|
HC BATT CHRG 12 VOLT UTAH OR EQUL
|
Facility
|
IP
|
$1,961.00
|
|
|
Service Code
|
CPT L7366
|
| Hospital Charge Code |
905357366
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$392.20 |
| Max. Negotiated Rate |
$1,764.90 |
| Rate for Payer: Adventist Health Commercial |
$392.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,515.85
|
| Rate for Payer: Blue Shield of California EPN |
$988.34
|
| Rate for Payer: Cash Price |
$1,078.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,568.80
|
| Rate for Payer: Cigna of CA HMO |
$1,372.70
|
| Rate for Payer: Cigna of CA PPO |
$1,372.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$784.40
|
| Rate for Payer: EPIC Health Plan Senior |
$784.40
|
| Rate for Payer: Galaxy Health WC |
$1,666.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,176.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,764.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,307.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$747.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,213.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.20
|
| Rate for Payer: Multiplan Commercial |
$1,470.75
|
| Rate for Payer: Networks By Design Commercial |
$1,274.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,666.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$735.96
|
| Rate for Payer: United Healthcare All Other HMO |
$716.35
|
| Rate for Payer: United Healthcare HMO Rider |
$700.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$642.23
|
|
|
HC BATT CHRG 12 VOLT UTAH OR EQUL
|
Facility
|
OP
|
$1,961.00
|
|
|
Service Code
|
CPT L7366
|
| Hospital Charge Code |
915357366
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$1,764.90 |
| Rate for Payer: Adventist Health Commercial |
$804.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,666.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,078.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,470.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,151.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1,515.85
|
| Rate for Payer: Blue Shield of California EPN |
$988.34
|
| Rate for Payer: Cash Price |
$1,078.55
|
| Rate for Payer: Cash Price |
$1,078.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,568.80
|
| Rate for Payer: Cigna of CA HMO |
$1,372.70
|
| Rate for Payer: Cigna of CA PPO |
$1,372.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,666.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,666.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,666.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$784.40
|
| Rate for Payer: EPIC Health Plan Senior |
$784.40
|
| Rate for Payer: Galaxy Health WC |
$1,666.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,176.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,764.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$481.60
|
| Rate for Payer: InnovAge PACE Commercial |
$980.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,307.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$532.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,213.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$804.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,372.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,372.70
|
| Rate for Payer: Multiplan Commercial |
$1,470.75
|
| Rate for Payer: Networks By Design Commercial |
$980.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,666.85
|
| Rate for Payer: Riverside University Health System MISP |
$784.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,176.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,176.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$735.96
|
| Rate for Payer: United Healthcare All Other HMO |
$716.35
|
| Rate for Payer: United Healthcare HMO Rider |
$700.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$642.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,666.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,666.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,666.85
|
|
|
HC BATT CHRG 6 VOLT OTTO BOCK OR
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT L7362
|
| Hospital Charge Code |
915357362
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.99
|
| Rate for Payer: Blue Shield of California EPN |
$224.28
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: Cigna of CA HMO |
$311.50
|
| Rate for Payer: Cigna of CA PPO |
$311.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$275.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.00
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.01
|
| Rate for Payer: United Healthcare All Other HMO |
$162.56
|
| Rate for Payer: United Healthcare HMO Rider |
$159.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.74
|
|
|
HC BATT CHRG 6 VOLT OTTO BOCK OR
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT L7362
|
| Hospital Charge Code |
905357362
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.99
|
| Rate for Payer: Blue Shield of California EPN |
$224.28
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: Cigna of CA HMO |
$311.50
|
| Rate for Payer: Cigna of CA PPO |
$311.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$275.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.00
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.01
|
| Rate for Payer: United Healthcare All Other HMO |
$162.56
|
| Rate for Payer: United Healthcare HMO Rider |
$159.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.74
|
|
|
HC BATT CHRG 6 VOLT OTTO BOCK OR
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT L7362
|
| Hospital Charge Code |
905357362
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$145.74 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Adventist Health Commercial |
$182.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$244.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$333.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.35
|
| Rate for Payer: Blue Shield of California Commercial |
$343.99
|
| Rate for Payer: Blue Shield of California EPN |
$224.28
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: Cigna of CA HMO |
$311.50
|
