|
HC KO SWEDISH TYPE
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT L1850
|
| Hospital Charge Code |
915351850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.63 |
| Max. Negotiated Rate |
$468.90 |
| Rate for Payer: Adventist Health Commercial |
$213.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$303.07
|
| Rate for Payer: Blue Shield of California Commercial |
$417.84
|
| Rate for Payer: Blue Shield of California EPN |
$262.58
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Central Health Plan Commercial |
$416.80
|
| Rate for Payer: Cigna of CA HMO |
$364.70
|
| Rate for Payer: Cigna of CA PPO |
$364.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$442.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$364.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.40
|
| Rate for Payer: EPIC Health Plan Senior |
$208.40
|
| Rate for Payer: Galaxy Health WC |
$442.85
|
| Rate for Payer: Global Benefits Group Commercial |
$312.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$300.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$331.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$307.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$364.70
|
| Rate for Payer: Multiplan Commercial |
$390.75
|
| Rate for Payer: Networks By Design Commercial |
$260.50
|
| Rate for Payer: Prime Health Services Commercial |
$442.85
|
| Rate for Payer: Riverside University Health System MISP |
$208.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.53
|
| Rate for Payer: United Healthcare All Other HMO |
$190.32
|
| Rate for Payer: United Healthcare HMO Rider |
$186.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.85
|
| Rate for Payer: Vantage Medical Group Senior |
$442.85
|
|
|
HC KO SWEDISH TYPE
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
CPT L1850
|
| Hospital Charge Code |
915351850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.20 |
| Max. Negotiated Rate |
$468.90 |
| Rate for Payer: Adventist Health Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California Commercial |
$417.84
|
| Rate for Payer: Blue Shield of California EPN |
$262.58
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Central Health Plan Commercial |
$416.80
|
| Rate for Payer: Cigna of CA HMO |
$364.70
|
| Rate for Payer: Cigna of CA PPO |
$364.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$364.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.40
|
| Rate for Payer: EPIC Health Plan Senior |
$208.40
|
| Rate for Payer: Galaxy Health WC |
$442.85
|
| Rate for Payer: Global Benefits Group Commercial |
$312.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$307.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.20
|
| Rate for Payer: Multiplan Commercial |
$390.75
|
| Rate for Payer: Networks By Design Commercial |
$338.65
|
| Rate for Payer: Prime Health Services Commercial |
$442.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.53
|
| Rate for Payer: United Healthcare All Other HMO |
$190.32
|
| Rate for Payer: United Healthcare HMO Rider |
$186.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.63
|
|
|
HC KO SWEDISH TYPE
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
CPT L1850
|
| Hospital Charge Code |
905351850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.20 |
| Max. Negotiated Rate |
$468.90 |
| Rate for Payer: Adventist Health Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California Commercial |
$417.84
|
| Rate for Payer: Blue Shield of California EPN |
$262.58
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Central Health Plan Commercial |
$416.80
|
| Rate for Payer: Cigna of CA HMO |
$364.70
|
| Rate for Payer: Cigna of CA PPO |
$364.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$364.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.40
|
| Rate for Payer: EPIC Health Plan Senior |
$208.40
|
| Rate for Payer: Galaxy Health WC |
$442.85
|
| Rate for Payer: Global Benefits Group Commercial |
$312.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$307.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.20
|
| Rate for Payer: Multiplan Commercial |
$390.75
|
| Rate for Payer: Networks By Design Commercial |
$338.65
|
| Rate for Payer: Prime Health Services Commercial |
$442.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.53
|
| Rate for Payer: United Healthcare All Other HMO |
$190.32
|
| Rate for Payer: United Healthcare HMO Rider |
$186.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.63
|
|
|
HC KO SWEDISH TYPE
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT L1850
|
| Hospital Charge Code |
905351850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.63 |
| Max. Negotiated Rate |
$468.90 |
| Rate for Payer: Adventist Health Commercial |
$213.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$303.07
|
| Rate for Payer: Blue Shield of California Commercial |
$417.84
|
| Rate for Payer: Blue Shield of California EPN |
$262.58
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Central Health Plan Commercial |
$416.80
|
| Rate for Payer: Cigna of CA HMO |
$364.70
|
| Rate for Payer: Cigna of CA PPO |
$364.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$442.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$364.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.40
|
| Rate for Payer: EPIC Health Plan Senior |
$208.40
|
| Rate for Payer: Galaxy Health WC |
$442.85
|
| Rate for Payer: Global Benefits Group Commercial |
$312.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$300.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$331.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$307.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$364.70
|
| Rate for Payer: Multiplan Commercial |
$390.75
|
| Rate for Payer: Networks By Design Commercial |
$260.50
|
| Rate for Payer: Prime Health Services Commercial |
