|
HC SYMES ANKLE W/O (SACH) FOOT
|
Facility
|
IP
|
$4,030.00
|
|
|
Service Code
|
CPT L5703
|
| Hospital Charge Code |
915355703
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$806.00 |
| Max. Negotiated Rate |
$3,627.00 |
| Rate for Payer: Adventist Health Commercial |
$806.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,115.19
|
| Rate for Payer: Blue Shield of California EPN |
$2,031.12
|
| Rate for Payer: Cash Price |
$2,216.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Cigna of CA HMO |
$2,821.00
|
| Rate for Payer: Cigna of CA PPO |
$2,821.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,612.00
|
| Rate for Payer: Galaxy Health WC |
$3,425.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,418.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,627.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,688.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,535.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,494.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$806.00
|
| Rate for Payer: Multiplan Commercial |
$3,022.50
|
| Rate for Payer: Networks By Design Commercial |
$2,619.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,425.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,512.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1,472.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1,440.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,319.83
|
|
|
HC SYMES MET FRM MOLD LEATH SOCKT
|
Facility
|
OP
|
$9,960.00
|
|
|
Service Code
|
CPT L5060
|
| Hospital Charge Code |
905355060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,780.91 |
| Max. Negotiated Rate |
$8,964.00 |
| Rate for Payer: Adventist Health Commercial |
$4,083.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,466.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,478.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,470.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,849.51
|
| Rate for Payer: Blue Shield of California Commercial |
$7,699.08
|
| Rate for Payer: Blue Shield of California EPN |
$5,019.84
|
| Rate for Payer: Cash Price |
$5,478.00
|
| Rate for Payer: Cash Price |
$5,478.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,968.00
|
| Rate for Payer: Cigna of CA HMO |
$6,972.00
|
| Rate for Payer: Cigna of CA PPO |
$6,972.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,466.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,466.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,466.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,984.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,984.00
|
| Rate for Payer: Galaxy Health WC |
$8,466.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,976.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,964.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,780.91
|
| Rate for Payer: InnovAge PACE Commercial |
$4,980.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,643.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,071.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,165.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,083.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,972.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,972.00
|
| Rate for Payer: Multiplan Commercial |
$7,470.00
|
| Rate for Payer: Networks By Design Commercial |
$4,980.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,466.00
|
| Rate for Payer: Riverside University Health System MISP |
$3,984.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,976.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,976.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,737.99
|
| Rate for Payer: United Healthcare All Other HMO |
$3,638.39
|
| Rate for Payer: United Healthcare HMO Rider |
$3,559.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,261.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,466.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,466.00
|
| Rate for Payer: Vantage Medical Group Senior |
$8,466.00
|
|
|
HC SYMES MET FRM MOLD LEATH SOCKT
|
Facility
|
IP
|
$9,960.00
|
|
|
Service Code
|
CPT L5060
|
| Hospital Charge Code |
915355060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,992.00 |
| Max. Negotiated Rate |
$8,964.00 |
| Rate for Payer: Adventist Health Commercial |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,699.08
|
| Rate for Payer: Blue Shield of California EPN |
$5,019.84
|
| Rate for Payer: Cash Price |
$5,478.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,968.00
|
| Rate for Payer: Cigna of CA HMO |
$6,972.00
|
| Rate for Payer: Cigna of CA PPO |
$6,972.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,984.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,984.00
|
| Rate for Payer: Galaxy Health WC |
$8,466.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,976.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,964.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,643.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,794.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,165.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,992.00
|
| Rate for Payer: Multiplan Commercial |
$7,470.00
|
| Rate for Payer: Networks By Design Commercial |
$6,474.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,466.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,737.99
|
| Rate for Payer: United Healthcare All Other HMO |
$3,638.39
|
| Rate for Payer: United Healthcare HMO Rider |
$3,559.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,261.90
|
|
|
HC SYMES MET FRM MOLD LEATH SOCKT
|
Facility
|
OP
|
$9,960.00
|
|
|
Service Code
|
CPT L5060
|
| Hospital Charge Code |
915355060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,780.91 |
| Max. Negotiated Rate |
$8,964.00 |
| Rate for Payer: Adventist Health Commercial |
$4,083.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,466.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,478.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,470.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,849.51
|
| Rate for Payer: Blue Shield of California Commercial |
$7,699.08
|
| Rate for Payer: Blue Shield of California EPN |
$5,019.84
|
| Rate for Payer: Cash Price |
$5,478.00
|
| Rate for Payer: Cash Price |
$5,478.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,968.00
|
| Rate for Payer: Cigna of CA HMO |
$6,972.00
|
| Rate for Payer: Cigna of CA PPO |
$6,972.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,466.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,466.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,466.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,984.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,984.00
|
| Rate for Payer: Galaxy Health WC |
$8,466.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,976.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,964.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,780.91
