|
HC RUBELLA ANTIBODY IGG QUANT
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
900913665
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$141.71 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.71
|
| Rate for Payer: Blue Shield of California Commercial |
$65.56
|
| Rate for Payer: Blue Shield of California EPN |
$43.32
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.43
|
| Rate for Payer: EPIC Health Plan Senior |
$14.39
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.65
|
| Rate for Payer: United Healthcare All Other HMO |
$11.65
|
| Rate for Payer: United Healthcare HMO Rider |
$11.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC RUBELLA ANTIBODY IGG QUANT
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
900913665
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$113.90 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.60
|
| Rate for Payer: EPIC Health Plan Senior |
$53.60
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.16
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
|
|
HC RUBEOLA ANTIBODY
|
Facility
|
IP
|
$144.06
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900913666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.81 |
| Max. Negotiated Rate |
$122.45 |
| Rate for Payer: Adventist Health Commercial |
$28.81
|
| Rate for Payer: Cash Price |
$64.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.62
|
| Rate for Payer: EPIC Health Plan Senior |
$57.62
|
| Rate for Payer: Galaxy Health WC |
$122.45
|
| Rate for Payer: Global Benefits Group Commercial |
$86.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.57
|
| Rate for Payer: Multiplan Commercial |
$115.25
|
| Rate for Payer: Networks By Design Commercial |
$93.64
|
| Rate for Payer: Prime Health Services Commercial |
$122.45
|
|
|
HC RUBEOLA ANTIBODY
|
Facility
|
OP
|
$130.96
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900913666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$127.28 |
| Rate for Payer: Adventist Health Commercial |
$26.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.28
|
| Rate for Payer: Blue Shield of California Commercial |
$87.61
|
| Rate for Payer: Blue Shield of California EPN |
$57.88
|
| Rate for Payer: Cash Price |
$58.93
|
| Rate for Payer: Cash Price |
$58.93
|
| Rate for Payer: Cigna of CA HMO |
$83.81
|
| Rate for Payer: Cigna of CA PPO |
$96.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Senior |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$111.32
|
| Rate for Payer: Global Benefits Group Commercial |
$78.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$87.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$104.77
|
| Rate for Payer: Networks By Design Commercial |
$85.12
|
| Rate for Payer: Prime Health Services Commercial |
$111.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC RYE IGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913639
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
HC RYE IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913639
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$156.13 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.13
|
| Rate for Payer: Blue Shield of California Commercial |
$44.15
|
| Rate for Payer: Blue Shield of California EPN |
$29.17
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SACHFOOT, REPLACEMENT
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT L5971
|
| Hospital Charge Code |
915355971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$86.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna of CA HMO |
$301.00
|
| Rate for Payer: Cigna of CA PPO |
$301.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Senior |
$172.00
|
| Rate for Payer: Galaxy Health WC |
$365.50
|
| Rate for Payer: Global Benefits Group Commercial |
$258.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.20
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: Networks By Design Commercial |
$215.00
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.38
|
| Rate for Payer: United Healthcare All Other HMO |
$157.08
|
| Rate for Payer: United Healthcare HMO Rider |
$153.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.82
|
|
|
HC SACHFOOT, REPLACEMENT
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT L5971
|
| Hospital Charge Code |
905355971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$86.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna of CA HMO |
$301.00
|
| Rate for Payer: Cigna of CA PPO |
$301.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Senior |
$172.00
|
| Rate for Payer: Galaxy Health WC |
$365.50
|
| Rate for Payer: Global Benefits Group Commercial |
$258.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.20
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: Networks By Design Commercial |
$215.00
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.38
|
| Rate for Payer: United Healthcare All Other HMO |
$157.08
|
| Rate for Payer: United Healthcare HMO Rider |
$153.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.82
|
|
|
HC SACHFOOT, REPLACEMENT
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT L5971
|
| Hospital Charge Code |
915355971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$103.20 |
| Max. Negotiated Rate |
$365.50 |
| Rate for Payer: Adventist Health Commercial |
$176.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$365.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$236.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$322.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$249.06
|
| Rate for Payer: Blue Shield of California Commercial |
$317.34
|
| Rate for Payer: Blue Shield of California EPN |
$208.98
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna of CA HMO |
$301.00
|
| Rate for Payer: Cigna of CA PPO |