| Rate for Payer: Cigna of CA PPO |
$311.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$378.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$378.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$200.91
|
| Rate for Payer: InnovAge PACE Commercial |
$222.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$275.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$311.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$311.50
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$222.50
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: Riverside University Health System MISP |
$178.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$267.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$267.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.01
|
| Rate for Payer: United Healthcare All Other HMO |
$162.56
|
| Rate for Payer: United Healthcare HMO Rider |
$159.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$378.25
|
| Rate for Payer: Vantage Medical Group Senior |
$378.25
|
|
|
HC BATT CHRG 6 VOLT OTTO BOCK OR
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT L7362
|
| Hospital Charge Code |
915357362
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$145.74 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Adventist Health Commercial |
$182.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$244.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$333.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.35
|
| Rate for Payer: Blue Shield of California Commercial |
$343.99
|
| Rate for Payer: Blue Shield of California EPN |
$224.28
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: Cigna of CA HMO |
$311.50
|
| Rate for Payer: Cigna of CA PPO |
$311.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$378.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$378.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$200.91
|
| Rate for Payer: InnovAge PACE Commercial |
$222.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$275.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$311.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$311.50
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$222.50
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: Riverside University Health System MISP |
$178.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$267.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$267.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.01
|
| Rate for Payer: United Healthcare All Other HMO |
$162.56
|
| Rate for Payer: United Healthcare HMO Rider |
$159.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$378.25
|
| Rate for Payer: Vantage Medical Group Senior |
$378.25
|
|
|
HC BATTERY 12 VOLT UTAH OR EQUAL
|
Facility
|
IP
|
$1,517.00
|
|
|
Service Code
|
CPT L7364
|
| Hospital Charge Code |
915357364
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$303.40 |
| Max. Negotiated Rate |
$1,365.30 |
| Rate for Payer: Adventist Health Commercial |
$303.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,172.64
|
| Rate for Payer: Blue Shield of California EPN |
$764.57
|
| Rate for Payer: Cash Price |
$834.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,213.60
|
| Rate for Payer: Cigna of CA HMO |
$1,061.90
|
| Rate for Payer: Cigna of CA PPO |
$1,061.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.80
|
| Rate for Payer: EPIC Health Plan Senior |
$606.80
|
| Rate for Payer: Galaxy Health WC |
$1,289.45
|
| Rate for Payer: Global Benefits Group Commercial |
$910.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,365.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,011.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$939.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.40
|
| Rate for Payer: Multiplan Commercial |
$1,137.75
|
| Rate for Payer: Networks By Design Commercial |
$986.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,289.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$569.33
|
| Rate for Payer: United Healthcare All Other HMO |
$554.16
|
| Rate for Payer: United Healthcare HMO Rider |
$542.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$496.82
|
|
|
HC BATTERY 12 VOLT UTAH OR EQUAL
|
Facility
|
IP
|
$1,517.00
|
|
|
Service Code
|
CPT L7364
|
| Hospital Charge Code |
905357364
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$303.40 |
| Max. Negotiated Rate |
$1,365.30 |
| Rate for Payer: Adventist Health Commercial |
$303.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,172.64
|
| Rate for Payer: Blue Shield of California EPN |
$764.57
|
| Rate for Payer: Cash Price |
$834.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,213.60
|
| Rate for Payer: Cigna of CA HMO |
$1,061.90
|
| Rate for Payer: Cigna of CA PPO |
$1,061.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.80
|
| Rate for Payer: EPIC Health Plan Senior |
$606.80
|
| Rate for Payer: Galaxy Health WC |
$1,289.45
|
| Rate for Payer: Global Benefits Group Commercial |
$910.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,365.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,011.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$939.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.40
|
| Rate for Payer: Multiplan Commercial |
$1,137.75
|
| Rate for Payer: Networks By Design Commercial |
$986.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,289.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$569.33
|
| Rate for Payer: United Healthcare All Other HMO |
$554.16
|
| Rate for Payer: United Healthcare HMO Rider |
$542.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$496.82
|
|
|
HC BATTERY 12 VOLT UTAH OR EQUAL
|
Facility
|
OP
|
$1,517.00
|
|
|
Service Code
|
CPT L7364
|
| Hospital Charge Code |
905357364
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$368.13 |
| Max. Negotiated Rate |
$1,365.30 |
| Rate for Payer: Adventist Health Commercial |
$621.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,289.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$834.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$890.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,172.64
|
| Rate for Payer: Blue Shield of California EPN |
