|
HC TCAT INTRA COR INFUS SUPSAT OXY
|
Facility
|
OP
|
$2,095.00
|
|
|
Service Code
|
CPT 0659T
|
| Hospital Charge Code |
906810659
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$419.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$419.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,780.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,152.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,571.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,286.54
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$942.75
|
| Rate for Payer: Cash Price |
$942.75
|
| Rate for Payer: Cigna of CA HMO |
$1,361.75
|
| Rate for Payer: Cigna of CA PPO |
$1,550.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,780.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,780.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,780.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$838.00
|
| Rate for Payer: EPIC Health Plan Senior |
$838.00
|
| Rate for Payer: Galaxy Health WC |
$1,780.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,257.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,397.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$798.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,296.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$502.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,466.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,466.50
|
| Rate for Payer: Multiplan Commercial |
$1,676.00
|
| Rate for Payer: Networks By Design Commercial |
$1,361.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,780.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,257.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,257.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,780.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,780.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,780.75
|
|
|
HC TCAT PLMT AND OR RMVL CEREBRAL EMOLIC
|
Facility
|
OP
|
$68,406.00
|
|
|
Service Code
|
CPT 33370
|
| Hospital Charge Code |
906813370
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$185.14 |
| Max. Negotiated Rate |
$58,145.10 |
| Rate for Payer: Adventist Health Commercial |
$13,681.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58,145.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37,623.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51,304.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$30,782.70
|
| Rate for Payer: Cash Price |
$30,782.70
|
| Rate for Payer: Cash Price |
$30,782.70
|
| Rate for Payer: Cigna of CA HMO |
$43,779.84
|
| Rate for Payer: Cigna of CA PPO |
$50,620.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58,145.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$58,145.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58,145.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$27,362.40
|
| Rate for Payer: EPIC Health Plan Senior |
$27,362.40
|
| Rate for Payer: Galaxy Health WC |
$58,145.10
|
| Rate for Payer: Global Benefits Group Commercial |
$41,043.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$185.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45,626.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42,343.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16,417.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47,884.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47,884.20
|
| Rate for Payer: Multiplan Commercial |
$54,724.80
|
| Rate for Payer: Networks By Design Commercial |
$44,463.90
|
| Rate for Payer: Prime Health Services Commercial |
$58,145.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41,043.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58,145.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58,145.10
|
| Rate for Payer: Vantage Medical Group Senior |
$58,145.10
|
|
|
HC TCAT PLMT AND OR RMVL CEREBRAL EMOLIC
|
Facility
|
IP
|
$68,406.00
|
|
|
Service Code
|
CPT 33370
|
| Hospital Charge Code |
906813370
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$13,681.20 |
| Max. Negotiated Rate |
$58,145.10 |
| Rate for Payer: Adventist Health Commercial |
$13,681.20
|
| Rate for Payer: Cash Price |
$30,782.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$27,362.40
|
| Rate for Payer: EPIC Health Plan Senior |
$27,362.40
|
| Rate for Payer: Galaxy Health WC |
$58,145.10
|
| Rate for Payer: Global Benefits Group Commercial |
$41,043.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45,626.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26,062.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42,343.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16,417.44
|
| Rate for Payer: Multiplan Commercial |
$54,724.80
|
| Rate for Payer: Networks By Design Commercial |
$44,463.90
|
| Rate for Payer: Prime Health Services Commercial |
$58,145.10
|
|
|
HC TCAT RMVL PERM LDLS PM R VENTR
|
Facility
|
IP
|
$7,898.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
906833275
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,579.60 |
| Max. Negotiated Rate |
$6,713.30 |
| Rate for Payer: Adventist Health Commercial |
$1,579.60
|
| Rate for Payer: Cash Price |
$3,554.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,159.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,159.20
|
| Rate for Payer: Galaxy Health WC |
$6,713.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,738.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,267.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,009.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,888.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,895.52
|
| Rate for Payer: Multiplan Commercial |
$6,318.40
|
| Rate for Payer: Networks By Design Commercial |
$5,133.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,713.30
