|
HC SOFT INTERFACE AFO SECTION
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT L2820
|
| Hospital Charge Code |
905352820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$291.60 |
| Rate for Payer: Adventist Health Commercial |
$64.80
|
| Rate for Payer: Blue Shield of California Commercial |
$259.85
|
| Rate for Payer: Blue Shield of California EPN |
$163.30
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Central Health Plan Commercial |
$259.20
|
| Rate for Payer: Cigna of CA HMO |
$226.80
|
| Rate for Payer: Cigna of CA PPO |
$226.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$226.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Senior |
$129.60
|
| Rate for Payer: Galaxy Health WC |
$275.40
|
| Rate for Payer: Global Benefits Group Commercial |
$194.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$291.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$243.00
|
| Rate for Payer: Networks By Design Commercial |
$210.60
|
| Rate for Payer: Prime Health Services Commercial |
$275.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.60
|
| Rate for Payer: United Healthcare All Other HMO |
$118.36
|
| Rate for Payer: United Healthcare HMO Rider |
$115.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.11
|
|
|
HC SOFT INTERFACE AFO SECTION
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT L2820
|
| Hospital Charge Code |
905352820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$106.11 |
| Max. Negotiated Rate |
$291.60 |
| Rate for Payer: Adventist Health Commercial |
$132.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$275.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$178.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$243.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.47
|
| Rate for Payer: Blue Shield of California Commercial |
$259.85
|
| Rate for Payer: Blue Shield of California EPN |
$163.30
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Central Health Plan Commercial |
$259.20
|
| Rate for Payer: Cigna of CA HMO |
$226.80
|
| Rate for Payer: Cigna of CA PPO |
$226.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$275.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$275.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$226.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Senior |
$129.60
|
| Rate for Payer: Galaxy Health WC |
$275.40
|
| Rate for Payer: Global Benefits Group Commercial |
$194.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$291.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$119.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$226.80
|
| Rate for Payer: Multiplan Commercial |
$243.00
|
| Rate for Payer: Networks By Design Commercial |
$162.00
|
| Rate for Payer: Prime Health Services Commercial |
$275.40
|
| Rate for Payer: Riverside University Health System MISP |
$129.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$194.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$194.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.60
|
| Rate for Payer: United Healthcare All Other HMO |
$118.36
|
| Rate for Payer: United Healthcare HMO Rider |
$115.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$275.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.40
|
| Rate for Payer: Vantage Medical Group Senior |
$275.40
|
|
|
HC SOFT INTERFACE AFO SECTION
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT L2820
|
| Hospital Charge Code |
915352820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$291.60 |
| Rate for Payer: Adventist Health Commercial |
$64.80
|
| Rate for Payer: Blue Shield of California Commercial |
$259.85
|
| Rate for Payer: Blue Shield of California EPN |
$163.30
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Central Health Plan Commercial |
$259.20
|
| Rate for Payer: Cigna of CA HMO |
$226.80
|
| Rate for Payer: Cigna of CA PPO |
$226.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$226.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Senior |
$129.60
|
| Rate for Payer: Galaxy Health WC |
$275.40
|
| Rate for Payer: Global Benefits Group Commercial |
$194.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$291.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$243.00
|
| Rate for Payer: Networks By Design Commercial |
$210.60
|
| Rate for Payer: Prime Health Services Commercial |
$275.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.60
|
| Rate for Payer: United Healthcare All Other HMO |
$118.36
|
| Rate for Payer: United Healthcare HMO Rider |
$115.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.11
|
|
|
HC SOFT INTERFACE AFO SECTION
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT L2820
|
| Hospital Charge Code |
915352820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$106.11 |
| Max. Negotiated Rate |
$291.60 |
| Rate for Payer: Adventist Health Commercial |
$132.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$275.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$178.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$243.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.47
|
| Rate for Payer: Blue Shield of California Commercial |
$259.85
|
| Rate for Payer: Blue Shield of California EPN |
$163.30
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Central Health Plan Commercial |
$259.20
|
| Rate for Payer: Cigna of CA HMO |
$226.80
|
| Rate for Payer: Cigna of CA PPO |
$226.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$275.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$275.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$226.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Senior |
$129.60
|
| Rate for Payer: Galaxy Health WC |
$275.40
|
| Rate for Payer: Global Benefits Group Commercial |
$194.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$291.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$119.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$226.80
|
| Rate for Payer: Multiplan Commercial |
$243.00
|
| Rate for Payer: Networks By Design Commercial |
$162.00
|
| Rate for Payer: Prime Health Services Commercial |
$275.40
|
| Rate for Payer: Riverside University Health System MISP |
$129.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$194.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$194.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.60
|
| Rate for Payer: United Healthcare All Other HMO |
$118.36
|
| Rate for Payer: United Healthcare HMO Rider |
$115.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$275.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.40
|
| Rate for Payer: Vantage Medical Group Senior |
$275.40
|
|
|