$764.57
|
| Rate for Payer: Cash Price |
$834.35
|
| Rate for Payer: Cash Price |
$834.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,213.60
|
| Rate for Payer: Cigna of CA HMO |
$1,061.90
|
| Rate for Payer: Cigna of CA PPO |
$1,061.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,289.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,289.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,289.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.80
|
| Rate for Payer: EPIC Health Plan Senior |
$606.80
|
| Rate for Payer: Galaxy Health WC |
$1,289.45
|
| Rate for Payer: Global Benefits Group Commercial |
$910.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,365.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$368.13
|
| Rate for Payer: InnovAge PACE Commercial |
$758.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,011.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$939.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$621.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,061.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,061.90
|
| Rate for Payer: Multiplan Commercial |
$1,137.75
|
| Rate for Payer: Networks By Design Commercial |
$758.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,289.45
|
| Rate for Payer: Riverside University Health System MISP |
$606.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$910.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$910.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$569.33
|
| Rate for Payer: United Healthcare All Other HMO |
$554.16
|
| Rate for Payer: United Healthcare HMO Rider |
$542.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$496.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,289.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,289.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,289.45
|
|
|
HC BATTERY 12 VOLT UTAH OR EQUAL
|
Facility
|
OP
|
$1,517.00
|
|
|
Service Code
|
CPT L7364
|
| Hospital Charge Code |
915357364
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$368.13 |
| Max. Negotiated Rate |
$1,365.30 |
| Rate for Payer: Adventist Health Commercial |
$621.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,289.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$834.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$890.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,172.64
|
| Rate for Payer: Blue Shield of California EPN |
$764.57
|
| Rate for Payer: Cash Price |
$834.35
|
| Rate for Payer: Cash Price |
$834.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,213.60
|
| Rate for Payer: Cigna of CA HMO |
$1,061.90
|
| Rate for Payer: Cigna of CA PPO |
$1,061.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,289.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,289.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,289.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.80
|
| Rate for Payer: EPIC Health Plan Senior |
$606.80
|
| Rate for Payer: Galaxy Health WC |
$1,289.45
|
| Rate for Payer: Global Benefits Group Commercial |
$910.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,365.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$368.13
|
| Rate for Payer: InnovAge PACE Commercial |
$758.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,011.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$939.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$621.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,061.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,061.90
|
| Rate for Payer: Multiplan Commercial |
$1,137.75
|
| Rate for Payer: Networks By Design Commercial |
$758.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,289.45
|
| Rate for Payer: Riverside University Health System MISP |
$606.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$910.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$910.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$569.33
|
| Rate for Payer: United Healthcare All Other HMO |
$554.16
|
| Rate for Payer: United Healthcare HMO Rider |
$542.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$496.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,289.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,289.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,289.45
|
|
|
HC BCEDP CASE MANAGEMENT FEE
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
909099998
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Cash Price |
$20.90
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
|
|
HC BCEDP CASE MANAGEMENT FEE
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
909099998
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.32
|
| Rate for Payer: Blue Shield of California Commercial |
$23.07
|
| Rate for Payer: Blue Shield of California EPN |
$15.09
|
| Rate for Payer: Cash Price |
$20.90
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: InnovAge PACE Commercial |
$19.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.60
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Riverside University Health System MISP |
$15.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19.00
|
| Rate for Payer: United Healthcare HMO Rider |
$19.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.30
|
| Rate for Payer: Vantage Medical Group Senior |
$32.30
|
|
|
HC B-CELL LYMPH FISH DNA PROBE SO
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914114
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$1,234.22 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$21.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,234.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.49
|
| Rate for Payer: Blue Shield of California Commercial |
$52.20
|
| Rate for Payer: Blue Shield of California EPN |
$34.14
|
| Rate for Payer: Cash Price |
$47.30
|
| Rate for Payer: Cash Price |
$47.30
|
| Rate for Payer: Central Health Plan Commercial |
$68.80
|
| Rate for Payer: Cigna of CA HMO |
$55.04
|
| Rate for Payer: Cigna of CA PPO |
$63.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.92
|
| Rate for Payer: EPIC Health Plan Senior |
$21.42
