|
HC OB ULTRASOUND RPT/FOLLOW-UP ADDL FETUS
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
CPT 76816 59
|
| Hospital Charge Code |
906601320
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$87.09 |
| Max. Negotiated Rate |
$1,330.25 |
| Rate for Payer: Adventist Health Commercial |
$313.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$447.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,330.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$860.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,173.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,004.26
|
| Rate for Payer: Blue Shield of California Commercial |
$998.47
|
| Rate for Payer: Blue Shield of California Commercial |
$658.87
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: Cigna of CA HMO |
$1,001.60
|
| Rate for Payer: Cigna of CA PPO |
$1,158.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,330.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,330.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,330.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,095.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$626.00
|
| Rate for Payer: EPIC Health Plan Senior |
$626.00
|
| Rate for Payer: Galaxy Health WC |
$1,330.25
|
| Rate for Payer: Global Benefits Group Commercial |
$939.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$87.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$993.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$923.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,095.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,095.50
|
| Rate for Payer: Multiplan Commercial |
$1,252.00
|
| Rate for Payer: Networks By Design Commercial |
$1,017.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,330.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$939.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$939.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,330.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,330.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,330.25
|
|
|
HC OB ULTRASOUND RPT/FOLLOW-UP SINGLE FETUS
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
906601311
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,330.25 |
| Rate for Payer: Adventist Health Commercial |
$313.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$447.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,004.26
|
| Rate for Payer: Blue Shield of California Commercial |
$998.47
|
| Rate for Payer: Blue Shield of California Commercial |
$658.87
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: Cigna of CA HMO |
$1,001.60
|
| Rate for Payer: Cigna of CA PPO |
$1,158.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,095.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,330.25
|
| Rate for Payer: Global Benefits Group Commercial |
$939.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$173.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$993.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$196.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,252.00
|
| Rate for Payer: Networks By Design Commercial |
$1,017.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,330.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$939.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$939.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC OB ULTRASOUND RPT/FOLLOW-UP SINGLE FETUS
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
906601311
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$313.00 |
| Max. Negotiated Rate |
$1,330.25 |
| Rate for Payer: Adventist Health Commercial |
$313.00
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,095.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$626.00
|
| Rate for Payer: EPIC Health Plan Senior |
$626.00
|
| Rate for Payer: Galaxy Health WC |
$1,330.25
|
| Rate for Payer: Global Benefits Group Commercial |
$939.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$993.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$923.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.60
|
| Rate for Payer: Multiplan Commercial |
$1,252.00
|
| Rate for Payer: Networks By Design Commercial |
$1,017.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,330.25
|
|
|
HC OB US AFI LMTD 1 OR MORE FETUS
|
Facility
|
IP
|
$1,640.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
910400110
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$328.00 |
| Max. Negotiated Rate |
$1,394.00 |
| Rate for Payer: Adventist Health Commercial |
$328.00
|
| Rate for Payer: Cash Price |
$738.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,148.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$656.00
|
| Rate for Payer: EPIC Health Plan Senior |
$656.00
|
| Rate for Payer: Galaxy Health WC |
$1,394.00
|
| Rate for Payer: Global Benefits Group Commercial |
$984.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,041.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$967.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.60
|
| Rate for Payer: Multiplan Commercial |
$1,312.00
|
| Rate for Payer: Networks By Design Commercial |
$1,066.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,394.00
|
|
|
HC OB US AFI LMTD 1 OR MORE FETUS
|
Facility
|
OP
|
$1,640.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
910400110
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$105.76 |
| Max. Negotiated Rate |
$1,394.00 |
| Rate for Payer: Adventist Health Commercial |
$328.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$432.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,052.39
|
| Rate for Payer: Blue Shield of California Commercial |
$690.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1,046.32
|
| Rate for Payer: Cash Price |
$738.00
|
| Rate for Payer: Cash Price |
$738.00
|
| Rate for Payer: Cigna of CA HMO |
$1,049.60
|
| Rate for Payer: Cigna of CA PPO |
$1,213.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,148.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,394.00
|
| Rate for Payer: Global Benefits Group Commercial |
$984.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,041.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,312.00
|
| Rate for Payer: Networks By Design Commercial |