|
|
|
HC TCAT RMVL PERM LDLS PM R VENTR
|
Facility
|
OP
|
$7,676.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
906820335
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$741.18 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,535.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,490.94
|
| Rate for Payer: Cash Price |
$3,454.20
|
| Rate for Payer: Cash Price |
$3,454.20
|
| Rate for Payer: Cash Price |
$3,454.20
|
| Rate for Payer: Cigna of CA HMO |
$4,912.64
|
| Rate for Payer: Cigna of CA PPO |
$5,680.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$6,524.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,605.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$741.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,119.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,842.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$6,140.80
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$4,989.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,524.60
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,605.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC TCAT RMVL PERM LDLS PM R VENTR
|
Facility
|
IP
|
$7,676.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
906820335
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,535.20 |
| Max. Negotiated Rate |
$6,524.60 |
| Rate for Payer: Adventist Health Commercial |
$1,535.20
|
| Rate for Payer: Cash Price |
$3,454.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,070.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,070.40
|
| Rate for Payer: Galaxy Health WC |
$6,524.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,605.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,119.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,924.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,751.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,842.24
|
| Rate for Payer: Multiplan Commercial |
$6,140.80
|
| Rate for Payer: Networks By Design Commercial |
$4,989.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,524.60
|
|
|
HC TCAT RMVL PERM LDLS PM R VENTR
|
Facility
|
OP
|
$7,898.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
906833275
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$741.18 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,579.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,490.94
|
| Rate for Payer: Cash Price |
$3,554.10
|
| Rate for Payer: Cash Price |
$3,554.10
|
| Rate for Payer: Cash Price |
$3,554.10
|
| Rate for Payer: Cigna of CA HMO |
$5,054.72
|
| Rate for Payer: Cigna of CA PPO |
$5,844.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$6,713.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,738.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$741.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,267.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,895.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$6,318.40
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$5,133.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,713.30
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,738.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC TCELL ABSOLUTE CD4
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
903900104
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.69 |
| Max. Negotiated Rate |
$265.99 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$93.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$265.99
|
| Rate for Payer: Blue Shield of California Commercial |
$95.00
|
| Rate for Payer: Blue Shield of California EPN |
$62.76
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna of CA HMO |
$90.88
|
| Rate for Payer: Cigna of CA PPO |
$105.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.15
|
| Rate for Payer: EPIC Health Plan Senior |
$26.78
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.89
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.69
|
| Rate for Payer: United Healthcare All Other HMO |
$21.69
|
| Rate for Payer: United Healthcare HMO Rider |
$21.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Vantage Medical Group Senior |
$26.78
|
|
|
HC TCELL ABSOLUTE CD4
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
903900104
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Adventist Health Commercial |
$78.00
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.00
|
| Rate for Payer: EPIC Health Plan Senior |
$156.00
|
| Rate for Payer: Galaxy Health WC |
$331.50
|
| Rate for Payer: Global Benefits Group Commercial |
$234.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$241.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.60
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Networks By Design Commercial |
$253.50
|
| Rate for Payer: Prime Health Services Commercial |
$331.50
|
|
|
HC TCELL ABSOLUTE CD8
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
903900105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$84.60 |
| Max. Negotiated Rate |
$359.55 |
| Rate for Payer: Adventist Health Commercial |
$84.60
|
| Rate for Payer: Cash Price |
$190.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.20
|
| Rate for Payer: EPIC Health Plan Senior |
$169.20
|
| Rate for Payer: Galaxy Health WC |
$359.55
|
| Rate for Payer: Global Benefits Group Commercial |
$253.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$261.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.52
|
| Rate for Payer: Multiplan Commercial |
$338.40
|
| Rate for Payer: Networks By Design Commercial |
$274.95
|
| Rate for Payer: Prime Health Services Commercial |
$359.55
|
|
|
HC TCELL ABSOLUTE CD8
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