$301.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$365.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$365.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$365.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Senior |
$172.00
|
| Rate for Payer: Galaxy Health WC |
$365.50
|
| Rate for Payer: Global Benefits Group Commercial |
$258.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$275.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$301.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$301.00
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: Networks By Design Commercial |
$215.00
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$258.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$258.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.38
|
| Rate for Payer: United Healthcare All Other HMO |
$157.08
|
| Rate for Payer: United Healthcare HMO Rider |
$153.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$365.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$365.50
|
| Rate for Payer: Vantage Medical Group Senior |
$365.50
|
|
|
HC SACHFOOT, REPLACEMENT
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT L5971
|
| Hospital Charge Code |
905355971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$103.20 |
| Max. Negotiated Rate |
$365.50 |
| Rate for Payer: Adventist Health Commercial |
$176.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$365.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$236.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$322.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$249.06
|
| Rate for Payer: Blue Shield of California Commercial |
$317.34
|
| Rate for Payer: Blue Shield of California EPN |
$208.98
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna of CA HMO |
$301.00
|
| Rate for Payer: Cigna of CA PPO |
$301.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$365.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$365.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$365.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Senior |
$172.00
|
| Rate for Payer: Galaxy Health WC |
$365.50
|
| Rate for Payer: Global Benefits Group Commercial |
$258.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$275.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$301.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$301.00
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: Networks By Design Commercial |
$215.00
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$258.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$258.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.38
|
| Rate for Payer: United Healthcare All Other HMO |
$157.08
|
| Rate for Payer: United Healthcare HMO Rider |
$153.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$365.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$365.50
|
| Rate for Payer: Vantage Medical Group Senior |
$365.50
|
|
|
HC SACRAL AUGMENTATION BILAT
|
Facility
|
OP
|
$30,807.00
|
|
|
Service Code
|
CPT 0201T
|
| Hospital Charge Code |
909020153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,845.77 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$6,161.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$13,863.15
|
| Rate for Payer: Cash Price |
$13,863.15
|
| Rate for Payer: Cash Price |
$13,863.15
|
| Rate for Payer: Cigna of CA HMO |
$19,716.48
|
| Rate for Payer: Cigna of CA PPO |
$22,797.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,253.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9,076.82
|
| Rate for Payer: Galaxy Health WC |
$26,185.95
|
| Rate for Payer: Global Benefits Group Commercial |
$18,484.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,885.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,548.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,737.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,076.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,393.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,436.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,162.94
|
| Rate for Payer: Multiplan Commercial |
$24,645.60
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$20,024.55
|
| Rate for Payer: Prime Health Services Commercial |
$26,185.95
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,484.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,076.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC SACRAL AUGMENTATION BILAT
|
Facility
|
IP
|
$30,807.00
|
|
|
Service Code
|
CPT 0201T
|
| Hospital Charge Code |
909020153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,161.40 |
| Max. Negotiated Rate |
$26,185.95 |
| Rate for Payer: Adventist Health Commercial |
$6,161.40
|
| Rate for Payer: Cash Price |
$13,863.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,322.80
|
| Rate for Payer: EPIC Health Plan Senior |
$12,322.80
|
| Rate for Payer: Galaxy Health WC |
$26,185.95
|
| Rate for Payer: Global Benefits Group Commercial |
$18,484.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,548.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,737.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,069.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,393.68
|
| Rate for Payer: Multiplan Commercial |
$24,645.60
|
| Rate for Payer: Networks By Design Commercial |
$20,024.55
|
| Rate for Payer: Prime Health Services Commercial |
$26,185.95
|
|
|
HC SACRAL AUGMENTATION UNILAT
|
Facility
|
IP
|
$16,594.00
|
|
|
Service Code
|
CPT 0200T
|
| Hospital Charge Code |
909020152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,318.80 |
| Max. Negotiated Rate |
$14,104.90 |
| Rate for Payer: Adventist Health Commercial |
$3,318.80
|
| Rate for Payer: Cash Price |
$7,467.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,637.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,637.60
|
