantage Medical Group Senior |
$145.35
|
|
|
HC MOHC LNAR DISK
|
Facility
|
IP
|
$34.00
|
|
| Hospital Charge Code |
909001084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$28.90 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.16
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
|
|
HC MOHC LNAR DISK
|
Facility
|
OP
|
$34.00
|
|
| Hospital Charge Code |
909001084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$28.90 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.88
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.80
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.00
|
| Rate for Payer: United Healthcare All Other HMO |
$17.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.90
|
| Rate for Payer: Vantage Medical Group Senior |
$28.90
|
|
|
HC MOLDED INNER BOOT ADDITION LE
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
CPT L2280
|
| Hospital Charge Code |
905352280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$233.76 |
| Max. Negotiated Rate |
$827.90 |
| Rate for Payer: Adventist Health Commercial |
$399.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$827.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$535.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$730.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$564.14
|
| Rate for Payer: Blue Shield of California Commercial |
$718.81
|
| Rate for Payer: Blue Shield of California EPN |
$473.36
|
| Rate for Payer: Cash Price |
$535.70
|
| Rate for Payer: Cash Price |
$535.70
|
| Rate for Payer: Cigna of CA HMO |
$681.80
|
| Rate for Payer: Cigna of CA PPO |
$681.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$827.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$827.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$827.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$389.60
|
| Rate for Payer: EPIC Health Plan Senior |
$389.60
|
| Rate for Payer: Galaxy Health WC |
$827.90
|
| Rate for Payer: Global Benefits Group Commercial |
$584.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$433.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$649.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$490.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$602.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$681.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$681.80
|
| Rate for Payer: Multiplan Commercial |
$779.20
|
| Rate for Payer: Networks By Design Commercial |
$487.00
|
| Rate for Payer: Prime Health Services Commercial |
$827.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$584.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$584.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$365.54
|
| Rate for Payer: United Healthcare All Other HMO |
$355.80
|
| Rate for Payer: United Healthcare HMO Rider |
$348.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$318.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$827.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$827.90
|
| Rate for Payer: Vantage Medical Group Senior |
$827.90
|
|
|
HC MOLDED INNER BOOT ADDITION LE
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
CPT L2280
|
| Hospital Charge Code |
915352280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$233.76 |
| Max. Negotiated Rate |
$827.90 |
| Rate for Payer: Adventist Health Commercial |
$399.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$827.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$535.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$730.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$564.14
|
| Rate for Payer: Blue Shield of California Commercial |
$718.81
|
| Rate for Payer: Blue Shield of California EPN |
$473.36
|
| Rate for Payer: Cash Price |
$535.70
|
| Rate for Payer: Cash Price |
$535.70
|
| Rate for Payer: Cigna of CA HMO |
$681.80
|
| Rate for Payer: Cigna of CA PPO |
$681.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$827.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$827.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$827.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$389.60
|
| Rate for Payer: EPIC Health Plan Senior |
$389.60
|
| Rate for Payer: Galaxy Health WC |
$827.90
|
| Rate for Payer: Global Benefits Group Commercial |
$584.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$433.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$649.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$490.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$602.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$681.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$681.80
|
| Rate for Payer: Multiplan Commercial |
$779.20
|
| Rate for Payer: Networks By Design Commercial |
$487.00
|
| Rate for Payer: Prime Health Services Commercial |
$827.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$584.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$584.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$365.54
|
| Rate for Payer: United Healthcare All Other HMO |
$355.80
|
| Rate for Payer: United Healthcare HMO Rider |
$348.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$318.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$827.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$827.90
|
| Rate for Payer: Vantage Medical Group Senior |
$827.90
|
|
|
HC MOLDED INNER BOOT ADDITION LE
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
CPT L2280
|
| Hospital Charge Code |
915352280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$194.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$194.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$535.70
|
| Rate for Payer: Cash Price |
$535.70
|
| Rate for Payer: Cigna of CA HMO |
$681.80
|
| Rate for Payer: Cigna of CA PPO |
$681.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$389.60
|
| Rate for Payer: EPIC Health Plan Senior |
$389.60
|
| Rate for Payer: Galaxy Health WC |
$827.90
|
| Rate for Payer: Global Benefits Group Commercial |
$584.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$649.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$602.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.76
|
| Rate for Payer: Multiplan Commercial |
$779.20
|
| Rate for Payer: Networks By Design Commercial |
$487.00
|