903900105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$389.74 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$93.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$389.74
|
| Rate for Payer: Blue Shield of California Commercial |
$95.00
|
| Rate for Payer: Blue Shield of California EPN |
$62.76
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna of CA HMO |
$90.88
|
| Rate for Payer: Cigna of CA PPO |
$105.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.42
|
| Rate for Payer: EPIC Health Plan Senior |
$46.98
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$46.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.95
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.05
|
| Rate for Payer: United Healthcare All Other HMO |
$38.05
|
| Rate for Payer: United Healthcare HMO Rider |
$38.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$46.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.68
|
| Rate for Payer: Vantage Medical Group Senior |
$46.98
|
|
|
HC TCELL TOTAL COUNT CD2/CD3
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
903900101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$84.60 |
| Max. Negotiated Rate |
$359.55 |
| Rate for Payer: Adventist Health Commercial |
$84.60
|
| Rate for Payer: Cash Price |
$190.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.20
|
| Rate for Payer: EPIC Health Plan Senior |
$169.20
|
| Rate for Payer: Galaxy Health WC |
$359.55
|
| Rate for Payer: Global Benefits Group Commercial |
$253.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$261.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.52
|
| Rate for Payer: Multiplan Commercial |
$338.40
|
| Rate for Payer: Networks By Design Commercial |
$274.95
|
| Rate for Payer: Prime Health Services Commercial |
$359.55
|
|
|
HC TCELL TOTAL COUNT CD2/CD3
|
Facility
|
OP
|
$182.16
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
903900101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.56 |
| Max. Negotiated Rate |
$373.25 |
| Rate for Payer: Adventist Health Commercial |
$36.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$373.25
|
| Rate for Payer: Blue Shield of California Commercial |
$121.87
|
| Rate for Payer: Blue Shield of California EPN |
$80.51
|
| Rate for Payer: Cash Price |
$81.97
|
| Rate for Payer: Cash Price |
$81.97
|
| Rate for Payer: Cigna of CA HMO |
$116.58
|
| Rate for Payer: Cigna of CA PPO |
$134.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.94
|
| Rate for Payer: EPIC Health Plan Senior |
$37.73
|
| Rate for Payer: Galaxy Health WC |
$154.84
|
| Rate for Payer: Global Benefits Group Commercial |
$109.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$145.73
|
| Rate for Payer: Networks By Design Commercial |
$118.40
|
| Rate for Payer: Prime Health Services Commercial |
$154.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.56
|
| Rate for Payer: United Healthcare All Other HMO |
$30.56
|
| Rate for Payer: United Healthcare HMO Rider |
$30.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC TD ELECT HOOD SWITCH CONTROL
|
Facility
|
IP
|
$3,454.00
|
|
|
Service Code
|
CPT L7045
|
| Hospital Charge Code |
905357045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$690.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$690.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,554.30
|
| Rate for Payer: Cash Price |
$1,554.30
|
| Rate for Payer: Cigna of CA HMO |
$2,417.80
|
| Rate for Payer: Cigna of CA PPO |
$2,417.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,381.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,381.60
|
| Rate for Payer: Galaxy Health WC |
$2,935.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,072.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,303.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,315.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,138.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$828.96
|
| Rate for Payer: Multiplan Commercial |
$2,763.20
|
| Rate for Payer: Networks By Design Commercial |
$1,727.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,935.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,296.29
|
| Rate for Payer: United Healthcare All Other HMO |
$1,261.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1,234.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,131.18
|
|
|
HC TD ELECT HOOD SWITCH CONTROL
|
Facility
|
IP
|
$3,454.00
|
|
|
Service Code
|
CPT L7045
|
| Hospital Charge Code |
915357045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$690.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$690.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,554.30
|
| Rate for Payer: Cash Price |
$1,554.30
|
| Rate for Payer: Cigna of CA HMO |
$2,417.80
|
| Rate for Payer: Cigna of CA PPO |
$2,417.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,381.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,381.60
|
| Rate for Payer: Galaxy Health WC |
$2,935.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,072.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,303.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,315.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,138.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$828.96
|
| Rate for Payer: Multiplan Commercial |
$2,763.20
|
| Rate for Payer: Networks By Design Commercial |
$1,727.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,935.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,296.29
|
| Rate for Payer: United Healthcare All Other HMO |
$1,261.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1,234.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,131.18
|
|
|
HC TD ELECT HOOD SWITCH CONTROL
|
Facility
|
OP
|
$3,454.00
|
|
|
Service Code
|
CPT L7045
|
| Hospital Charge Code |
