|
HC SODIUM URINE 24 HOURS
|
Facility
IP
|
$106.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
900912221
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
|
|
HC SODIUM URINE RANDOM
|
Facility
IP
|
$106.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
900912220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
|
|
HC SODIUM URINE RANDOM
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
900912220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$43.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.13
|
| Rate for Payer: BCBS Transplant Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.27
|
| Rate for Payer: Blue Shield of California EPN |
$7.29
|
| Rate for Payer: Caremore Medicare Advantage |
$5.06
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.06
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.30
|
| Rate for Payer: IEHP medi-cal |
$8.35
|
| Rate for Payer: IEHP Medicare Advantage |
$5.06
|
| Rate for Payer: Innovage PACE Commercial |
$7.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.78
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Medicare |
$5.36
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: Riverside University Health MISP |
$5.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.10
|
| Rate for Payer: United Healthcare All Other HMO |
$4.10
|
| Rate for Payer: United Healthcare HMO Rider |
$4.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.57
|
| Rate for Payer: Vantage Medical Group Senior |
$5.06
|
|
|
HC SOF 60735 MYCOP IGG 86738
|
Facility
IP
|
$65.04
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900914877
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$58.54 |
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Central Health Plan Commercial |
$52.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.02
|
| Rate for Payer: Galaxy Health WC |
$55.28
|
| Rate for Payer: Global Benefits Group Commercial |
$39.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.01
|
| Rate for Payer: Multiplan Commercial |
$48.78
|
| Rate for Payer: Networks By Design Commercial |
$42.28
|
| Rate for Payer: Prime Health Services Commercial |
$55.28
|
|
|
HC SOF 60735 MYCOP IGG 86738
|
Facility
OP
|
$65.04
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900914877
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$117.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.03
|
| Rate for Payer: BCBS Transplant Transplant |
$39.02
|
| Rate for Payer: Blue Shield of California Commercial |
$40.19
|
| Rate for Payer: Blue Shield of California EPN |
$31.61
|
| Rate for Payer: Caremore Medicare Advantage |
$13.24
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Central Health Plan Commercial |
$52.03
|
| Rate for Payer: Cigna of CA HMO |
$41.63
|
| Rate for Payer: Cigna of CA PPO |
$48.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.24
|
| Rate for Payer: Galaxy Health WC |
$55.28
|
| Rate for Payer: Global Benefits Group Commercial |
$39.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$48.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.71
|
| Rate for Payer: IEHP medi-cal |
$21.85
|
| Rate for Payer: IEHP Medicare Advantage |
$13.24
|
| Rate for Payer: Innovage PACE Commercial |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$48.78
|
| Rate for Payer: Networks By Design Commercial |
$42.28
|
| Rate for Payer: Prime Health Services Commercial |
$55.28
|
| Rate for Payer: Prime Health Services Medicare |
$14.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$39.02
|
| Rate for Payer: Riverside University Health MISP |
$14.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.73
|
| Rate for Payer: United Healthcare All Other HMO |
$10.73
|
| Rate for Payer: United Healthcare HMO Rider |
$10.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC SOF 60735 MYCOP IGM 86738
|
Facility
IP
|
$65.04
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900914878
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$58.54 |
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Central Health Plan Commercial |
$52.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.02
|
| Rate for Payer: Galaxy Health WC |
$55.28
|
| Rate for Payer: Global Benefits Group Commercial |
$39.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.01
|
| Rate for Payer: Multiplan Commercial |
$48.78
|
| Rate for Payer: Networks By Design Commercial |
$42.28
|
| Rate for Payer: Prime Health Services Commercial |
$55.28
|
|
|
HC SOF 60735 MYCOP IGM 86738
|
Facility
OP
|
$65.04
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900914878
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$117.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.03
|
| Rate for Payer: BCBS Transplant Transplant |
$39.02
|
| Rate for Payer: Blue Shield of California Commercial |
$40.19
|
| Rate for Payer: Blue Shield of California EPN |
$31.61
|
| Rate for Payer: Caremore Medicare Advantage |
$13.24
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Central Health Plan Commercial |
$52.03
|
| Rate for Payer: Cigna of CA HMO |
$41.63
|
| Rate for Payer: Cigna of CA PPO |
$48.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.24
|
| Rate for Payer: Galaxy Health WC |
$55.28
|
| Rate for Payer: Global Benefits Group Commercial |
$39.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$48.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.71
|
| Rate for Payer: IEHP medi-cal |
$21.85
|
| Rate for Payer: IEHP Medicare Advantage |
$13.24
|
| Rate for Payer: Innovage PACE Commercial |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$48.78
|
| Rate for Payer: Networks By Design Commercial |
$42.28
|
| Rate for Payer: Prime Health Services Commercial |
$55.28
|