HC SOFT INTERFACE KAFO SECTION
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT L2830
|
| Hospital Charge Code |
915352830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$106.11 |
| Max. Negotiated Rate |
$291.60 |
| Rate for Payer: Adventist Health Commercial |
$132.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$275.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$178.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$243.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.47
|
| Rate for Payer: Blue Shield of California Commercial |
$259.85
|
| Rate for Payer: Blue Shield of California EPN |
$163.30
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Central Health Plan Commercial |
$259.20
|
| Rate for Payer: Cigna of CA HMO |
$226.80
|
| Rate for Payer: Cigna of CA PPO |
$226.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$275.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$275.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$226.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Senior |
$129.60
|
| Rate for Payer: Galaxy Health WC |
$275.40
|
| Rate for Payer: Global Benefits Group Commercial |
$194.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$291.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$129.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$226.80
|
| Rate for Payer: Multiplan Commercial |
$243.00
|
| Rate for Payer: Networks By Design Commercial |
$162.00
|
| Rate for Payer: Prime Health Services Commercial |
$275.40
|
| Rate for Payer: Riverside University Health System MISP |
$129.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$194.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$194.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.60
|
| Rate for Payer: United Healthcare All Other HMO |
$118.36
|
| Rate for Payer: United Healthcare HMO Rider |
$115.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$275.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.40
|
| Rate for Payer: Vantage Medical Group Senior |
$275.40
|
|
|
HC SOFT INTERFACE KAFO SECTION
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT L2830
|
| Hospital Charge Code |
915352830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$291.60 |
| Rate for Payer: Adventist Health Commercial |
$64.80
|
| Rate for Payer: Blue Shield of California Commercial |
$259.85
|
| Rate for Payer: Blue Shield of California EPN |
$163.30
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Central Health Plan Commercial |
$259.20
|
| Rate for Payer: Cigna of CA HMO |
$226.80
|
| Rate for Payer: Cigna of CA PPO |
$226.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$226.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Senior |
$129.60
|
| Rate for Payer: Galaxy Health WC |
$275.40
|
| Rate for Payer: Global Benefits Group Commercial |
$194.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$291.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$243.00
|
| Rate for Payer: Networks By Design Commercial |
$210.60
|
| Rate for Payer: Prime Health Services Commercial |
$275.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.60
|
| Rate for Payer: United Healthcare All Other HMO |
$118.36
|
| Rate for Payer: United Healthcare HMO Rider |
$115.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.11
|
|
|
HC SOFT INTERFACE KAFO SECTION
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT L2830
|
| Hospital Charge Code |
905352830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$106.11 |
| Max. Negotiated Rate |
$291.60 |
| Rate for Payer: Adventist Health Commercial |
$132.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$275.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$178.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$243.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.47
|
| Rate for Payer: Blue Shield of California Commercial |
$259.85
|
| Rate for Payer: Blue Shield of California EPN |
$163.30
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Central Health Plan Commercial |
$259.20
|
| Rate for Payer: Cigna of CA HMO |
$226.80
|
| Rate for Payer: Cigna of CA PPO |
$226.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$275.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$275.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$226.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Senior |
$129.60
|
| Rate for Payer: Galaxy Health WC |
$275.40
|
| Rate for Payer: Global Benefits Group Commercial |
$194.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$291.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$129.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$226.80
|
| Rate for Payer: Multiplan Commercial |
$243.00
|
| Rate for Payer: Networks By Design Commercial |
$162.00
|
| Rate for Payer: Prime Health Services Commercial |
$275.40
|
| Rate for Payer: Riverside University Health System MISP |
$129.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$194.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$194.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.60
|
| Rate for Payer: United Healthcare All Other HMO |
$118.36
|
| Rate for Payer: United Healthcare HMO Rider |
$115.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$275.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.40
|
| Rate for Payer: Vantage Medical Group Senior |
$275.40
|
|
|
HC SOFT INTERFACE KAFO SECTION
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT L2830
|
| Hospital Charge Code |
905352830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$291.60 |
| Rate for Payer: Adventist Health Commercial |
$64.80
|
| Rate for Payer: Blue Shield of California Commercial |
$259.85
|
| Rate for Payer: Blue Shield of California EPN |
$163.30
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Central Health Plan Commercial |
$259.20
|
| Rate for Payer: Cigna of CA HMO |
$226.80
|
| Rate for Payer: Cigna of CA PPO |
$226.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$226.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Senior |
$129.60
|
| Rate for Payer: Galaxy Health WC |
$275.40
|
| Rate for Payer: Global Benefits Group Commercial |
$194.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$291.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$243.00
|
| Rate for Payer: Networks By Design Commercial |
$210.60
|
| Rate for Payer: Prime Health Services Commercial |
$275.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.60
|
| Rate for Payer: United Healthcare All Other HMO |
$118.36
|
| Rate for Payer: United Healthcare HMO Rider |
$115.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.11
|
|
|
HC SOFT PALATE