905357045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$828.96 |
| Max. Negotiated Rate |
$2,935.90 |
| Rate for Payer: Adventist Health Commercial |
$1,416.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,935.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,899.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,590.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,000.56
|
| Rate for Payer: Blue Shield of California Commercial |
$2,549.05
|
| Rate for Payer: Blue Shield of California EPN |
$1,678.64
|
| Rate for Payer: Cash Price |
$1,554.30
|
| Rate for Payer: Cash Price |
$1,554.30
|
| Rate for Payer: Cigna of CA HMO |
$2,417.80
|
| Rate for Payer: Cigna of CA PPO |
$2,417.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,935.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,935.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,935.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,381.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,381.60
|
| Rate for Payer: Galaxy Health WC |
$2,935.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,072.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,135.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,303.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,283.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,138.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$828.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,417.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,417.80
|
| Rate for Payer: Multiplan Commercial |
$2,763.20
|
| Rate for Payer: Networks By Design Commercial |
$1,727.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,935.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,072.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,072.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,296.29
|
| Rate for Payer: United Healthcare All Other HMO |
$1,261.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1,234.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,131.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,935.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,935.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,935.90
|
|
|
HC TD ELECT HOOD SWITCH CONTROL
|
Facility
|
OP
|
$3,454.00
|
|
|
Service Code
|
CPT L7045
|
| Hospital Charge Code |
915357045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$828.96 |
| Max. Negotiated Rate |
$2,935.90 |
| Rate for Payer: Adventist Health Commercial |
$1,416.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,935.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,899.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,590.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,000.56
|
| Rate for Payer: Blue Shield of California Commercial |
$2,549.05
|
| Rate for Payer: Blue Shield of California EPN |
$1,678.64
|
| Rate for Payer: Cash Price |
$1,554.30
|
| Rate for Payer: Cash Price |
$1,554.30
|
| Rate for Payer: Cigna of CA HMO |
$2,417.80
|
| Rate for Payer: Cigna of CA PPO |
$2,417.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,935.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,935.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,935.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,381.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,381.60
|
| Rate for Payer: Galaxy Health WC |
$2,935.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,072.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,135.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,303.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,283.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,138.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$828.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,417.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,417.80
|
| Rate for Payer: Multiplan Commercial |
$2,763.20
|
| Rate for Payer: Networks By Design Commercial |
$1,727.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,935.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,072.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,072.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,296.29
|
| Rate for Payer: United Healthcare All Other HMO |
$1,261.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1,234.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,131.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,935.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,935.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,935.90
|
|
|
HC TD GLOVE ABOVE HANDS PROD GLVE
|
Facility
|
OP
|
$712.00
|
|
|
Service Code
|
CPT L6890
|
| Hospital Charge Code |
905356890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$155.22 |
| Max. Negotiated Rate |
$605.20 |
| Rate for Payer: Adventist Health Commercial |
$291.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$605.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$391.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$534.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$412.39
|
| Rate for Payer: Blue Shield of California Commercial |
$525.46
|
| Rate for Payer: Blue Shield of California EPN |
$346.03
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cigna of CA HMO |
$498.40
|
| Rate for Payer: Cigna of CA PPO |
$498.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$605.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$605.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$605.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.80
|
| Rate for Payer: EPIC Health Plan Senior |
$284.80
|
| Rate for Payer: Galaxy Health WC |
$605.20
|
| Rate for Payer: Global Benefits Group Commercial |