| Rate for Payer: Prime Health Services Medicare |
$14.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$39.02
|
| Rate for Payer: Riverside University Health MISP |
$14.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.73
|
| Rate for Payer: United Healthcare All Other HMO |
$10.73
|
| Rate for Payer: United Healthcare HMO Rider |
$10.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC SOF ADENOVIRUS DNA QUANT PCR
|
Facility
IP
|
$349.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912932
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$69.80 |
| Max. Negotiated Rate |
$314.10 |
| Rate for Payer: Cash Price |
$157.05
|
| Rate for Payer: Central Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.60
|
| Rate for Payer: Galaxy Health WC |
$296.65
|
| Rate for Payer: Global Benefits Group Commercial |
$209.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$314.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.80
|
| Rate for Payer: Multiplan Commercial |
$261.75
|
| Rate for Payer: Networks By Design Commercial |
$226.85
|
| Rate for Payer: Prime Health Services Commercial |
$296.65
|
|
|
HC SOF ADENOVIRUS DNA QUANT PCR
|
Facility
OP
|
$349.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912932
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$314.39 |
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$229.58
|
| Rate for Payer: BCBS Transplant Transplant |
$209.40
|
| Rate for Payer: Blue Shield of California Commercial |
$215.68
|
| Rate for Payer: Blue Shield of California EPN |
$169.61
|
| Rate for Payer: Caremore Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$157.05
|
| Rate for Payer: Cash Price |
$157.05
|
| Rate for Payer: Central Health Plan Commercial |
$279.20
|
| Rate for Payer: Cigna of CA HMO |
$223.36
|
| Rate for Payer: Cigna of CA PPO |
$258.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$42.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$296.65
|
| Rate for Payer: Global Benefits Group Commercial |
$209.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$314.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$261.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: IEHP medi-cal |
$70.69
|
| Rate for Payer: IEHP Medicare Advantage |
$42.84
|
| Rate for Payer: Innovage PACE Commercial |
$64.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$261.75
|
| Rate for Payer: Networks By Design Commercial |
$226.85
|
| Rate for Payer: Prime Health Services Commercial |
$296.65
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$209.40
|
| Rate for Payer: Riverside University Health MISP |
$47.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$209.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$209.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC SOF INFLUENZA TYPE A AB
|
Facility
OP
|
$54.31
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900914694
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$122.59 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$100.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.59
|
| Rate for Payer: BCBS Transplant Transplant |
$32.59
|
| Rate for Payer: Blue Shield of California Commercial |
$33.56
|
| Rate for Payer: Blue Shield of California EPN |
$26.39
|
| Rate for Payer: Caremore Medicare Advantage |
$13.55
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Central Health Plan Commercial |
$43.45
|
| Rate for Payer: Cigna of CA HMO |
$34.76
|
| Rate for Payer: Cigna of CA PPO |
$40.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.29
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.55
|
| Rate for Payer: Galaxy Health WC |
$46.16
|
| Rate for Payer: Global Benefits Group Commercial |
$32.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.88
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$40.73
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.22
|
| Rate for Payer: IEHP medi-cal |
$22.36
|
| Rate for Payer: IEHP Medicare Advantage |
$13.55
|
| Rate for Payer: Innovage PACE Commercial |
$20.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.16
|
| Rate for Payer: Multiplan Commercial |
$40.73
|
| Rate for Payer: Networks By Design Commercial |
$35.30
|
| Rate for Payer: Prime Health Services Commercial |
$46.16
|
| Rate for Payer: Prime Health Services Medicare |
$14.36
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$32.59
|
| Rate for Payer: Riverside University Health MISP |
$14.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.98
|
| Rate for Payer: United Healthcare All Other HMO |
$10.98
|
| Rate for Payer: United Healthcare HMO Rider |
$10.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13.55
|
|
|
HC SOF INFLUENZA TYPE A AB
|
Facility
IP
|
$54.31
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900914694
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$48.88 |
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Central Health Plan Commercial |
$43.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.72
|
| Rate for Payer: Galaxy Health WC |
$46.16
|
| Rate for Payer: Global Benefits Group Commercial |
$32.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.86
|
| Rate for Payer: Multiplan Commercial |
$40.73
|
| Rate for Payer: Networks By Design Commercial |
$35.30
|
| Rate for Payer: Prime Health Services Commercial |
$46.16
|
|
|
HC SOF INFLUENZA TYPE B AB
|
Facility
IP
|
$54.31
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900914695
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$48.88 |
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Central Health Plan Commercial |
$43.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.72
|
| Rate for Payer: Galaxy Health WC |
$46.16
|
| Rate for Payer: Global Benefits Group Commercial |