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: InnovAge PACE Commercial |
$32.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21.42
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
| Rate for Payer: Prime Health Services Medicare |
$22.71
|
| Rate for Payer: Riverside University Health System MISP |
$23.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.35
|
| Rate for Payer: United Healthcare All Other HMO |
$17.35
|
| Rate for Payer: United Healthcare HMO Rider |
$17.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC B-CELL LYMPH FISH DNA PROBE SO
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914114
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Cash Price |
$47.30
|
| Rate for Payer: Central Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.40
|
| Rate for Payer: EPIC Health Plan Senior |
$34.40
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.20
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
|
|
HC B-CELL LYMPH FISH INTRPHAS IN
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914115
|
|
Hospital Revenue Code
|
309
|
| 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 B-CELL LYMPH FISH INTRPHAS IN
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914115
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$1,904.23 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$51.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,904.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$386.47
|
| 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 |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.11
|
| Rate for Payer: EPIC Health Plan Senior |
$51.19
|
| 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 |
$83.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$54.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: InnovAge PACE Commercial |
$76.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.59
|
| 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 |
$51.19
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
| Rate for Payer: Prime Health Services Medicare |
$54.26
|
| Rate for Payer: Riverside University Health System MISP |
$56.31
|
| 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 |
$41.46
|
| Rate for Payer: United Healthcare All Other HMO |
$41.46
|
| Rate for Payer: United Healthcare HMO Rider |
$41.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC BC-GN NUCLEIC ACID ID CULTURE
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912467
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$145.76 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$145.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.58
|
| Rate for Payer: Blue Shield of California Commercial |
$25.49
|
| Rate for Payer: Blue Shield of California EPN |
$16.67
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.07
|
| Rate for Payer: EPIC Health Plan Senior |
$20.05
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: InnovAge PACE Commercial |
$30.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.87
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20.05
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Medicare |
$21.25
|
| Rate for Payer: Riverside University Health System MISP |
$22.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.25
|
| Rate for Payer: United Healthcare All Other HMO |
$16.25
|
| Rate for Payer: United Healthcare HMO Rider |
$16.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
HC BC-GN NUCLEIC ACID ID CULTURE
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912467
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
|
|
HC BC-GP NUCLEIC ACID ID CULTURE
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$145.76 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$145.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.58
|
| Rate for Payer: Blue Shield of California Commercial |
$25.49
|
| Rate for Payer: Blue Shield of California EPN |
$16.67
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.07
|
| Rate for Payer: EPIC Health Plan Senior |
$20.05
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: InnovAge PACE Commercial |
$30.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.87
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20.05
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Medicare |
$21.25
|
| Rate for Payer: Riverside University Health System MISP |
$22.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.25
|
| Rate for Payer: United Healthcare All Other HMO |
$16.25
|
| Rate for Payer: United Healthcare HMO Rider |
$16.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
HC BC-GP NUCLEIC ACID ID CULTURE
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
|
|
HC BCID2
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 87154
|
| Hospital Charge Code |
900913011
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$446.18 |
| Rate for Payer: Adventist Health Commercial |
$44.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$218.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$133.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$327.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$218.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$446.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.55
|
| Rate for Payer: Blue Shield of California Commercial |
$133.54
|
| Rate for Payer: Blue Shield of California EPN |
$87.34
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Central Health Plan Commercial |
$176.00
|
| Rate for Payer: Cigna of CA HMO |
$140.80
|
| Rate for Payer: Cigna of CA PPO |
$162.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$327.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$218.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.38
|
| Rate for Payer: EPIC Health Plan Senior |
$218.06
|
| Rate for Payer: Galaxy Health WC |
$187.00
|
| Rate for Payer: Global Benefits Group Commercial |
$132.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$198.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$357.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$375.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$218.06
|
| Rate for Payer: InnovAge PACE Commercial |