$442.85
|
| Rate for Payer: Riverside University Health System MISP |
$208.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.53
|
| Rate for Payer: United Healthcare All Other HMO |
$190.32
|
| Rate for Payer: United Healthcare HMO Rider |
$186.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.85
|
| Rate for Payer: Vantage Medical Group Senior |
$442.85
|
|
|
HC KO THIGH/CALF FUNCT RESIST CNT
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
CPT E1810
|
| Hospital Charge Code |
905351885
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$162.80 |
| Max. Negotiated Rate |
$732.60 |
| Rate for Payer: Adventist Health Commercial |
$162.80
|
| Rate for Payer: Blue Shield of California Commercial |
$652.83
|
| Rate for Payer: Blue Shield of California EPN |
$410.26
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Central Health Plan Commercial |
$651.20
|
| Rate for Payer: Cigna of CA HMO |
$569.80
|
| Rate for Payer: Cigna of CA PPO |
$569.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$569.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.60
|
| Rate for Payer: EPIC Health Plan Senior |
$325.60
|
| Rate for Payer: Galaxy Health WC |
$691.90
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$732.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$516.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$480.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.80
|
| Rate for Payer: Multiplan Commercial |
$610.50
|
| Rate for Payer: Networks By Design Commercial |
$529.10
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$305.49
|
| Rate for Payer: United Healthcare All Other HMO |
$297.35
|
| Rate for Payer: United Healthcare HMO Rider |
$290.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$266.58
|
|
|
HC KO THIGH/CALF FUNCT RESIST CNT
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
CPT E1810
|
| Hospital Charge Code |
915351885
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$162.80 |
| Max. Negotiated Rate |
$732.60 |
| Rate for Payer: Adventist Health Commercial |
$162.80
|
| Rate for Payer: Blue Shield of California Commercial |
$652.83
|
| Rate for Payer: Blue Shield of California EPN |
$410.26
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Central Health Plan Commercial |
$651.20
|
| Rate for Payer: Cigna of CA HMO |
$569.80
|
| Rate for Payer: Cigna of CA PPO |
$569.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$569.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.60
|
| Rate for Payer: EPIC Health Plan Senior |
$325.60
|
| Rate for Payer: Galaxy Health WC |
$691.90
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$732.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$516.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$480.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.80
|
| Rate for Payer: Multiplan Commercial |
$610.50
|
| Rate for Payer: Networks By Design Commercial |
$529.10
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$305.49
|
| Rate for Payer: United Healthcare All Other HMO |
$297.35
|
| Rate for Payer: United Healthcare HMO Rider |
$290.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$266.58
|
|
|
HC KO THIGH/CALF FUNCT RESIST CNT
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
CPT E1810
|
| Hospital Charge Code |
905351885
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$266.58 |
| Max. Negotiated Rate |
$2,272.34 |
| Rate for Payer: Adventist Health Commercial |
$333.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$447.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$610.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$473.50
|
| Rate for Payer: Blue Shield of California Commercial |
$652.83
|
| Rate for Payer: Blue Shield of California EPN |
$410.26
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Central Health Plan Commercial |
$651.20
|
| Rate for Payer: Cigna of CA HMO |
$569.80
|
| Rate for Payer: Cigna of CA PPO |
$569.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$691.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$691.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$691.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$569.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.60
|
| Rate for Payer: EPIC Health Plan Senior |
$325.60
|
| Rate for Payer: Galaxy Health WC |
$691.90
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$732.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,057.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$516.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,272.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$480.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$569.80
|
| Rate for Payer: Multiplan Commercial |
$610.50
|
| Rate for Payer: Networks By Design Commercial |
$407.00
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
| Rate for Payer: Riverside University Health System MISP |
$325.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$488.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$488.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$305.49
|
| Rate for Payer: United Healthcare All Other HMO |
$297.35
|
| Rate for Payer: United Healthcare HMO Rider |
$290.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$266.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$691.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$691.90
|
| Rate for Payer: Vantage Medical Group Senior |
$691.90
|
|
|
HC KO THIGH/CALF FUNCT RESIST CNT
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
CPT E1810
|
| Hospital Charge Code |
915351885
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$266.58 |
| Max. Negotiated Rate |
$2,272.34 |
| Rate for Payer: Adventist Health Commercial |
$333.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$447.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$610.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$473.50