$32.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.86
|
| Rate for Payer: Multiplan Commercial |
$40.73
|
| Rate for Payer: Networks By Design Commercial |
$35.30
|
| Rate for Payer: Prime Health Services Commercial |
$46.16
|
|
|
HC SOF INFLUENZA TYPE B AB
|
Facility
OP
|
$54.31
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900914695
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$122.59 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$100.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.59
|
| Rate for Payer: BCBS Transplant Transplant |
$32.59
|
| Rate for Payer: Blue Shield of California Commercial |
$33.56
|
| Rate for Payer: Blue Shield of California EPN |
$26.39
|
| Rate for Payer: Caremore Medicare Advantage |
$13.55
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Central Health Plan Commercial |
$43.45
|
| Rate for Payer: Cigna of CA HMO |
$34.76
|
| Rate for Payer: Cigna of CA PPO |
$40.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.29
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.55
|
| Rate for Payer: Galaxy Health WC |
$46.16
|
| Rate for Payer: Global Benefits Group Commercial |
$32.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.88
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$40.73
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.22
|
| Rate for Payer: IEHP medi-cal |
$22.36
|
| Rate for Payer: IEHP Medicare Advantage |
$13.55
|
| Rate for Payer: Innovage PACE Commercial |
$20.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.16
|
| Rate for Payer: Multiplan Commercial |
$40.73
|
| Rate for Payer: Networks By Design Commercial |
$35.30
|
| Rate for Payer: Prime Health Services Commercial |
$46.16
|
| Rate for Payer: Prime Health Services Medicare |
$14.36
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$32.59
|
| Rate for Payer: Riverside University Health MISP |
$14.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.98
|
| Rate for Payer: United Healthcare All Other HMO |
$10.98
|
| Rate for Payer: United Healthcare HMO Rider |
$10.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13.55
|
|
|
HC SOF NOROVIRUS RNA
|
Facility
IP
|
$298.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914720
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$268.20 |
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Central Health Plan Commercial |
$238.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.20
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$268.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.60
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
|
|
HC SOF NOROVIRUS RNA
|
Facility
OP
|
$298.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914720
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$301.33 |
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.33
|
| Rate for Payer: BCBS Transplant Transplant |
$178.80
|
| Rate for Payer: Blue Shield of California Commercial |
$184.16
|
| Rate for Payer: Blue Shield of California EPN |
$144.83
|
| Rate for Payer: Caremore Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Central Health Plan Commercial |
$238.40
|
| Rate for Payer: Cigna of CA HMO |
$190.72
|
| Rate for Payer: Cigna of CA PPO |
$220.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$268.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$223.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: IEHP medi-cal |
$57.90
|
| Rate for Payer: IEHP Medicare Advantage |
$35.09
|
| Rate for Payer: Innovage PACE Commercial |
$52.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$178.80
|
| Rate for Payer: Riverside University Health MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOFT INTERFACE AFO SECTION
|
Facility
IP
|
$324.00
|
|
|
Service Code
|
CPT L2820
|
| Hospital Charge Code |
905352820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$291.60 |
| Rate for Payer: Blue Shield of California EPN |
$173.02
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Central Health Plan Commercial |
$259.20
|
| Rate for Payer: Cigna of CA HMO |
$226.80
|
| Rate for Payer: Cigna of CA PPO |
$226.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$129.60
|
| Rate for Payer: Galaxy Health WC |
$275.40
|
| Rate for Payer: Global Benefits Group Commercial |
$194.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$291.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$243.00
|
| Rate for Payer: Networks By Design Commercial |
$162.00
|
| Rate for Payer: Prime Health Services Commercial |
$275.40
|
|
|
HC SOFT INTERFACE AFO SECTION
|
Facility
OP
|
$324.00
|
|
|
Service Code
|
CPT L2820
|
| Hospital Charge Code |
905352820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$360.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$360.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$275.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$178.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$178.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$156.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.42
|
| Rate for Payer: BCBS Transplant Transplant |
$194.40
|
| Rate for Payer: Blue Shield of California Commercial |
$243.00
|
| Rate for Payer: Blue Shield of California EPN |
$176.26
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Central Health Plan Commercial |
$259.20
|
| Rate for Payer: Cigna of CA HMO |
$226.80
|
| Rate for Payer: Cigna of CA PPO |
$226.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$275.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$129.60
|
| Rate for Payer: Galaxy Health WC |
$275.40
|
| Rate for Payer: Global Benefits Group Commercial |
$194.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$291.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$243.00