|
| Rate for Payer: InnovAge PACE Commercial |
$4,980.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,643.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,071.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,165.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,083.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,972.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,972.00
|
| Rate for Payer: Multiplan Commercial |
$7,470.00
|
| Rate for Payer: Networks By Design Commercial |
$4,980.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,466.00
|
| Rate for Payer: Riverside University Health System MISP |
$3,984.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,976.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,976.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,737.99
|
| Rate for Payer: United Healthcare All Other HMO |
$3,638.39
|
| Rate for Payer: United Healthcare HMO Rider |
$3,559.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,261.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,466.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,466.00
|
| Rate for Payer: Vantage Medical Group Senior |
$8,466.00
|
|
|
HC SYMES MET FRM MOLD LEATH SOCKT
|
Facility
|
IP
|
$9,960.00
|
|
|
Service Code
|
CPT L5060
|
| Hospital Charge Code |
905355060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,992.00 |
| Max. Negotiated Rate |
$8,964.00 |
| Rate for Payer: Adventist Health Commercial |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,699.08
|
| Rate for Payer: Blue Shield of California EPN |
$5,019.84
|
| Rate for Payer: Cash Price |
$5,478.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,968.00
|
| Rate for Payer: Cigna of CA HMO |
$6,972.00
|
| Rate for Payer: Cigna of CA PPO |
$6,972.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,984.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,984.00
|
| Rate for Payer: Galaxy Health WC |
$8,466.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,976.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,964.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,643.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,794.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,165.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,992.00
|
| Rate for Payer: Multiplan Commercial |
$7,470.00
|
| Rate for Payer: Networks By Design Commercial |
$6,474.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,466.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,737.99
|
| Rate for Payer: United Healthcare All Other HMO |
$3,638.39
|
| Rate for Payer: United Healthcare HMO Rider |
$3,559.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,261.90
|
|
|
HC SYMES MOLDED SOCKET SACH FOOT
|
Facility
|
OP
|
$6,319.00
|
|
|
Service Code
|
CPT L5050
|
| Hospital Charge Code |
905355050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,643.98 |
| Max. Negotiated Rate |
$5,687.10 |
| Rate for Payer: Adventist Health Commercial |
$2,590.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,371.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,475.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,739.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,711.15
|
| Rate for Payer: Blue Shield of California Commercial |
$4,884.59
|
| Rate for Payer: Blue Shield of California EPN |
$3,184.78
|
| Rate for Payer: Cash Price |
$3,475.45
|
| Rate for Payer: Cash Price |
$3,475.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,055.20
|
| Rate for Payer: Cigna of CA HMO |
$4,423.30
|
| Rate for Payer: Cigna of CA PPO |
$4,423.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,371.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,371.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,371.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,527.60
|
| Rate for Payer: Galaxy Health WC |
$5,371.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,791.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,687.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,643.98
|
| Rate for Payer: InnovAge PACE Commercial |
$3,159.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,214.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,816.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,911.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,590.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,423.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,423.30
|
| Rate for Payer: Multiplan Commercial |
$4,739.25
|
| Rate for Payer: Networks By Design Commercial |
$3,159.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,371.15
|
| Rate for Payer: Riverside University Health System MISP |
$2,527.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,791.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,791.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,371.52
|
| Rate for Payer: United Healthcare All Other HMO |
$2,308.33
|
| Rate for Payer: United Healthcare HMO Rider |
$2,258.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,069.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,371.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,371.15
|
| Rate for Payer: Vantage Medical Group Senior |
$5,371.15
|
|
|
HC SYMES MOLDED SOCKET SACH FOOT
|
Facility
|
OP
|
$6,319.00
|
|
|
Service Code
|
CPT L5050
|
| Hospital Charge Code |
915355050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,643.98 |
| Max. Negotiated Rate |
$5,687.10 |
| Rate for Payer: Adventist Health Commercial |
$2,590.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,371.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,475.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,739.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,711.15
|
| Rate for Payer: Blue Shield of California Commercial |
$4,884.59
|
| Rate for Payer: Blue Shield of California EPN |
$3,184.78
|
| Rate for Payer: Cash Price |
$3,475.45
|
| Rate for Payer: Cash Price |
$3,475.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,055.20
|
| Rate for Payer: Cigna of CA HMO |
$4,423.30
|
| Rate for Payer: Cigna of CA PPO |
$4,423.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,371.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,371.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,371.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,527.60
|
| Rate for Payer: Galaxy Health WC |
$5,371.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,791.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,687.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,643.98
|
| Rate for Payer: InnovAge PACE Commercial |
$3,159.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,214.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,816.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,911.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,590.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,423.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,423.30