|
| Rate for Payer: Blue Shield of California Commercial |
$652.83
|
| Rate for Payer: Blue Shield of California EPN |
$410.26
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Central Health Plan Commercial |
$651.20
|
| Rate for Payer: Cigna of CA HMO |
$569.80
|
| Rate for Payer: Cigna of CA PPO |
$569.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$691.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$691.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$691.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$569.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.60
|
| Rate for Payer: EPIC Health Plan Senior |
$325.60
|
| Rate for Payer: Galaxy Health WC |
$691.90
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$732.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,057.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$516.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,272.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$480.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$569.80
|
| Rate for Payer: Multiplan Commercial |
$610.50
|
| Rate for Payer: Networks By Design Commercial |
$407.00
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
| Rate for Payer: Riverside University Health System MISP |
$325.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$488.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$488.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$305.49
|
| Rate for Payer: United Healthcare All Other HMO |
$297.35
|
| Rate for Payer: United Healthcare HMO Rider |
$290.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$266.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$691.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$691.90
|
| Rate for Payer: Vantage Medical Group Senior |
$691.90
|
|
|
HC K PLST SKT JOINT&THIGH LAC SAC
|
Facility
|
OP
|
$9,945.00
|
|
|
Service Code
|
CPT L5105
|
| Hospital Charge Code |
905355105
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,863.70 |
| Max. Negotiated Rate |
$8,950.50 |
| Rate for Payer: Adventist Health Commercial |
$4,077.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,453.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,469.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,458.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,785.01
|
| Rate for Payer: Blue Shield of California Commercial |
$7,975.89
|
| Rate for Payer: Blue Shield of California EPN |
$5,012.28
|
| Rate for Payer: Cash Price |
$4,475.25
|
| Rate for Payer: Cash Price |
$4,475.25
|
| Rate for Payer: Central Health Plan Commercial |
$7,956.00
|
| Rate for Payer: Cigna of CA HMO |
$6,961.50
|
| Rate for Payer: Cigna of CA PPO |
$6,961.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,453.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,453.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,453.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,961.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,978.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,978.00
|
| Rate for Payer: Galaxy Health WC |
$8,453.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,967.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,950.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,863.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,315.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,163.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,867.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,077.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,961.50
|
| Rate for Payer: Multiplan Commercial |
$7,458.75
|
| Rate for Payer: Networks By Design Commercial |
$4,972.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,453.25
|
| Rate for Payer: Riverside University Health System MISP |
$3,978.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,967.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,967.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,732.36
|
| Rate for Payer: United Healthcare All Other HMO |
$3,632.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3,554.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,256.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,453.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,453.25
|
| Rate for Payer: Vantage Medical Group Senior |
$8,453.25
|
|
|
HC K PLST SKT JOINT&THIGH LAC SAC
|
Facility
|
IP
|
$9,945.00
|
|
|
Service Code
|
CPT L5105
|
| Hospital Charge Code |
915355105
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,989.00 |
| Max. Negotiated Rate |
$8,950.50 |
| Rate for Payer: Cash Price |
$4,475.25
|
| Rate for Payer: Central Health Plan Commercial |
$7,956.00
|
| Rate for Payer: Cigna of CA HMO |
$6,961.50
|
| Rate for Payer: Cigna of CA PPO |
$6,961.50
|
| Rate for Payer: Adventist Health Commercial |
$1,989.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,975.89
|
| Rate for Payer: Blue Shield of California EPN |
$5,012.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,961.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,978.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,978.00
|
| Rate for Payer: Galaxy Health WC |
$8,453.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,967.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,950.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,315.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,867.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,989.00
|
| Rate for Payer: Multiplan Commercial |
$7,458.75
|
| Rate for Payer: Networks By Design Commercial |
$6,464.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,453.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,732.36
|
| Rate for Payer: United Healthcare All Other HMO |