|
| Rate for Payer: IEHP medi-cal |
$113.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.84
|
| Rate for Payer: Multiplan Commercial |
$243.00
|
| Rate for Payer: Networks By Design Commercial |
$162.00
|
| Rate for Payer: Prime Health Services Commercial |
$275.40
|
| Rate for Payer: Riverside University Health MISP |
$129.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$194.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$194.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.00
|
| Rate for Payer: United Healthcare All Other HMO |
$162.00
|
| Rate for Payer: United Healthcare HMO Rider |
$162.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$162.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.40
|
| Rate for Payer: Vantage Medical Group Senior |
$275.40
|
|
|
HC SOFT INTERFACE KAFO SECTION
|
Facility
OP
|
$324.00
|
|
|
Service Code
|
CPT L2830
|
| Hospital Charge Code |
905352830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$390.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$390.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$275.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$178.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$178.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$156.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.42
|
| Rate for Payer: BCBS Transplant Transplant |
$194.40
|
| Rate for Payer: Blue Shield of California Commercial |
$243.00
|
| Rate for Payer: Blue Shield of California EPN |
$176.26
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Central Health Plan Commercial |
$259.20
|
| Rate for Payer: Cigna of CA HMO |
$226.80
|
| Rate for Payer: Cigna of CA PPO |
$226.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$275.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$129.60
|
| Rate for Payer: Galaxy Health WC |
$275.40
|
| Rate for Payer: Global Benefits Group Commercial |
$194.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$291.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$243.00
|
| Rate for Payer: IEHP medi-cal |
$113.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.84
|
| Rate for Payer: Multiplan Commercial |
$243.00
|
| Rate for Payer: Networks By Design Commercial |
$162.00
|
| Rate for Payer: Prime Health Services Commercial |
$275.40
|
| Rate for Payer: Riverside University Health MISP |
$129.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$194.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$194.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.00
|
| Rate for Payer: United Healthcare All Other HMO |
$162.00
|
| Rate for Payer: United Healthcare HMO Rider |
$162.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$162.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.40
|
| Rate for Payer: Vantage Medical Group Senior |
$275.40
|
|
|
HC SOFT INTERFACE KAFO SECTION
|
Facility
IP
|
$324.00
|
|
|
Service Code
|
CPT L2830
|
| Hospital Charge Code |
905352830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$291.60 |
| Rate for Payer: Blue Shield of California EPN |
$173.02
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Central Health Plan Commercial |
$259.20
|
| Rate for Payer: Cigna of CA HMO |
$226.80
|
| Rate for Payer: Cigna of CA PPO |
$226.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$129.60
|
| Rate for Payer: Galaxy Health WC |
$275.40
|
| Rate for Payer: Global Benefits Group Commercial |
$194.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$291.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$243.00
|
| Rate for Payer: Networks By Design Commercial |
$162.00
|
| Rate for Payer: Prime Health Services Commercial |
$275.40
|
|
|
HC SOFT PALATE
|
Facility
OP
|
$1,397.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.54 |
| Max. Negotiated Rate |
$1,257.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$253.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$676.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$825.35
|
| Rate for Payer: BCBS Transplant Transplant |
$838.20
|
| Rate for Payer: Blue Shield of California Commercial |
$863.35
|
| Rate for Payer: Blue Shield of California EPN |
$678.94
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$628.65
|
| Rate for Payer: Cash Price |
$628.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,117.60
|
| Rate for Payer: Cigna of CA HMO |
$894.08
|
| Rate for Payer: Cigna of CA PPO |
$1,033.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$1,187.45
|
| Rate for Payer: Global Benefits Group Commercial |
$838.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,257.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,047.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: IEHP medi-cal |
$187.34
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Innovage PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$931.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$1,047.75
|
| Rate for Payer: Networks By Design Commercial |
$908.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,187.45
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$838.20
|
| Rate for Payer: Riverside University Health MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$838.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$838.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC SOFT PALATE
|
Facility
IP
|
$1,397.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$279.40 |
| Max. Negotiated Rate |
$1,257.30 |
| Rate for Payer: Cash Price |
$628.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,117.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$558.80
|
| Rate for Payer: Galaxy Health WC |
$1,187.45
|
| Rate for Payer: Global Benefits Group Commercial |