$1,066.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,394.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$984.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$984.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC OCCLUSION CATHETER
|
Facility
|
OP
|
$595.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
909081214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$2,616.32 |
| Rate for Payer: Adventist Health Commercial |
$119.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,616.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$505.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$327.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$446.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$381.81
|
| Rate for Payer: Cash Price |
$267.75
|
| Rate for Payer: Cash Price |
$267.75
|
| Rate for Payer: Cigna of CA HMO |
$380.80
|
| Rate for Payer: Cigna of CA PPO |
$440.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$505.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$505.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$505.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$416.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.00
|
| Rate for Payer: EPIC Health Plan Senior |
$238.00
|
| Rate for Payer: Galaxy Health WC |
$505.75
|
| Rate for Payer: Global Benefits Group Commercial |
$357.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$377.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$215.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$351.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$416.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$416.50
|
| Rate for Payer: Multiplan Commercial |
$476.00
|
| Rate for Payer: Networks By Design Commercial |
$386.75
|
| Rate for Payer: Prime Health Services Commercial |
$505.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$357.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$357.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other HMO |
$297.50
|
| Rate for Payer: United Healthcare HMO Rider |
$297.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$505.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$505.75
|
| Rate for Payer: Vantage Medical Group Senior |
$505.75
|
|
|
HC OCCLUSION CATHETER
|
Facility
|
IP
|
$595.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
909081214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$505.75 |
| Rate for Payer: Adventist Health Commercial |
$119.00
|
| Rate for Payer: Cash Price |
$267.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$416.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.00
|
| Rate for Payer: EPIC Health Plan Senior |
$238.00
|
| Rate for Payer: Galaxy Health WC |
$505.75
|
| Rate for Payer: Global Benefits Group Commercial |
$357.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$377.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$351.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.80
|
| Rate for Payer: Multiplan Commercial |
$476.00
|
| Rate for Payer: Networks By Design Commercial |
$386.75
|
| Rate for Payer: Prime Health Services Commercial |
$505.75
|
|
|
HC OCCLUSIVE DEVICE IN VEIN ART
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
CPT G0269
|
| Hospital Charge Code |
906811384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$892.50 |
| Rate for Payer: Adventist Health Commercial |
$210.00
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$735.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.00
|
| Rate for Payer: EPIC Health Plan Senior |
$420.00
|
| Rate for Payer: Galaxy Health WC |
$892.50
|
| Rate for Payer: Global Benefits Group Commercial |
$630.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$666.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$619.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: Networks By Design Commercial |
$682.50
|
| Rate for Payer: Prime Health Services Commercial |
$892.50
|
|
|
HC OCCLUSIVE DEVICE IN VEIN ART
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
CPT G0269
|
| Hospital Charge Code |
906811384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$210.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$892.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$577.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$787.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna of CA HMO |
$672.00
|
| Rate for Payer: Cigna of CA PPO |
$777.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$892.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$892.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$892.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$735.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.00
|
| Rate for Payer: EPIC Health Plan Senior |
$420.00
|
| Rate for Payer: Galaxy Health WC |
$892.50
|
| Rate for Payer: Global Benefits Group Commercial |
$630.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$666.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$381.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$619.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$735.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$735.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: Networks By Design Commercial |
$682.50
|
| Rate for Payer: Prime Health Services Commercial |
$892.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$630.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$525.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$892.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$892.50
|
| Rate for Payer: Vantage Medical Group Senior |
$892.50
|
|
|
HC OCCULT BLOOD, FECES 1-3 SIMUL
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
900501612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.92
|
| Rate for Payer: Blue Shield of California Commercial |
$139.40
|
| Rate for Payer: Blue Shield of California Commercial |
$92.20
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.23
|
| Rate for Payer: EPIC Health Plan Senior |
$4.82
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.87
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.55
|
| Rate for Payer: United Healthcare All Other HMO |
$3.55
|