| Rate for Payer: Prime Health Services Commercial |
$827.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$365.54
|
| Rate for Payer: United Healthcare All Other HMO |
$355.80
|
| Rate for Payer: United Healthcare HMO Rider |
$348.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$318.99
|
|
|
HC MOLDED INNER BOOT ADDITION LE
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
CPT L2280
|
| Hospital Charge Code |
905352280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$194.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$194.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$535.70
|
| Rate for Payer: Cash Price |
$535.70
|
| Rate for Payer: Cigna of CA HMO |
$681.80
|
| Rate for Payer: Cigna of CA PPO |
$681.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$389.60
|
| Rate for Payer: EPIC Health Plan Senior |
$389.60
|
| Rate for Payer: Galaxy Health WC |
$827.90
|
| Rate for Payer: Global Benefits Group Commercial |
$584.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$649.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$602.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.76
|
| Rate for Payer: Multiplan Commercial |
$779.20
|
| Rate for Payer: Networks By Design Commercial |
$487.00
|
| Rate for Payer: Prime Health Services Commercial |
$827.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$365.54
|
| Rate for Payer: United Healthcare All Other HMO |
$355.80
|
| Rate for Payer: United Healthcare HMO Rider |
$348.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$318.99
|
|
|
HC MOLDED LACER KAFO ADDITION LE
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
CPT L2330
|
| Hospital Charge Code |
905352330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$168.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$168.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Cigna of CA HMO |
$590.80
|
| Rate for Payer: Cigna of CA PPO |
$590.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.60
|
| Rate for Payer: EPIC Health Plan Senior |
$337.60
|
| Rate for Payer: Galaxy Health WC |
$717.40
|
| Rate for Payer: Global Benefits Group Commercial |
$506.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.56
|
| Rate for Payer: Multiplan Commercial |
$675.20
|
| Rate for Payer: Networks By Design Commercial |
$422.00
|
| Rate for Payer: Prime Health Services Commercial |
$717.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$316.75
|
| Rate for Payer: United Healthcare All Other HMO |
$308.31
|
| Rate for Payer: United Healthcare HMO Rider |
$301.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.41
|
|
|
HC MOLDED LACER KAFO ADDITION LE
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
CPT L2330
|
| Hospital Charge Code |
915352330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$202.56 |
| Max. Negotiated Rate |
$717.40 |
| Rate for Payer: Adventist Health Commercial |
$346.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$717.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$464.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$633.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$488.84
|
| Rate for Payer: Blue Shield of California Commercial |
$622.87
|
| Rate for Payer: Blue Shield of California EPN |
$410.18
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Cigna of CA HMO |
$590.80
|
| Rate for Payer: Cigna of CA PPO |
$590.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$717.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$717.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$717.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.60
|
| Rate for Payer: EPIC Health Plan Senior |
$337.60
|
| Rate for Payer: Galaxy Health WC |
$717.40
|
| Rate for Payer: Global Benefits Group Commercial |
$506.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$346.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$392.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$590.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$590.80
|
| Rate for Payer: Multiplan Commercial |
$675.20
|
| Rate for Payer: Networks By Design Commercial |
$422.00
|
| Rate for Payer: Prime Health Services Commercial |
$717.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$316.75
|
| Rate for Payer: United Healthcare All Other HMO |
$308.31
|
| Rate for Payer: United Healthcare HMO Rider |
$301.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$717.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$717.40
|
| Rate for Payer: Vantage Medical Group Senior |
$717.40
|
|
|
HC MOLDED LACER KAFO ADDITION LE
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
CPT L2330
|
| Hospital Charge Code |
915352330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$168.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$168.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Cigna of CA HMO |
$590.80
|
| Rate for Payer: Cigna of CA PPO |
$590.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.60
|
| Rate for Payer: EPIC Health Plan Senior |
$337.60
|
| Rate for Payer: Galaxy Health WC |
$717.40
|
| Rate for Payer: Global Benefits Group Commercial |
$506.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.56
|
| Rate for Payer: Multiplan Commercial |
$675.20
|
| Rate for Payer: Networks By Design Commercial |
$422.00
|
| Rate for Payer: Prime Health Services Commercial |
$717.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$316.75
|
| Rate for Payer: United Healthcare All Other HMO |
$308.31
|
| Rate for Payer: United Healthcare HMO Rider |
$301.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.41
|
|
|
HC MOLDED LACER KAFO ADDITION LE
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
CPT L2330
|
| Hospital Charge Code |
905352330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$202.56 |
| Max. Negotiated Rate |
$717.40 |
| Rate for Payer: Adventist Health Commercial |
$346.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$717.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$464.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$633.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$488.84
|
| Rate for Payer: Blue Shield of California Commercial |
$622.87
|
| Rate for Payer: Blue Shield of California EPN |
$410.18
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Cigna of CA HMO |
$590.80
|