$3,632.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3,554.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,256.99
|
|
|
HC K PLST SKT JOINT&THIGH LAC SAC
|
Facility
|
IP
|
$9,945.00
|
|
|
Service Code
|
CPT L5105
|
| Hospital Charge Code |
905355105
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,989.00 |
| Max. Negotiated Rate |
$8,950.50 |
| Rate for Payer: Adventist Health Commercial |
$1,989.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,975.89
|
| Rate for Payer: Blue Shield of California EPN |
$5,012.28
|
| Rate for Payer: Cash Price |
$4,475.25
|
| Rate for Payer: Central Health Plan Commercial |
$7,956.00
|
| Rate for Payer: Cigna of CA HMO |
$6,961.50
|
| Rate for Payer: Cigna of CA PPO |
$6,961.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,961.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,978.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,978.00
|
| Rate for Payer: Galaxy Health WC |
$8,453.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,967.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,950.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,315.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,867.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,989.00
|
| Rate for Payer: Multiplan Commercial |
$7,458.75
|
| Rate for Payer: Networks By Design Commercial |
$6,464.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,453.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,732.36
|
| Rate for Payer: United Healthcare All Other HMO |
$3,632.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3,554.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,256.99
|
|
|
HC K PLST SKT JOINT&THIGH LAC SAC
|
Facility
|
OP
|
$9,945.00
|
|
|
Service Code
|
CPT L5105
|
| Hospital Charge Code |
915355105
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,863.70 |
| Max. Negotiated Rate |
$8,950.50 |
| Rate for Payer: Adventist Health Commercial |
$4,077.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,453.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,469.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,458.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,785.01
|
| Rate for Payer: Blue Shield of California Commercial |
$7,975.89
|
| Rate for Payer: Blue Shield of California EPN |
$5,012.28
|
| Rate for Payer: Cash Price |
$4,475.25
|
| Rate for Payer: Cash Price |
$4,475.25
|
| Rate for Payer: Central Health Plan Commercial |
$7,956.00
|
| Rate for Payer: Cigna of CA HMO |
$6,961.50
|
| Rate for Payer: Cigna of CA PPO |
$6,961.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,453.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,453.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,453.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,961.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,978.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,978.00
|
| Rate for Payer: Galaxy Health WC |
$8,453.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,967.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,950.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,863.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,315.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,163.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,867.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,077.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,961.50
|
| Rate for Payer: Multiplan Commercial |
$7,458.75
|
| Rate for Payer: Networks By Design Commercial |
$4,972.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,453.25
|
| Rate for Payer: Riverside University Health System MISP |
$3,978.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,967.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,967.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,732.36
|
| Rate for Payer: United Healthcare All Other HMO |
$3,632.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3,554.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,256.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,453.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,453.25
|
| Rate for Payer: Vantage Medical Group Senior |
$8,453.25
|
|
|
HC KRAS EXON 2
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 81275
|
| Hospital Charge Code |
903800316
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$100.40 |
| Max. Negotiated Rate |
$1,140.64 |
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Adventist Health Commercial |
$138.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$193.25
|
| Rate for Payer: Adventist Health Medi-Cal |
$193.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$554.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$554.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$289.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$289.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$212.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$212.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$193.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$193.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$820.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$820.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,140.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,140.64
|
| Rate for Payer: Blue Shield of California Commercial |
$437.22
|
| Rate for Payer: Blue Shield of California Commercial |
$316.26
|
| Rate for Payer: Blue Shield of California EPN |
$275.52
|
| Rate for Payer: Blue Shield of California EPN |
$199.29
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Central Health Plan Commercial |
$401.60
|
| Rate for Payer: Central Health Plan Commercial |
$555.20
|
| Rate for Payer: Cigna of CA HMO |
$444.16
|
| Rate for Payer: Cigna of CA HMO |
$321.28
|
| Rate for Payer: Cigna of CA PPO |
$513.56