|
Facility
|
OP
|
$1,187.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.93 |
| Max. Negotiated Rate |
$1,068.30 |
| Rate for Payer: Adventist Health Commercial |
$237.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$286.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$574.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$690.48
|
| Rate for Payer: Blue Shield of California Commercial |
$747.81
|
| Rate for Payer: Blue Shield of California EPN |
$471.24
|
| Rate for Payer: Cash Price |
$534.15
|
| Rate for Payer: Cash Price |
$534.15
|
| Rate for Payer: Central Health Plan Commercial |
$949.60
|
| Rate for Payer: Cigna of CA HMO |
$759.68
|
| Rate for Payer: Cigna of CA PPO |
$878.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$830.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$1,008.95
|
| Rate for Payer: Global Benefits Group Commercial |
$712.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,068.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$753.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$890.25
|
| Rate for Payer: Networks By Design Commercial |
$771.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$1,008.95
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$712.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$712.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC SOFT PALATE
|
Facility
|
IP
|
$1,187.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$237.40 |
| Max. Negotiated Rate |
$1,068.30 |
| Rate for Payer: Adventist Health Commercial |
$237.40
|
| Rate for Payer: Cash Price |
$534.15
|
| Rate for Payer: Central Health Plan Commercial |
$949.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$830.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$474.80
|
| Rate for Payer: EPIC Health Plan Senior |
$474.80
|
| Rate for Payer: Galaxy Health WC |
$1,008.95
|
| Rate for Payer: Global Benefits Group Commercial |
$712.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,068.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$753.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$700.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.40
|
| Rate for Payer: Multiplan Commercial |
$890.25
|
| Rate for Payer: Networks By Design Commercial |
$771.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,008.95
|
|
|
HC SOGDX 230 GCH1 81479
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914803
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$185.00 |
| Max. Negotiated Rate |
$832.50 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$786.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$508.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$447.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$538.07
|
| Rate for Payer: Blue Shield of California Commercial |
$582.75
|
| Rate for Payer: Blue Shield of California EPN |
$367.23
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Central Health Plan Commercial |
$740.00
|
| Rate for Payer: Cigna of CA HMO |
$592.00
|
| Rate for Payer: Cigna of CA PPO |
$684.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$786.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$786.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$786.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$647.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.00
|
| Rate for Payer: EPIC Health Plan Senior |
$370.00
|
| Rate for Payer: Galaxy Health WC |
$786.25
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$832.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$587.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$545.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$647.50
|
| Rate for Payer: Multiplan Commercial |
$693.75
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
| Rate for Payer: Riverside University Health System MISP |
$370.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$555.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$555.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$462.50
|
| Rate for Payer: United Healthcare All Other HMO |
$462.50
|
| Rate for Payer: United Healthcare HMO Rider |
$462.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$462.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$786.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$786.25
|
| Rate for Payer: Vantage Medical Group Senior |
$786.25
|
|
|
HC SOGDX 230 GCH1 81479
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914803
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$185.00 |
| Max. Negotiated Rate |
$832.50 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Central Health Plan Commercial |
$740.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$647.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.00
|
| Rate for Payer: EPIC Health Plan Senior |
$370.00
|
| Rate for Payer: Galaxy Health WC |
$786.25
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$832.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$587.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$545.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.00
|
| Rate for Payer: Multiplan Commercial |
$693.75
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
|
|
HC SOGDX 317 SIX1 81479
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914808
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Adventist Health Commercial |
$135.00
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Central Health Plan Commercial |
$540.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$472.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.00
|
| Rate for Payer: EPIC Health Plan Senior |
$270.00
|
| Rate for Payer: Galaxy Health WC |
$573.75
|
| Rate for Payer: Global Benefits Group Commercial |
$405.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$607.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$428.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$398.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Multiplan Commercial |
$506.25
|
| Rate for Payer: Networks By Design Commercial |
$438.75
|
| Rate for Payer: Prime Health Services Commercial |
$573.75
|
|
|
HC SOGDX 317 SIX1 81479
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914808
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Adventist Health Commercial |
$135.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$573.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$371.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$506.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$326.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$392.65
|
| Rate for Payer: Blue Shield of California Commercial |