|
| Rate for Payer: Multiplan Commercial |
$4,739.25
|
| Rate for Payer: Networks By Design Commercial |
$3,159.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,371.15
|
| Rate for Payer: Riverside University Health System MISP |
$2,527.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,791.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,791.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,371.52
|
| Rate for Payer: United Healthcare All Other HMO |
$2,308.33
|
| Rate for Payer: United Healthcare HMO Rider |
$2,258.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,069.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,371.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,371.15
|
| Rate for Payer: Vantage Medical Group Senior |
$5,371.15
|
|
|
HC SYMES MOLDED SOCKET SACH FOOT
|
Facility
|
IP
|
$6,319.00
|
|
|
Service Code
|
CPT L5050
|
| Hospital Charge Code |
905355050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,263.80 |
| Max. Negotiated Rate |
$5,687.10 |
| Rate for Payer: Adventist Health Commercial |
$1,263.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,884.59
|
| Rate for Payer: Blue Shield of California EPN |
$3,184.78
|
| Rate for Payer: Cash Price |
$3,475.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,055.20
|
| Rate for Payer: Cigna of CA HMO |
$4,423.30
|
| Rate for Payer: Cigna of CA PPO |
$4,423.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,527.60
|
| Rate for Payer: Galaxy Health WC |
$5,371.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,791.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,687.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,214.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,407.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,911.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,263.80
|
| Rate for Payer: Multiplan Commercial |
$4,739.25
|
| Rate for Payer: Networks By Design Commercial |
$4,107.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,371.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,371.52
|
| Rate for Payer: United Healthcare All Other HMO |
$2,308.33
|
| Rate for Payer: United Healthcare HMO Rider |
$2,258.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,069.47
|
|
|
HC SYMES MOLDED SOCKET SACH FOOT
|
Facility
|
IP
|
$6,319.00
|
|
|
Service Code
|
CPT L5050
|
| Hospital Charge Code |
915355050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,263.80 |
| Max. Negotiated Rate |
$5,687.10 |
| Rate for Payer: Adventist Health Commercial |
$1,263.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,884.59
|
| Rate for Payer: Blue Shield of California EPN |
$3,184.78
|
| Rate for Payer: Cash Price |
$3,475.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,055.20
|
| Rate for Payer: Cigna of CA HMO |
$4,423.30
|
| Rate for Payer: Cigna of CA PPO |
$4,423.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,527.60
|
| Rate for Payer: Galaxy Health WC |
$5,371.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,791.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,687.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,214.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,407.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,911.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,263.80
|
| Rate for Payer: Multiplan Commercial |
$4,739.25
|
| Rate for Payer: Networks By Design Commercial |
$4,107.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,371.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,371.52
|
| Rate for Payer: United Healthcare All Other HMO |
$2,308.33
|
| Rate for Payer: United Healthcare HMO Rider |
$2,258.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,069.47
|
|
|
HC SYNERCID E TEST
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912447
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$16.41 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.33
|
| Rate for Payer: Blue Shield of California Commercial |
$10.32
|
| Rate for Payer: Blue Shield of California EPN |
$6.75
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Central Health Plan Commercial |
$13.60
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.41
|
| Rate for Payer: EPIC Health Plan Senior |
$4.75
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: InnovAge PACE Commercial |
$7.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.75
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Prime Health Services Medicare |
$5.04
|
| Rate for Payer: Riverside University Health System MISP |
$5.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC SYNERCID E TEST
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912447
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Central Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6.80
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
|
|
HC SYPHILIS NON TREP QUAL RPR
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
900913673
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Central Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Senior |
$20.80
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.40
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
|
|
HC SYPHILIS NON TREP QUAL RPR
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
900913673
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.30
|
| Rate for Payer: Blue Shield of California Commercial |
$31.56
|
| Rate for Payer: Blue Shield of California EPN |
$20.64
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Central Health Plan Commercial |
$41.60
|
| Rate for Payer: Cigna of CA HMO |
$33.28
|
| Rate for Payer: Cigna of CA PPO |
$38.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: InnovAge PACE Commercial |
$6.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.27
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
| Rate for Payer: Prime Health Services Medicare |
$4.53
|
| Rate for Payer: Riverside University Health System MISP |
$4.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC SYPHILIS NON TREP QUANT
|
Facility
|
OP
|
$42.06
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
900913672
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$37.85 |
| Rate for Payer: Adventist Health Commercial |
$8.41
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.50
|
| Rate for Payer: Blue Shield of California Commercial |
$25.53
|
| Rate for Payer: Blue Shield of California EPN |
$16.70
|
| Rate for Payer: Cash Price |
$23.13
|
| Rate for Payer: Cash Price |
$23.13
|
| Rate for Payer: Central Health Plan Commercial |
$33.65
|
| Rate for Payer: Cigna of CA HMO |
$26.92
|
| Rate for Payer: Cigna of CA PPO |
$31.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.94
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$35.75
|
| Rate for Payer: Global Benefits Group Commercial |
$25.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.85