$427.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$155.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$474.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$440.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$498.40
|
| Rate for Payer: Multiplan Commercial |
$569.60
|
| Rate for Payer: Networks By Design Commercial |
$356.00
|
| Rate for Payer: Prime Health Services Commercial |
$605.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$427.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$427.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.21
|
| Rate for Payer: United Healthcare All Other HMO |
$260.09
|
| Rate for Payer: United Healthcare HMO Rider |
$254.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$233.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$605.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$605.20
|
| Rate for Payer: Vantage Medical Group Senior |
$605.20
|
|
|
HC TD GLOVE ABOVE HANDS PROD GLVE
|
Facility
|
OP
|
$712.00
|
|
|
Service Code
|
CPT L6890
|
| Hospital Charge Code |
915356890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$155.22 |
| Max. Negotiated Rate |
$605.20 |
| Rate for Payer: Adventist Health Commercial |
$291.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$605.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$391.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$534.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$412.39
|
| Rate for Payer: Blue Shield of California Commercial |
$525.46
|
| Rate for Payer: Blue Shield of California EPN |
$346.03
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cigna of CA HMO |
$498.40
|
| Rate for Payer: Cigna of CA PPO |
$498.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$605.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$605.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$605.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.80
|
| Rate for Payer: EPIC Health Plan Senior |
$284.80
|
| Rate for Payer: Galaxy Health WC |
$605.20
|
| Rate for Payer: Global Benefits Group Commercial |
$427.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$155.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$474.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$440.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$498.40
|
| Rate for Payer: Multiplan Commercial |
$569.60
|
| Rate for Payer: Networks By Design Commercial |
$356.00
|
| Rate for Payer: Prime Health Services Commercial |
$605.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$427.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$427.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.21
|
| Rate for Payer: United Healthcare All Other HMO |
$260.09
|
| Rate for Payer: United Healthcare HMO Rider |
$254.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$233.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$605.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$605.20
|
| Rate for Payer: Vantage Medical Group Senior |
$605.20
|
|
|
HC TD GLOVE ABOVE HANDS PROD GLVE
|
Facility
|
IP
|
$712.00
|
|
|
Service Code
|
CPT L6890
|
| Hospital Charge Code |
905356890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$142.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cigna of CA HMO |
$498.40
|
| Rate for Payer: Cigna of CA PPO |
$498.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.80
|
| Rate for Payer: EPIC Health Plan Senior |
$284.80
|
| Rate for Payer: Galaxy Health WC |
$605.20
|
| Rate for Payer: Global Benefits Group Commercial |
$427.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$474.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$271.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$440.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.88
|
| Rate for Payer: Multiplan Commercial |
$569.60
|
| Rate for Payer: Networks By Design Commercial |
$356.00
|
| Rate for Payer: Prime Health Services Commercial |
$605.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.21
|
| Rate for Payer: United Healthcare All Other HMO |
$260.09
|
| Rate for Payer: United Healthcare HMO Rider |
$254.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$233.18
|
|
|
HC TD GLOVE ABOVE HANDS PROD GLVE
|
Facility
|
IP
|
$712.00
|
|
|
Service Code
|
CPT L6890
|
| Hospital Charge Code |
915356890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$142.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cigna of CA HMO |
$498.40
|
| Rate for Payer: Cigna of CA PPO |
$498.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.80
|
| Rate for Payer: EPIC Health Plan Senior |
$284.80
|
| Rate for Payer: Galaxy Health WC |
$605.20
|
| Rate for Payer: Global Benefits Group Commercial |
$427.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$474.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$271.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$440.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.88
|
| Rate for Payer: Multiplan Commercial |
$569.60
|
| Rate for Payer: Networks By Design Commercial |
$356.00
|
| Rate for Payer: Prime Health Services Commercial |
$605.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.21
|
| Rate for Payer: United Healthcare All Other HMO |
$260.09
|
| Rate for Payer: United Healthcare HMO Rider |
$254.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$233.18
|
|
|
HC TD GLOVE CUSTOM
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
CPT L6895
|
| Hospital Charge Code |
905356895
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$208.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cigna of CA HMO |
$728.00
|
| Rate for Payer: Cigna of CA PPO |
$728.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.00
|
| Rate for Payer: EPIC Health Plan Senior |
$416.00
|
| Rate for Payer: Galaxy Health WC |