| Rate for Payer: United Healthcare HMO Rider |
$3.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.55
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4.38
|
|
|
HC OCCULT BLOOD, FECES 1-3 SIMUL
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
900501612
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.23
|
| Rate for Payer: EPIC Health Plan Senior |
$4.82
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.87
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4.38
|
|
|
HC OCCULT BLOOD, FECES 1-3 SIMUL
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
900501612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC OCCULT BLOOD, FECES 1-3 SIMUL
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
900501612
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.34
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.23
|
| Rate for Payer: EPIC Health Plan Senior |
$4.82
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.87
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO |
$100.00
|
| Rate for Payer: United Healthcare HMO Rider |
$100.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4.38
|
|
|
HC OCCULT BLOOD, FECES 1-3 SIMUL
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
900501612
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC OCCULT BLOOD, FECES 1-3 SIMUL
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
900501612
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC OCCULT BLOOD GASTRIC
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
900912329
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3.69
|
| Rate for Payer: Blue Shield of California Commercial |
$62.23
|
| Rate for Payer: Blue Shield of California Commercial |
$5.58
|
| Rate for Payer: Blue Shield of California Commercial |
$94.09
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna of CA HMO |
$5.12
|
| Rate for Payer: Cigna of CA HMO |
$86.40
|
| Rate for Payer: Cigna of CA PPO |
$99.90
|
| Rate for Payer: Cigna of CA PPO |
$5.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.78
|
| Rate for Payer: EPIC Health Plan Senior |
$5.85
|
| Rate for Payer: EPIC Health Plan Senior |
$5.85
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Galaxy Health WC |
$6.80
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.13
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$5.20
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Prime Health Services Commercial |
$6.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Other HMO |
$4.31
|
| Rate for Payer: United Healthcare All Other HMO |
$4.31
|
| Rate for Payer: United Healthcare HMO Rider |
$4.31
|
| Rate for Payer: United Healthcare HMO Rider |
$4.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.32
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5.32
|
| Rate for Payer: Vantage Medical Group Senior |
$5.32
|
|
|
HC OCCULT BLOOD GASTRIC
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
900912329
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
|
|
HC OCCULT BLOOD OTHR SOURCE
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
900911536
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$32.80 |
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Cigna of CA PPO |
$99.90
|
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.80
|
| Rate for Payer: Blue Shield of California Commercial |
$62.23
|
| Rate for Payer: Blue Shield of California Commercial |
$4.61
|
| Rate for Payer: Blue Shield of California Commercial |
$94.09
|
| Rate for Payer: Blue Shield of California Commercial |
$6.97
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna of CA HMO |
$86.40
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.78
|
| Rate for Payer: EPIC Health Plan Senior |
$5.85
|
| Rate for Payer: EPIC Health Plan Senior |
$5.85
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.13
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Other HMO |
$4.31
|
| Rate for Payer: United Healthcare All Other HMO |
$4.31
|
| Rate for Payer: United Healthcare HMO Rider |
$4.31
|
| Rate for Payer: United Healthcare HMO Rider |
$4.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.32
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5.32
|
| Rate for Payer: Vantage Medical Group Senior |
$5.32
|
|
|
HC OCCULT BLOOD OTHR SOURCE
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
900911536
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
|
|
HC OCTAPLAS STUDY
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT P9023
|
| Hospital Charge Code |
900904772
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$13.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$105.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.99
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cigna of CA HMO |
$42.88
|
| Rate for Payer: Cigna of CA PPO |
$49.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$105.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$70.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.24
|
| Rate for Payer: EPIC Health Plan Senior |
$77.50
|
| Rate for Payer: Galaxy Health WC |
$56.95
|
| Rate for Payer: Global Benefits Group Commercial |
$40.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$115.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$70.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$98.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$88.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: Networks By Design Commercial |
$43.55
|
| Rate for Payer: Prime Health Services Commercial |
$56.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$70.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$105.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.50
|
| Rate for Payer: Vantage Medical Group Senior |
$70.45
|
|
|
HC OCTAPLAS STUDY
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT P9023
|
| Hospital Charge Code |
900904772
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$56.95 |
| Rate for Payer: Adventist Health Commercial |
$13.40
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.80
|
| Rate for Payer: EPIC Health Plan Senior |
$26.80
|
| Rate for Payer: Galaxy Health WC |
$56.95
|
| Rate for Payer: Global Benefits Group Commercial |
$40.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: Networks By Design Commercial |