$425.25
|
| Rate for Payer: Blue Shield of California EPN |
$267.98
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Central Health Plan Commercial |
$540.00
|
| Rate for Payer: Cigna of CA HMO |
$432.00
|
| Rate for Payer: Cigna of CA PPO |
$499.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$573.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$573.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$573.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$472.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.00
|
| Rate for Payer: EPIC Health Plan Senior |
$270.00
|
| Rate for Payer: Galaxy Health WC |
$573.75
|
| Rate for Payer: Global Benefits Group Commercial |
$405.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$607.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$428.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$398.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$472.50
|
| Rate for Payer: Multiplan Commercial |
$506.25
|
| Rate for Payer: Networks By Design Commercial |
$438.75
|
| Rate for Payer: Prime Health Services Commercial |
$573.75
|
| Rate for Payer: Riverside University Health System MISP |
$270.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$405.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$405.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$337.50
|
| Rate for Payer: United Healthcare All Other HMO |
$337.50
|
| Rate for Payer: United Healthcare HMO Rider |
$337.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$573.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$573.75
|
| Rate for Payer: Vantage Medical Group Senior |
$573.75
|
|
|
HC SOGDX 559 TP53 GENE 81405
|
Facility
|
OP
|
$1,395.00
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914849
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$244.10 |
| Max. Negotiated Rate |
$2,383.56 |
| Rate for Payer: Adventist Health Commercial |
$279.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$301.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$644.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$331.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$301.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,714.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,383.56
|
| Rate for Payer: Blue Shield of California Commercial |
$878.85
|
| Rate for Payer: Blue Shield of California EPN |
$553.82
|
| Rate for Payer: Cash Price |
$627.75
|
| Rate for Payer: Cash Price |
$627.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,116.00
|
| Rate for Payer: Cigna of CA HMO |
$892.80
|
| Rate for Payer: Cigna of CA PPO |
$1,032.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$452.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$331.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$301.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$976.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.23
|
| Rate for Payer: EPIC Health Plan Senior |
$331.49
|
| Rate for Payer: Galaxy Health WC |
$1,185.75
|
| Rate for Payer: Global Benefits Group Commercial |
$837.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,255.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$494.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$518.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$301.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$885.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$572.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$421.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$403.81
|
| Rate for Payer: Multiplan Commercial |
$1,046.25
|
| Rate for Payer: Networks By Design Commercial |
$906.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$301.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,185.75
|
| Rate for Payer: Prime Health Services Medicare |
$319.43
|
| Rate for Payer: Riverside University Health System MISP |
$331.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$837.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$837.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$244.10
|
| Rate for Payer: United Healthcare All Other HMO |
$244.10
|
| Rate for Payer: United Healthcare HMO Rider |
$244.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$244.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$301.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$331.49
|
| Rate for Payer: Vantage Medical Group Senior |
$301.35
|
|
|
HC SOGDX 559 TP53 GENE 81405
|
Facility
|
IP
|
$1,395.00
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914849
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$279.00 |
| Max. Negotiated Rate |
$1,255.50 |
| Rate for Payer: Adventist Health Commercial |
$279.00
|
| Rate for Payer: Cash Price |
$627.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,116.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$976.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$558.00
|
| Rate for Payer: EPIC Health Plan Senior |
$558.00
|
| Rate for Payer: Galaxy Health WC |
$1,185.75
|
| Rate for Payer: Global Benefits Group Commercial |
$837.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,255.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$885.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$823.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.00
|
| Rate for Payer: Multiplan Commercial |
$1,046.25
|
| Rate for Payer: Networks By Design Commercial |
$906.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,185.75
|
|
|
HC SOHAR HERED PARAGANG PHEO A
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914679
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Adventist Health Commercial |
$240.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,020.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$660.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$900.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$581.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$698.04
|
| Rate for Payer: Blue Shield of California Commercial |
$756.00
|
| Rate for Payer: Blue Shield of California EPN |
$476.40
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Central Health Plan Commercial |
$960.00
|
| Rate for Payer: Cigna of CA HMO |
$768.00
|
| Rate for Payer: Cigna of CA PPO |
$888.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,020.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,020.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,020.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$840.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$480.00
|
| Rate for Payer: EPIC Health Plan Senior |
$480.00