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.40
|
| Rate for Payer: InnovAge PACE Commercial |
$6.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.90
|
| Rate for Payer: Multiplan Commercial |
$31.55
|
| Rate for Payer: Networks By Design Commercial |
$27.34
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.40
|
| Rate for Payer: Prime Health Services Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Medicare |
$4.66
|
| Rate for Payer: Riverside University Health System MISP |
$4.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.56
|
| Rate for Payer: United Healthcare All Other HMO |
$3.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Vantage Medical Group Senior |
$4.40
|
|
|
HC SYPHILIS NON TREP QUANT
|
Facility
|
IP
|
$42.06
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
900913672
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$37.85 |
| Rate for Payer: Adventist Health Commercial |
$8.41
|
| Rate for Payer: Cash Price |
$23.13
|
| Rate for Payer: Central Health Plan Commercial |
$33.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.82
|
| Rate for Payer: EPIC Health Plan Senior |
$16.82
|
| Rate for Payer: Galaxy Health WC |
$35.75
|
| Rate for Payer: Global Benefits Group Commercial |
$25.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.41
|
| Rate for Payer: Multiplan Commercial |
$31.55
|
| Rate for Payer: Networks By Design Commercial |
$27.34
|
| Rate for Payer: Prime Health Services Commercial |
$35.75
|
|
|
HC SYPHILIS TOTAL
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913674
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$170.20 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$170.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.54
|
| Rate for Payer: Blue Shield of California Commercial |
$29.74
|
| Rate for Payer: Blue Shield of California EPN |
$19.45
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: InnovAge PACE Commercial |
$17.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Prime Health Services Medicare |
$12.22
|
| Rate for Payer: Riverside University Health System MISP |
$12.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SYPHILIS TOTAL
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913674
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
|
|
HC SYPHILLIS IGG
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
900913561
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$126.21 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$126.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.62
|
| Rate for Payer: Blue Shield of California Commercial |
$43.70
|
| Rate for Payer: Blue Shield of California EPN |
$28.58
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.87
|
| Rate for Payer: EPIC Health Plan Senior |
$13.24
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: InnovAge PACE Commercial |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| 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 |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.24
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Prime Health Services Medicare |
$14.03
|
| Rate for Payer: Riverside University Health System MISP |
$14.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| 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: Upland Medical Group Pediatric |
$13.24
|
| 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 SYPHILLIS IGG
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
900913561
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
|
|
HC SYPHILLIS IGG INDIVIDUAL
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
900913563
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$167.40 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$126.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.62
|
| Rate for Payer: Blue Shield of California Commercial |
$112.90
|
| Rate for Payer: Blue Shield of California EPN |
$73.84
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Central Health Plan Commercial |
$148.80
|
| Rate for Payer: Cigna of CA HMO |
$119.04
|
| Rate for Payer: Cigna of CA PPO |
$137.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.87
|
| Rate for Payer: EPIC Health Plan Senior |
$13.24
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$167.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: InnovAge PACE Commercial |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.20
|
| 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 |
$139.50
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.24
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
| Rate for Payer: Prime Health Services Medicare |
$14.03
|
| Rate for Payer: Riverside University Health System MISP |
$14.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.60
|
| 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: Upland Medical Group Pediatric |
$13.24
|
| 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 SYPHILLIS IGG INDIVIDUAL
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
900913563
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$167.40 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Central Health Plan Commercial |
$148.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.40
|
| Rate for Payer: EPIC Health Plan Senior |
$74.40
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$167.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.20
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
|
|
HC SYPHILLIS TEST RPR
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
900910892
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.30
|
| Rate for Payer: Blue Shield of California Commercial |
$15.18
|
| Rate for Payer: Blue Shield of California EPN |
$9.93
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: InnovAge PACE Commercial |
$6.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.27
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$4.53
|
| Rate for Payer: Riverside University Health System MISP |
$4.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC SYPHILLIS TEST RPR
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
900910892
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SYPHILLIS TEST RPR INDIVIDUAL
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
900912331
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SYPHILLIS TEST RPR INDIVIDUAL
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
900912331
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.30
|
| Rate for Payer: Blue Shield of California Commercial |
$15.18
|
| Rate for Payer: Blue Shield of California EPN |
$9.93
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: InnovAge PACE Commercial |
$6.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.27
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$4.53
|
| Rate for Payer: Riverside University Health System MISP |
$4.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