$327.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$146.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$414.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$218.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$292.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$292.20
|
| Rate for Payer: Multiplan Commercial |
$165.00
|
| Rate for Payer: Networks By Design Commercial |
$143.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$218.06
|
| Rate for Payer: Prime Health Services Commercial |
$187.00
|
| Rate for Payer: Prime Health Services Medicare |
$231.14
|
| Rate for Payer: Riverside University Health System MISP |
$239.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$132.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$132.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$176.62
|
| Rate for Payer: United Healthcare All Other HMO |
$176.62
|
| Rate for Payer: United Healthcare HMO Rider |
$176.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$218.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$327.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.87
|
| Rate for Payer: Vantage Medical Group Senior |
$218.06
|
|
|
HC BCID2
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 87154
|
| Hospital Charge Code |
900913011
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Adventist Health Commercial |
$44.00
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Central Health Plan Commercial |
$176.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.00
|
| Rate for Payer: EPIC Health Plan Senior |
$88.00
|
| Rate for Payer: Galaxy Health WC |
$187.00
|
| Rate for Payer: Global Benefits Group Commercial |
$132.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$198.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$146.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.00
|
| Rate for Payer: Multiplan Commercial |
$165.00
|
| Rate for Payer: Networks By Design Commercial |
$143.00
|
| Rate for Payer: Prime Health Services Commercial |
$187.00
|
|
|
HC BCT LIMITED STUDY
|
Facility
|
OP
|
$888.00
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
909201971
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Adventist Health Commercial |
$177.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$663.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$521.52
|
| Rate for Payer: Blue Shield of California Commercial |
$539.02
|
| Rate for Payer: Blue Shield of California EPN |
$352.54
|
| Rate for Payer: Cash Price |
$488.40
|
| Rate for Payer: Cash Price |
$488.40
|
| Rate for Payer: Cash Price |
$488.40
|
| Rate for Payer: Central Health Plan Commercial |
$710.40
|
| Rate for Payer: Cigna of CA HMO |
$568.32
|
| Rate for Payer: Cigna of CA PPO |
$657.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$754.80
|
| Rate for Payer: Global Benefits Group Commercial |
$532.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$799.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$218.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$592.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$666.00
|
| Rate for Payer: Networks By Design Commercial |
$577.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$754.80
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$532.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$532.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$444.00
|
| Rate for Payer: United Healthcare All Other HMO |
$444.00
|
| Rate for Payer: United Healthcare HMO Rider |
$444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$444.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC BCT LIMITED STUDY
|
Facility
|
IP
|
$888.00
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
909201971
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$177.60 |
| Max. Negotiated Rate |
$799.20 |
| Rate for Payer: Adventist Health Commercial |
$177.60
|
| Rate for Payer: Cash Price |
$488.40
|
| Rate for Payer: Central Health Plan Commercial |
$710.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$355.20
|
| Rate for Payer: Galaxy Health WC |
$754.80
|
| Rate for Payer: Global Benefits Group Commercial |
$532.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$799.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$592.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$338.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$549.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.60
|
| Rate for Payer: Multiplan Commercial |
$666.00
|
| Rate for Payer: Networks By Design Commercial |
$577.20
|
| Rate for Payer: Prime Health Services Commercial |
$754.80
|
|
|
HC BE ENDOSK INCLUD TISSUE SHAPNG
|
Facility
|
IP
|
$4,043.00
|
|
|
Service Code
|
CPT L6400
|
| Hospital Charge Code |
915356400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$808.60 |
| Max. Negotiated Rate |
$3,638.70 |
| Rate for Payer: Adventist Health Commercial |
$808.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,125.24
|
| Rate for Payer: Blue Shield of California EPN |
$2,037.67
|
| Rate for Payer: Cash Price |
$2,223.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,234.40
|
| Rate for Payer: Cigna of CA HMO |
$2,830.10
|
| Rate for Payer: Cigna of CA PPO |
$2,830.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,617.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,617.20
|
| Rate for Payer: Galaxy Health WC |
$3,436.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,425.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,638.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,696.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,540.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,502.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$808.60
|
| Rate for Payer: Multiplan Commercial |
$3,032.25
|
| Rate for Payer: Networks By Design Commercial |
$2,627.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,436.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,517.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1,476.91
|
| Rate for Payer: United Healthcare HMO Rider |
$1,444.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,324.08
|
|