$838.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,257.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$931.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.40
|
| Rate for Payer: Multiplan Commercial |
$1,047.75
|
| Rate for Payer: Networks By Design Commercial |
$908.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,187.45
|
|
|
HC SOGDX 230 GCH1 81479
|
Facility
IP
|
$925.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914803
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$185.00 |
| Max. Negotiated Rate |
$832.50 |
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Central Health Plan Commercial |
$740.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.00
|
| Rate for Payer: Galaxy Health WC |
$786.25
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$832.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$616.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.00
|
| Rate for Payer: Multiplan Commercial |
$693.75
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
|
|
HC SOGDX 230 GCH1 81479
|
Facility
OP
|
$925.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914803
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$185.00 |
| Max. Negotiated Rate |
$832.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$276.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$786.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$508.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$508.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$447.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$546.49
|
| Rate for Payer: BCBS Transplant Transplant |
$555.00
|
| Rate for Payer: Blue Shield of California Commercial |
$571.65
|
| Rate for Payer: Blue Shield of California EPN |
$449.55
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Central Health Plan Commercial |
$740.00
|
| Rate for Payer: Cigna of CA HMO |
$592.00
|
| Rate for Payer: Cigna of CA PPO |
$684.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$786.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.00
|
| Rate for Payer: Galaxy Health WC |
$786.25
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$832.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$693.75
|
| Rate for Payer: IEHP medi-cal |
$323.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$616.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.00
|
| Rate for Payer: Multiplan Commercial |
$693.75
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$555.00
|
| Rate for Payer: Riverside University Health MISP |
$370.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$555.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$555.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$462.50
|
| Rate for Payer: United Healthcare All Other HMO |
$462.50
|
| Rate for Payer: United Healthcare HMO Rider |
$462.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$462.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$786.25
|
| Rate for Payer: Vantage Medical Group Senior |
$786.25
|
|
|
HC SOGDX 317 SIX1 81479
|
Facility
IP
|
$675.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914808
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Central Health Plan Commercial |
$540.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.00
|
| Rate for Payer: Galaxy Health WC |
$573.75
|
| Rate for Payer: Global Benefits Group Commercial |
$405.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$607.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$450.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Multiplan Commercial |
$506.25
|
| Rate for Payer: Networks By Design Commercial |
$438.75
|
| Rate for Payer: Prime Health Services Commercial |
$573.75
|
|
|
HC SOGDX 317 SIX1 81479
|
Facility
OP
|
$675.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914808
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$276.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$573.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$371.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$371.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$326.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$398.79
|
| Rate for Payer: BCBS Transplant Transplant |
$405.00
|
| Rate for Payer: Blue Shield of California Commercial |
$417.15
|
| Rate for Payer: Blue Shield of California EPN |
$328.05
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Central Health Plan Commercial |
$540.00
|
| Rate for Payer: Cigna of CA HMO |
$432.00
|
| Rate for Payer: Cigna of CA PPO |
$499.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$573.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$270.00
|
| Rate for Payer: Galaxy Health WC |
$573.75
|
| Rate for Payer: Global Benefits Group Commercial |
$405.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$607.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$506.25
|
| Rate for Payer: IEHP medi-cal |
$236.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$450.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Multiplan Commercial |
$506.25
|
| Rate for Payer: Networks By Design Commercial |
$438.75
|
| Rate for Payer: Prime Health Services Commercial |
$573.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$405.00
|
| Rate for Payer: Riverside University Health MISP |
$270.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$405.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$405.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$337.50
|
| Rate for Payer: United Healthcare All Other HMO |
$337.50
|
| Rate for Payer: United Healthcare HMO Rider |
$337.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$573.75
|
| Rate for Payer: Vantage Medical Group Senior |
$573.75
|
|