| Rate for Payer: Cigna of CA PPO |
$590.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$717.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$717.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$717.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.60
|
| Rate for Payer: EPIC Health Plan Senior |
$337.60
|
| Rate for Payer: Galaxy Health WC |
$717.40
|
| Rate for Payer: Global Benefits Group Commercial |
$506.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$346.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$392.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$590.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$590.80
|
| Rate for Payer: Multiplan Commercial |
$675.20
|
| Rate for Payer: Networks By Design Commercial |
$422.00
|
| Rate for Payer: Prime Health Services Commercial |
$717.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$316.75
|
| Rate for Payer: United Healthcare All Other HMO |
$308.31
|
| Rate for Payer: United Healthcare HMO Rider |
$301.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$717.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$717.40
|
| Rate for Payer: Vantage Medical Group Senior |
$717.40
|
|
|
HC MOLECULAR CYTOGEN DNA PROBE,EA
|
Facility
|
OP
|
$385.51
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
903800160
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$1,675.72 |
| Rate for Payer: Adventist Health Commercial |
$77.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$252.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,675.72
|
| Rate for Payer: Blue Shield of California Commercial |
$257.91
|
| Rate for Payer: Blue Shield of California EPN |
$170.40
|
| Rate for Payer: Cash Price |
$212.03
|
| Rate for Payer: Cash Price |
$212.03
|
| Rate for Payer: Cigna of CA HMO |
$246.73
|
| Rate for Payer: Cigna of CA PPO |
$285.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.92
|
| Rate for Payer: EPIC Health Plan Senior |
$21.42
|
| Rate for Payer: Galaxy Health WC |
$327.68
|
| Rate for Payer: Global Benefits Group Commercial |
$231.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$257.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$308.41
|
| Rate for Payer: Networks By Design Commercial |
$250.58
|
| Rate for Payer: Prime Health Services Commercial |
$327.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$231.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$231.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.35
|
| Rate for Payer: United Healthcare All Other HMO |
$17.35
|
| Rate for Payer: United Healthcare HMO Rider |
$17.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC MOLECULAR CYTOGEN DNA PROBE,EA
|
Facility
|
IP
|
$385.51
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
903800160
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$77.10 |
| Max. Negotiated Rate |
$327.68 |
| Rate for Payer: Adventist Health Commercial |
$77.10
|
| Rate for Payer: Cash Price |
$212.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.20
|
| Rate for Payer: EPIC Health Plan Senior |
$154.20
|
| Rate for Payer: Galaxy Health WC |
$327.68
|
| Rate for Payer: Global Benefits Group Commercial |
$231.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$257.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$238.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.52
|
| Rate for Payer: Multiplan Commercial |
$308.41
|
| Rate for Payer: Networks By Design Commercial |
$250.58
|
| Rate for Payer: Prime Health Services Commercial |
$327.68
|
|
|
HC MOLECULAR PATH INTERPRETATION
|
Facility
|
IP
|
$382.00
|
|
|
Service Code
|
CPT G0452
|
| Hospital Charge Code |
903800940
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$76.40 |
| Max. Negotiated Rate |
$324.70 |
| Rate for Payer: Adventist Health Commercial |
$76.40
|
| Rate for Payer: Cash Price |
$210.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.80
|
| Rate for Payer: EPIC Health Plan Senior |
$152.80
|
| Rate for Payer: Galaxy Health WC |
$324.70
|
| Rate for Payer: Global Benefits Group Commercial |
$229.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$254.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$236.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.68
|
| Rate for Payer: Multiplan Commercial |
$305.60
|
| Rate for Payer: Networks By Design Commercial |
$248.30
|
| Rate for Payer: Prime Health Services Commercial |
$324.70
|
|
|
HC MOLECULAR PATH INTERPRETATION
|
Facility
|
OP
|
$382.00
|
|
|
Service Code
|
CPT G0452
|
| Hospital Charge Code |
903800940
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$324.70 |
| Rate for Payer: Adventist Health Commercial |
$76.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$250.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$324.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$210.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$286.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.05
|
| Rate for Payer: Blue Shield of California Commercial |
$255.56
|
| Rate for Payer: Blue Shield of California EPN |
$168.84
|
| Rate for Payer: Cash Price |
$210.10
|
| Rate for Payer: Cash Price |
$210.10
|
| Rate for Payer: Cigna of CA HMO |
$244.48
|
| Rate for Payer: Cigna of CA PPO |
$282.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$324.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$324.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.80
|
| Rate for Payer: EPIC Health Plan Senior |
$152.80
|
| Rate for Payer: Galaxy Health WC |
$324.70
|
| Rate for Payer: Global Benefits Group Commercial |
$229.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$75.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$254.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$236.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$267.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$267.40
|
| Rate for Payer: Multiplan Commercial |
$305.60
|
| Rate for Payer: Networks By Design Commercial |
$248.30
|
| Rate for Payer: Prime Health Services Commercial |
$324.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.52
|
| Rate for Payer: United Healthcare All Other HMO |
$2.52
|
| Rate for Payer: United Healthcare HMO Rider |
$2.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$324.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.70