|
| Rate for Payer: Galaxy Health WC |
$1,020.00
|
| Rate for Payer: Global Benefits Group Commercial |
$720.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,080.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$762.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$708.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$840.00
|
| Rate for Payer: Multiplan Commercial |
$900.00
|
| Rate for Payer: Networks By Design Commercial |
$780.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,020.00
|
| Rate for Payer: Riverside University Health System MISP |
$480.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$720.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$720.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$600.00
|
| Rate for Payer: United Healthcare All Other HMO |
$600.00
|
| Rate for Payer: United Healthcare HMO Rider |
$600.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$600.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,020.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,020.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,020.00
|
|
|
HC SOHAR HERED PARAGANG PHEO A
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914679
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Adventist Health Commercial |
$240.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Central Health Plan Commercial |
$960.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$840.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$480.00
|
| Rate for Payer: EPIC Health Plan Senior |
$480.00
|
| Rate for Payer: Galaxy Health WC |
$1,020.00
|
| Rate for Payer: Global Benefits Group Commercial |
$720.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,080.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$762.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$708.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.00
|
| Rate for Payer: Multiplan Commercial |
$900.00
|
| Rate for Payer: Networks By Design Commercial |
$780.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,020.00
|
|
|
HC SOHAR HERED PARAGANG PHEO B
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914680
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$425.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$242.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$290.85
|
| Rate for Payer: Blue Shield of California Commercial |
$315.00
|
| Rate for Payer: Blue Shield of California EPN |
$198.50
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Central Health Plan Commercial |
$400.00
|
| Rate for Payer: Cigna of CA HMO |
$320.00
|
| Rate for Payer: Cigna of CA PPO |
$370.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$425.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$425.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$350.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$200.00
|
| Rate for Payer: Galaxy Health WC |
$425.00
|
| Rate for Payer: Global Benefits Group Commercial |
$300.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$450.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$317.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$295.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$350.00
|
| Rate for Payer: Multiplan Commercial |
$375.00
|
| Rate for Payer: Networks By Design Commercial |
$325.00
|
| Rate for Payer: Prime Health Services Commercial |
$425.00
|
| Rate for Payer: Riverside University Health System MISP |
$200.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$300.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$300.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$250.00
|
| Rate for Payer: United Healthcare All Other HMO |
$250.00
|
| Rate for Payer: United Healthcare HMO Rider |
$250.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$250.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$425.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.00
|
| Rate for Payer: Vantage Medical Group Senior |
$425.00
|
|
|
HC SOHAR HERED PARAGANG PHEO B
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914680
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Central Health Plan Commercial |
$400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$350.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$200.00
|
| Rate for Payer: Galaxy Health WC |
$425.00
|
| Rate for Payer: Global Benefits Group Commercial |
$300.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$450.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$317.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$295.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| Rate for Payer: Multiplan Commercial |
$375.00
|
| Rate for Payer: Networks By Design Commercial |
$325.00
|
| Rate for Payer: Prime Health Services Commercial |
$425.00
|
|
|
HC SOHAR HERED PARAGANG PHEO C
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914681
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Adventist Health Commercial |
$170.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$722.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$637.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$411.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$494.44
|
| Rate for Payer: Blue Shield of California Commercial |
$535.50
|
| Rate for Payer: Blue Shield of California EPN |
$337.45
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Central Health Plan Commercial |
$680.00
|
| Rate for Payer: Cigna of CA HMO |
$544.00
|
| Rate for Payer: Cigna of CA PPO |
$629.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$722.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$722.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$722.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$595.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.00
|
| Rate for Payer: EPIC Health Plan Senior |
$340.00
|
| Rate for Payer: Galaxy Health WC |
$722.50
|
| Rate for Payer: Global Benefits Group Commercial |
$510.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$765.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$539.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$501.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$595.00
|
| Rate for Payer: Multiplan Commercial |
$637.50
|
| Rate for Payer: Networks By Design Commercial |
$552.50
|
| Rate for Payer: Prime Health Services Commercial |
$722.50
|
| Rate for Payer: Riverside University Health System MISP |
$340.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$510.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$510.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO |
$425.00
|