|
| Rate for Payer: Cigna of CA PPO |
$371.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$289.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$289.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$193.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$193.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$485.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.86
|
| Rate for Payer: EPIC Health Plan Senior |
$212.57
|
| Rate for Payer: EPIC Health Plan Senior |
$212.57
|
| Rate for Payer: Galaxy Health WC |
$589.90
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Global Benefits Group Commercial |
$416.40
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$624.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$451.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$316.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$316.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$265.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$265.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$193.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$193.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$318.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$440.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$293.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$293.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$270.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$270.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$258.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$258.95
|
| Rate for Payer: Multiplan Commercial |
$520.50
|
| Rate for Payer: Multiplan Commercial |
$376.50
|
| Rate for Payer: Networks By Design Commercial |
$326.30
|
| Rate for Payer: Networks By Design Commercial |
$451.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$193.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$193.25
|
| Rate for Payer: Prime Health Services Commercial |
$589.90
|
| Rate for Payer: Prime Health Services Commercial |
$426.70
|
| Rate for Payer: Prime Health Services Medicare |
$204.84
|
| Rate for Payer: Prime Health Services Medicare |
$204.84
|
| Rate for Payer: Riverside University Health System MISP |
$212.57
|
| Rate for Payer: Riverside University Health System MISP |
$212.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$416.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$416.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$301.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$156.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$156.54
|
| Rate for Payer: United Healthcare All Other HMO |
$156.54
|
| Rate for Payer: United Healthcare All Other HMO |
$156.54
|
| Rate for Payer: United Healthcare HMO Rider |
$156.54
|
| Rate for Payer: United Healthcare HMO Rider |
$156.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$193.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$193.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$289.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$289.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.57
|
| Rate for Payer: Vantage Medical Group Senior |
$193.25
|
| Rate for Payer: Vantage Medical Group Senior |
$193.25
|
|
|
HC KRAS EXON 2
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
CPT 81275
|
| Hospital Charge Code |
903800316
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$138.80 |
| Max. Negotiated Rate |
$624.60 |
| Rate for Payer: Adventist Health Commercial |
$138.80
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Central Health Plan Commercial |
$555.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$485.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.60
|
| Rate for Payer: EPIC Health Plan Senior |
$277.60
|
| Rate for Payer: Galaxy Health WC |
$589.90
|
| Rate for Payer: Global Benefits Group Commercial |
$416.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$624.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$440.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$409.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.80
|
| Rate for Payer: Multiplan Commercial |
$520.50
|
| Rate for Payer: Networks By Design Commercial |
$451.10
|
| Rate for Payer: Prime Health Services Commercial |
$589.90
|
|
|
HC KRAS EXON VARIANTS
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 81276
|
| Hospital Charge Code |
903800317
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$100.40 |
| Max. Negotiated Rate |
$1,555.18 |
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Adventist Health Commercial |
$138.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$193.25
|
| Rate for Payer: Adventist Health Medi-Cal |
$193.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,028.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,028.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$289.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$289.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$212.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$212.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$193.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$193.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,118.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,118.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,555.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,555.18
|
| Rate for Payer: Blue Shield of California Commercial |
$437.22
|
| Rate for Payer: Blue Shield of California Commercial |
$316.26
|
| Rate for Payer: Blue Shield of California EPN |
$275.52
|
| Rate for Payer: Blue Shield of California EPN |
$199.29
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Central Health Plan Commercial |
$401.60
|
| Rate for Payer: Central Health Plan Commercial |
$555.20
|
| Rate for Payer: Cigna of CA HMO |