|
| Rate for Payer: Vantage Medical Group Senior |
$324.70
|
|
|
HC MONITRNG FLUID PRESSURE/MUSCLE
|
Facility
|
IP
|
$972.00
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
900501343
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.40 |
| Max. Negotiated Rate |
$826.20 |
| Rate for Payer: Adventist Health Commercial |
$194.40
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.80
|
| Rate for Payer: EPIC Health Plan Senior |
$388.80
|
| Rate for Payer: Galaxy Health WC |
$826.20
|
| Rate for Payer: Global Benefits Group Commercial |
$583.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$648.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$370.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$601.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.28
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: Networks By Design Commercial |
$631.80
|
| Rate for Payer: Prime Health Services Commercial |
$826.20
|
|
|
HC MONITRNG FLUID PRESSURE/MUSCLE
|
Facility
|
OP
|
$972.00
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
900501343
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.40 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$194.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cigna of CA HMO |
$622.08
|
| Rate for Payer: Cigna of CA PPO |
$719.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$826.20
|
| Rate for Payer: Global Benefits Group Commercial |
$583.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$648.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$631.80
|
| Rate for Payer: Prime Health Services Commercial |
$826.20
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$583.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$486.00
|
| Rate for Payer: United Healthcare All Other HMO |
$486.00
|
| Rate for Payer: United Healthcare HMO Rider |
$486.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$486.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC MONOSPOT (INFECT. MONO TEST)
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
900910867
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Adventist Health Commercial |
$39.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$129.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.07
|
| Rate for Payer: Blue Shield of California Commercial |
$132.46
|
| Rate for Payer: Blue Shield of California EPN |
$87.52
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna of CA HMO |
$126.72
|
| Rate for Payer: Cigna of CA PPO |
$146.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$168.30
|
| Rate for Payer: Global Benefits Group Commercial |
$118.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$158.40
|
| Rate for Payer: Networks By Design Commercial |
$128.70
|
| Rate for Payer: Prime Health Services Commercial |
$168.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC MONOSPOT (INFECT. MONO TEST)
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
900910867
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Adventist Health Commercial |
$39.60
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$79.20
|
| Rate for Payer: Galaxy Health WC |
$168.30
|
| Rate for Payer: Global Benefits Group Commercial |
$118.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$122.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.52
|
| Rate for Payer: Multiplan Commercial |
$158.40
|
| Rate for Payer: Networks By Design Commercial |
$128.70
|
| Rate for Payer: Prime Health Services Commercial |
$168.30
|
|
|
HC MOTOR NCS W/F-WAVES
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 95905
|
| Hospital Charge Code |
900600257
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$176.80 |
| Rate for Payer: Adventist Health Commercial |
$41.60
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.20
|
| Rate for Payer: EPIC Health Plan Senior |
$83.20
|
| Rate for Payer: Galaxy Health WC |
$176.80
|
| Rate for Payer: Global Benefits Group Commercial |
$124.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.92
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: Networks By Design Commercial |
$135.20
|
| Rate for Payer: Prime Health Services Commercial |
$176.80
|
|
|
HC MOTOR NCS W/F-WAVES
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 95905
|
| Hospital Charge Code |
900600257
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$1,297.00 |
| Rate for Payer: Adventist Health Commercial |
$41.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.73
|
| Rate for Payer: Blue Shield of California Commercial |
$127.30
|
| Rate for Payer: Blue Shield of California EPN |
$84.03
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cigna of CA HMO |
$133.12
|
| Rate for Payer: Cigna of CA PPO |
$153.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.48
|
| Rate for Payer: EPIC Health Plan Senior |
$507.02
|
| Rate for Payer: Galaxy Health WC |
$176.80
|
| Rate for Payer: Global Benefits Group Commercial |
$124.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$831.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$638.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.41
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: Networks By Design Commercial |
$135.20
|
| Rate for Payer: Prime Health Services Commercial |
$176.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$124.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$124.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC MOTOR & SENS 11-12 NRV CNDJ TEST
|
Facility
|
IP
|
$1,090.00
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
900600329
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$218.00 |
| Max. Negotiated Rate |
$926.50 |
| Rate for Payer: Adventist Health Commercial |
$218.00
|
| Rate for Payer: Cash Price |
$599.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$436.00
|
| Rate for Payer: EPIC Health Plan Senior |
$436.00
|
| Rate for Payer: Galaxy Health WC |
$926.50
|
| Rate for Payer: Global Benefits Group Commercial |
$654.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$727.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.60
|
| Rate for Payer: Multiplan Commercial |
$872.00
|
| Rate for Payer: Networks By Design Commercial |
$708.50
|
| Rate for Payer: Prime Health Services Commercial |
$926.50
|
|