| Rate for Payer: United Healthcare HMO Rider |
$425.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$425.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$722.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$722.50
|
| Rate for Payer: Vantage Medical Group Senior |
$722.50
|
|
|
HC SOHAR HERED PARAGANG PHEO C
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914681
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Adventist Health Commercial |
$170.00
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Central Health Plan Commercial |
$680.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$595.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.00
|
| Rate for Payer: EPIC Health Plan Senior |
$340.00
|
| Rate for Payer: Galaxy Health WC |
$722.50
|
| Rate for Payer: Global Benefits Group Commercial |
$510.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$765.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$539.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$501.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.00
|
| Rate for Payer: Multiplan Commercial |
$637.50
|
| Rate for Payer: Networks By Design Commercial |
$552.50
|
| Rate for Payer: Prime Health Services Commercial |
$722.50
|
|
|
HC SOK KARIUS TEST
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
CPT 0152U
|
| Hospital Charge Code |
900915508
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.04 |
| Max. Negotiated Rate |
$11,088.87 |
| Rate for Payer: Adventist Health Commercial |
$320.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,126.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,088.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,189.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,338.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,126.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1,008.00
|
| Rate for Payer: Blue Shield of California EPN |
$635.20
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,280.00
|
| Rate for Payer: Cigna of CA HMO |
$1,024.00
|
| Rate for Payer: Cigna of CA PPO |
$1,184.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,189.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,338.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,126.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,508.23
|
| Rate for Payer: EPIC Health Plan Senior |
$2,338.82
|
| Rate for Payer: Galaxy Health WC |
$1,360.00
|
| Rate for Payer: Global Benefits Group Commercial |
$960.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,440.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,486.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,126.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,016.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$580.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,976.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,849.11
|
| Rate for Payer: Multiplan Commercial |
$1,200.00
|
| Rate for Payer: Networks By Design Commercial |
$1,040.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,126.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,360.00
|
| Rate for Payer: Prime Health Services Medicare |
$2,253.77
|
| Rate for Payer: Riverside University Health System MISP |
$2,338.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$960.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$960.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,722.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1,722.22
|
| Rate for Payer: United Healthcare HMO Rider |
$1,722.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,722.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,126.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,189.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,338.82
|
| Rate for Payer: Vantage Medical Group Senior |
$2,126.20
|
|
|
HC SOK KARIUS TEST
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
CPT 0152U
|
| Hospital Charge Code |
900915508
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$320.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Adventist Health Commercial |
$320.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,280.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.00
|
| Rate for Payer: EPIC Health Plan Senior |
$640.00
|
| Rate for Payer: Galaxy Health WC |
$1,360.00
|
| Rate for Payer: Global Benefits Group Commercial |
$960.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,440.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,016.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$944.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.00
|
| Rate for Payer: Multiplan Commercial |
$1,200.00
|
| Rate for Payer: Networks By Design Commercial |
$1,040.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,360.00
|
|
|
HC SOLE FULL SHOE ADD
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT L3540
|
| Hospital Charge Code |
915353540
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.02 |
| Max. Negotiated Rate |
$164.70 |
| Rate for Payer: Adventist Health Commercial |
$75.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$155.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.45
|
| Rate for Payer: Blue Shield of California Commercial |
$146.77
|
| Rate for Payer: Blue Shield of California EPN |
$92.23
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Central Health Plan Commercial |
$146.40
|
| Rate for Payer: Cigna of CA HMO |
$128.10
|
| Rate for Payer: Cigna of CA PPO |
$128.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$155.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$155.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$155.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.20
|
| Rate for Payer: EPIC Health Plan Senior |
$73.20
|
| Rate for Payer: Galaxy Health WC |
$155.55
|
| Rate for Payer: Global Benefits Group Commercial |
$109.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$164.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$55.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$128.10
|
| Rate for Payer: Multiplan Commercial |
$137.25
|
| Rate for Payer: Networks By Design Commercial |
$91.50
|
| Rate for Payer: Prime Health Services Commercial |
$155.55
|
| Rate for Payer: Riverside University Health System MISP |
$73.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.68
|
| Rate for Payer: United Healthcare All Other HMO |
$66.85
|
| Rate for Payer: United Healthcare HMO Rider |
$65.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$155.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$155.55
|
| Rate for Payer: Vantage Medical Group Senior |
$155.55
|
|