$444.16
|
| Rate for Payer: Cigna of CA HMO |
$321.28
|
| Rate for Payer: Cigna of CA PPO |
$513.56
|
| Rate for Payer: Cigna of CA PPO |
$371.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$289.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$289.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$193.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$193.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$485.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.86
|
| Rate for Payer: EPIC Health Plan Senior |
$212.57
|
| Rate for Payer: EPIC Health Plan Senior |
$212.57
|
| Rate for Payer: Galaxy Health WC |
$589.90
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Global Benefits Group Commercial |
$416.40
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$624.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$451.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$316.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$316.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$265.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$265.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$193.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$193.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$318.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$440.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$293.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$293.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$270.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$270.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$258.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$258.95
|
| Rate for Payer: Multiplan Commercial |
$520.50
|
| Rate for Payer: Multiplan Commercial |
$376.50
|
| Rate for Payer: Networks By Design Commercial |
$326.30
|
| Rate for Payer: Networks By Design Commercial |
$451.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$193.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$193.25
|
| Rate for Payer: Prime Health Services Commercial |
$589.90
|
| Rate for Payer: Prime Health Services Commercial |
$426.70
|
| Rate for Payer: Prime Health Services Medicare |
$204.84
|
| Rate for Payer: Prime Health Services Medicare |
$204.84
|
| Rate for Payer: Riverside University Health System MISP |
$212.57
|
| Rate for Payer: Riverside University Health System MISP |
$212.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$416.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$416.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$301.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$156.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$156.54
|
| Rate for Payer: United Healthcare All Other HMO |
$156.54
|
| Rate for Payer: United Healthcare All Other HMO |
$156.54
|
| Rate for Payer: United Healthcare HMO Rider |
$156.54
|
| Rate for Payer: United Healthcare HMO Rider |
$156.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$193.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$193.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$289.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$289.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.57
|
| Rate for Payer: Vantage Medical Group Senior |
$193.25
|
| Rate for Payer: Vantage Medical Group Senior |
$193.25
|
|
|
HC KRAS EXON VARIANTS
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
CPT 81276
|
| Hospital Charge Code |
903800317
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$138.80 |
| Max. Negotiated Rate |
$624.60 |
| Rate for Payer: Adventist Health Commercial |
$138.80
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Central Health Plan Commercial |
$555.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$485.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.60
|
| Rate for Payer: EPIC Health Plan Senior |
$277.60
|
| Rate for Payer: Galaxy Health WC |
$589.90
|
| Rate for Payer: Global Benefits Group Commercial |
$416.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$624.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$440.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$409.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.80
|
| Rate for Payer: Multiplan Commercial |
$520.50
|
| Rate for Payer: Networks By Design Commercial |
$451.10
|
| Rate for Payer: Prime Health Services Commercial |
$589.90
|
|
|
HC LAA PERI DEVICE LEAK CLOSURE
|
Facility
|
IP
|
$25,018.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906819768
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$5,003.60 |
| Max. Negotiated Rate |
$22,516.20 |
| Rate for Payer: Adventist Health Commercial |
$5,003.60
|
| Rate for Payer: Cash Price |
$11,258.10
|
| Rate for Payer: Central Health Plan Commercial |
$20,014.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,512.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,007.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10,007.20
|
| Rate for Payer: Galaxy Health WC |
$21,265.30
|
| Rate for Payer: Global Benefits Group Commercial |
$15,010.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,516.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,886.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,760.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,003.60
|
| Rate for Payer: Multiplan Commercial |
$18,763.50
|
| Rate for Payer: Networks By Design Commercial |
$16,261.70
|
| Rate for Payer: Prime Health Services Commercial |
$21,265.30
|
|
|
HC LAA PERI DEVICE LEAK CLOSURE
|
Facility
|
OP
|
$25,018.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906819768
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$165.49 |
| Max. Negotiated Rate |
$22,516.20 |
| Rate for Payer: Adventist Health Commercial |