| Rate for Payer: Galaxy Health WC |
$14,104.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,956.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,068.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,322.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,271.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,982.56
|
| Rate for Payer: Multiplan Commercial |
$13,275.20
|
| Rate for Payer: Networks By Design Commercial |
$10,786.10
|
| Rate for Payer: Prime Health Services Commercial |
$14,104.90
|
|
|
HC SACRAL AUGMENTATION UNILAT
|
Facility
|
OP
|
$16,594.00
|
|
|
Service Code
|
CPT 0200T
|
| Hospital Charge Code |
909020152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,845.77 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,318.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$7,467.30
|
| Rate for Payer: Cash Price |
$7,467.30
|
| Rate for Payer: Cash Price |
$7,467.30
|
| Rate for Payer: Cigna of CA HMO |
$10,620.16
|
| Rate for Payer: Cigna of CA PPO |
$12,279.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,253.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9,076.82
|
| Rate for Payer: Galaxy Health WC |
$14,104.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,956.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,885.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,068.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,322.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,076.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,982.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,436.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,162.94
|
| Rate for Payer: Multiplan Commercial |
$13,275.20
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$10,786.10
|
| Rate for Payer: Prime Health Services Commercial |
$14,104.90
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,956.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,076.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC SACROILIAC ARTHROGRAPHY
|
Facility
|
OP
|
$2,457.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
909000223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$491.40 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$491.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,088.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,351.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,842.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: Cigna of CA HMO |
$1,572.48
|
| Rate for Payer: Cigna of CA PPO |
$1,818.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,088.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,088.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,088.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$982.80
|
| Rate for Payer: EPIC Health Plan Senior |
$982.80
|
| Rate for Payer: Galaxy Health WC |
$2,088.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$493.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,638.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$558.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,520.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,719.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,719.90
|
| Rate for Payer: Multiplan Commercial |
$1,965.60
|
| Rate for Payer: Networks By Design Commercial |
$1,597.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,088.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,474.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,088.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,088.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,088.45
|
|
|
HC SACROILIAC ARTHROGRAPHY
|
Facility
|
IP
|
$2,457.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
909000223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$491.40 |
| Max. Negotiated Rate |
$2,088.45 |
| Rate for Payer: Adventist Health Commercial |
$491.40
|
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$982.80
|
| Rate for Payer: EPIC Health Plan Senior |
$982.80
|
| Rate for Payer: Galaxy Health WC |
$2,088.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,638.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$936.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,520.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.68
|
| Rate for Payer: Multiplan Commercial |
$1,965.60
|
| Rate for Payer: Networks By Design Commercial |
$1,597.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,088.45
|
|
|
HC SACRO ILIAC JOINTS
|
Facility
|
IP
|
$877.00
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
909001344
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.40 |
| Max. Negotiated Rate |
$745.45 |
| Rate for Payer: Adventist Health Commercial |
$175.40
|
| Rate for Payer: Cash Price |
$394.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.80
|
| Rate for Payer: EPIC Health Plan Senior |
$350.80
|
| Rate for Payer: Galaxy Health WC |
$745.45
|
| Rate for Payer: Global Benefits Group Commercial |
$526.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$584.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$334.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$542.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.48
|
| Rate for Payer: Multiplan Commercial |
$701.60
|
| Rate for Payer: Networks By Design Commercial |
$570.05
|
| Rate for Payer: Prime Health Services Commercial |
$745.45
|
|
|
HC SACRO ILIAC JOINTS
|
Facility
|
OP
|
$877.00
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
909001344
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.68 |
| Max. Negotiated Rate |
$745.45 |
| Rate for Payer: Adventist Health Commercial |
$175.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$575.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.95
|
| Rate for Payer: Blue Shield of California Commercial |