$884.00
|
| Rate for Payer: Global Benefits Group Commercial |
$624.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$693.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$643.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.60
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: Networks By Design Commercial |
$520.00
|
| Rate for Payer: Prime Health Services Commercial |
$884.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$390.31
|
| Rate for Payer: United Healthcare All Other HMO |
$379.91
|
| Rate for Payer: United Healthcare HMO Rider |
$371.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.60
|
|
|
HC TD GLOVE CUSTOM
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
CPT L6895
|
| Hospital Charge Code |
905356895
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$249.60 |
| Max. Negotiated Rate |
$884.00 |
| Rate for Payer: Adventist Health Commercial |
$426.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$884.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$572.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$602.37
|
| Rate for Payer: Blue Shield of California Commercial |
$767.52
|
| Rate for Payer: Blue Shield of California EPN |
$505.44
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cigna of CA HMO |
$728.00
|
| Rate for Payer: Cigna of CA PPO |
$728.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$884.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$884.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$884.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.00
|
| Rate for Payer: EPIC Health Plan Senior |
$416.00
|
| Rate for Payer: Galaxy Health WC |
$884.00
|
| Rate for Payer: Global Benefits Group Commercial |
$624.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$361.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$693.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$643.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$728.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$728.00
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: Networks By Design Commercial |
$520.00
|
| Rate for Payer: Prime Health Services Commercial |
$884.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$624.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$624.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$390.31
|
| Rate for Payer: United Healthcare All Other HMO |
$379.91
|
| Rate for Payer: United Healthcare HMO Rider |
$371.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$884.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$884.00
|
| Rate for Payer: Vantage Medical Group Senior |
$884.00
|
|
|
HC TD GLOVE CUSTOM
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
CPT L6895
|
| Hospital Charge Code |
915356895
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$249.60 |
| Max. Negotiated Rate |
$884.00 |
| Rate for Payer: Adventist Health Commercial |
$426.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$884.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$572.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$602.37
|
| Rate for Payer: Blue Shield of California Commercial |
$767.52
|
| Rate for Payer: Blue Shield of California EPN |
$505.44
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cigna of CA HMO |
$728.00
|
| Rate for Payer: Cigna of CA PPO |
$728.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$884.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$884.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$884.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.00
|
| Rate for Payer: EPIC Health Plan Senior |
$416.00
|
| Rate for Payer: Galaxy Health WC |
$884.00
|
| Rate for Payer: Global Benefits Group Commercial |
$624.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$361.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$693.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$643.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$728.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$728.00
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: Networks By Design Commercial |
$520.00
|
| Rate for Payer: Prime Health Services Commercial |
$884.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$624.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$624.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$390.31
|
| Rate for Payer: United Healthcare All Other HMO |
$379.91
|
| Rate for Payer: United Healthcare HMO Rider |
$371.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$884.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$884.00
|
| Rate for Payer: Vantage Medical Group Senior |
$884.00
|
|
|
HC TD GLOVE CUSTOM
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
CPT L6895
|
| Hospital Charge Code |
915356895
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$208.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cigna of CA HMO |
$728.00
|
| Rate for Payer: Cigna of CA PPO |
$728.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.00
|
| Rate for Payer: EPIC Health Plan Senior |
$416.00
|
| Rate for Payer: Galaxy Health WC |
$884.00
|
| Rate for Payer: Global Benefits Group Commercial |
$624.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$693.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$643.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.60
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: Networks By Design Commercial |
$520.00
|
| Rate for Payer: Prime Health Services Commercial |
$884.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$390.31
|
| Rate for Payer: United Healthcare All Other HMO |
$379.91
|
| Rate for Payer: United Healthcare HMO Rider |
$371.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.60
|
|