$5,003.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$165.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15,193.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,113.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,552.97
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$11,258.10
|
| Rate for Payer: Cash Price |
$11,258.10
|
| Rate for Payer: Cash Price |
$11,258.10
|
| Rate for Payer: Cash Price |
$11,258.10
|
| Rate for Payer: Central Health Plan Commercial |
$20,014.40
|
| Rate for Payer: Cigna of CA HMO |
$16,011.52
|
| Rate for Payer: Cigna of CA PPO |
$18,513.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,512.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$21,265.30
|
| Rate for Payer: Global Benefits Group Commercial |
$15,010.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,516.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,886.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,003.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$18,763.50
|
| Rate for Payer: Networks By Design Commercial |
$16,261.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$165.49
|
| Rate for Payer: Prime Health Services Commercial |
$21,265.30
|
| Rate for Payer: Prime Health Services Medicare |
$175.42
|
| Rate for Payer: Riverside University Health System MISP |
$182.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,010.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,010.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC LAB REF ACANTHAMEOBA CULTURE
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
900911538
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
|
|
HC LAB REF ACANTHAMEOBA CULTURE
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
900911538
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$66.52 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.52
|
| Rate for Payer: Blue Shield of California Commercial |
$6.93
|
| Rate for Payer: Blue Shield of California EPN |
$4.37
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: Cigna of CA HMO |
$7.04
|
| Rate for Payer: Cigna of CA PPO |
$8.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.94
|
| Rate for Payer: EPIC Health Plan Senior |
$7.29
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.88
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Prime Health Services Medicare |
$7.03
|
| Rate for Payer: Riverside University Health System MISP |
$7.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.37
|
| Rate for Payer: United Healthcare All Other HMO |
$5.37
|
| Rate for Payer: United Healthcare HMO Rider |
$5.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.29
|
| Rate for Payer: Vantage Medical Group Senior |
$6.63
|
|
|
HC LAB REF ADDITION KARYOTYPE
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
900910745
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$253.84 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$33.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$182.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$253.84
|
| Rate for Payer: Blue Shield of California Commercial |
$25.20
|
| Rate for Payer: Blue Shield of California EPN |
$15.88
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.23
|
| Rate for Payer: EPIC Health Plan Senior |
$36.82
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$54.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$44.85
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$33.47
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Prime Health Services Medicare |
$35.48
|
| Rate for Payer: Riverside University Health System MISP |
$36.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.11
|
| Rate for Payer: United Healthcare All Other HMO |
$27.11
|
| Rate for Payer: United Healthcare HMO Rider |
$27.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$33.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Vantage Medical Group Senior |
$33.47
|
|
|
HC LAB REF ADDITION KARYOTYPE
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
900910745
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC LAB REF ADENOVIRUS AB TITER (CF)
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
900911759
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$130.19 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.19
|
| Rate for Payer: Blue Shield of California Commercial |
$63.63
|
| Rate for Payer: Blue Shield of California EPN |
$40.10
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Central Health Plan Commercial |
$80.80
|
| Rate for Payer: Cigna of CA HMO |
$64.64
|
| Rate for Payer: Cigna of CA PPO |
$74.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.16
|
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$64.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.87
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
| Rate for Payer: Prime Health Services Medicare |
$13.64
|
| Rate for Payer: Riverside University Health System MISP |
$14.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC LAB REF ADENOVIRUS AB TITER (CF)
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
900911759
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Central Health Plan Commercial |
$80.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.40
|
| Rate for Payer: EPIC Health Plan Senior |
$40.40
|
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$64.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.20
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
|
|
HC LAB REF AEROBIC ROUTINE MIC PANEL
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900911299
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Central Health Plan Commercial |
$11.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5.60
|
| Rate for Payer: Galaxy Health WC |
$11.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: Networks By Design Commercial |
$9.10
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
|