$536.72
|
| Rate for Payer: Blue Shield of California EPN |
$354.31
|
| Rate for Payer: Cash Price |
$394.65
|
| Rate for Payer: Cash Price |
$394.65
|
| Rate for Payer: Cigna of CA HMO |
$561.28
|
| Rate for Payer: Cigna of CA PPO |
$648.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$745.45
|
| Rate for Payer: Global Benefits Group Commercial |
$526.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$49.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$584.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$701.60
|
| Rate for Payer: Networks By Design Commercial |
$570.05
|
| Rate for Payer: Prime Health Services Commercial |
$745.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$526.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$526.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC SACRUM AND COCCYX
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
909001343
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$688.50 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$324.00
|
| Rate for Payer: EPIC Health Plan Senior |
$324.00
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$540.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$501.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.40
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: Networks By Design Commercial |
$526.50
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
|
|
HC SACRUM AND COCCYX
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
909001343
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.03 |
| Max. Negotiated Rate |
$688.50 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$531.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.19
|
| Rate for Payer: Blue Shield of California Commercial |
$495.72
|
| Rate for Payer: Blue Shield of California EPN |
$327.24
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cigna of CA HMO |
$518.40
|
| Rate for Payer: Cigna of CA PPO |
$599.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$540.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: Networks By Design Commercial |
$526.50
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$486.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$486.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC SALICYLATES
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910366
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$608.65 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$608.65
|
| Rate for Payer: Blue Shield of California Commercial |
$54.86
|
| Rate for Payer: Blue Shield of California EPN |
$36.24
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Senior |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC SALICYLATES
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910366
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$101.60 |
| Max. Negotiated Rate |
$431.80 |
| Rate for Payer: Adventist Health Commercial |
$101.60
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.20
|
| Rate for Payer: EPIC Health Plan Senior |
$203.20
|
| Rate for Payer: Galaxy Health WC |
$431.80
|
| Rate for Payer: Global Benefits Group Commercial |
$304.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$338.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$314.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.92
|
| Rate for Payer: Multiplan Commercial |
$406.40
|
| Rate for Payer: Networks By Design Commercial |
$330.20
|
| Rate for Payer: Prime Health Services Commercial |
$431.80
|
|
|
HC SALIVARY DUCT DILATOR
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
909081730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$67.15 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.51
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cigna of CA HMO |
$50.56
|
| Rate for Payer: Cigna of CA PPO |
$58.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: EPIC Health Plan Senior |
$31.60
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.30
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.50
|
| Rate for Payer: United Healthcare All Other HMO |
$39.50
|
| Rate for Payer: United Healthcare HMO Rider |
$39.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.15
|
| Rate for Payer: Vantage Medical Group Senior |
$67.15
|
|
|
HC SALIVARY DUCT DILATOR
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
909081730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$67.15 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: EPIC Health Plan Senior |
$31.60
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.96
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
|
|
HC SALIVARY GLAND
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
CPT 70380
|
| Hospital Charge Code |
909001145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.54 |
| Max. Negotiated Rate |
$292.40 |
| Rate for Payer: Adventist Health Commercial |
$68.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$225.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.52
|
| Rate for Payer: Blue Shield of California Commercial |
$210.53
|
| Rate for Payer: Blue Shield of California EPN |
$138.98
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cigna of CA HMO |
$220.16
|
| Rate for Payer: Cigna of CA PPO |
$254.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$292.40
|
| Rate for Payer: Global Benefits Group Commercial |
$206.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$46.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$229.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$275.20
|
| Rate for Payer: Networks By Design Commercial |
$223.60
|
| Rate for Payer: Prime Health Services Commercial |
$292.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$206.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$206.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