$43.55
|
| Rate for Payer: Prime Health Services Commercial |
$56.95
|
|
|
HC OFFSET KNEE HEAVY DUTY EA ADDITION LE
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
CPT L2395
|
| Hospital Charge Code |
915352395
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$65.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cigna of CA HMO |
$228.90
|
| Rate for Payer: Cigna of CA PPO |
$228.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$228.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.80
|
| Rate for Payer: EPIC Health Plan Senior |
$130.80
|
| Rate for Payer: Galaxy Health WC |
$277.95
|
| Rate for Payer: Global Benefits Group Commercial |
$196.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$207.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$192.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.48
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: Networks By Design Commercial |
$212.55
|
| Rate for Payer: Prime Health Services Commercial |
$277.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.72
|
| Rate for Payer: United Healthcare All Other HMO |
$119.45
|
| Rate for Payer: United Healthcare HMO Rider |
$116.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.09
|
|
|
HC OFFSET KNEE HEAVY DUTY EA ADDITION LE
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
CPT L2395
|
| Hospital Charge Code |
905352395
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$65.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cigna of CA HMO |
$228.90
|
| Rate for Payer: Cigna of CA PPO |
$228.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$228.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.80
|
| Rate for Payer: EPIC Health Plan Senior |
$130.80
|
| Rate for Payer: Galaxy Health WC |
$277.95
|
| Rate for Payer: Global Benefits Group Commercial |
$196.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$207.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$192.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.48
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: Networks By Design Commercial |
$212.55
|
| Rate for Payer: Prime Health Services Commercial |
$277.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.72
|
| Rate for Payer: United Healthcare All Other HMO |
$119.45
|
| Rate for Payer: United Healthcare HMO Rider |
$116.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.09
|
|
|
HC OFFSET KNEE HEAVY DUTY EA ADDITION LE
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT L2395
|
| Hospital Charge Code |
905352395
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$78.48 |
| Max. Negotiated Rate |
$277.95 |
| Rate for Payer: Adventist Health Commercial |
$134.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$179.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$245.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.93
|
| Rate for Payer: Blue Shield of California Commercial |
$251.46
|
| Rate for Payer: Blue Shield of California Commercial |
$165.79
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cigna of CA HMO |
$228.90
|
| Rate for Payer: Cigna of CA PPO |
$228.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$228.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.80
|
| Rate for Payer: EPIC Health Plan Senior |
$130.80
|
| Rate for Payer: Galaxy Health WC |
$277.95
|
| Rate for Payer: Global Benefits Group Commercial |
$196.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$143.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$207.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$162.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$192.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$228.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$228.90
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: Networks By Design Commercial |
$163.50
|
| Rate for Payer: Prime Health Services Commercial |
$277.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$196.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$196.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.72
|
| Rate for Payer: United Healthcare All Other HMO |
$119.45
|
| Rate for Payer: United Healthcare HMO Rider |
$116.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.95
|
| Rate for Payer: Vantage Medical Group Senior |
$277.95
|
|
|
HC OFFSET KNEE HEAVY DUTY EA ADDITION LE
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT L2395
|
| Hospital Charge Code |
915352395
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$78.48 |
| Max. Negotiated Rate |
$277.95 |
| Rate for Payer: Adventist Health Commercial |
$134.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$179.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$245.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.93
|
| Rate for Payer: Blue Shield of California Commercial |
$251.46
|
| Rate for Payer: Blue Shield of California Commercial |
$165.79
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cigna of CA HMO |
$228.90
|
| Rate for Payer: Cigna of CA PPO |
$228.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$228.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.80
|
| Rate for Payer: EPIC Health Plan Senior |
$130.80
|
| Rate for Payer: Galaxy Health WC |
$277.95
|
| Rate for Payer: Global Benefits Group Commercial |
$196.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$143.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$207.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$162.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$192.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$228.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$228.90
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: Networks By Design Commercial |
$163.50
|
| Rate for Payer: Prime Health Services Commercial |
$277.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$196.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$196.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.72
|
| Rate for Payer: United Healthcare All Other HMO |
$119.45
|
| Rate for Payer: United Healthcare HMO Rider |
$116.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.95
|
| Rate for Payer: Vantage Medical Group Senior |
$277.95
|
|
