|
HC TC-99 SUCCIMER/DMSA LT 10 MCI
|
Facility
|
IP
|
$706.00
|
|
|
Service Code
|
CPT A9551
|
| Hospital Charge Code |
909301500
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$141.20 |
| Max. Negotiated Rate |
$600.10 |
| Rate for Payer: Adventist Health Commercial |
$141.20
|
| Rate for Payer: Blue Shield of California Commercial |
$357.94
|
| Rate for Payer: Blue Shield of California Commercial |
$542.91
|
| Rate for Payer: Cash Price |
$317.70
|
| Rate for Payer: Cigna of CA HMO |
$494.20
|
| Rate for Payer: Cigna of CA PPO |
$494.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$494.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.40
|
| Rate for Payer: EPIC Health Plan Senior |
$282.40
|
| Rate for Payer: Galaxy Health WC |
$600.10
|
| Rate for Payer: Global Benefits Group Commercial |
$423.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$448.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$416.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.44
|
| Rate for Payer: Multiplan Commercial |
$564.80
|
| Rate for Payer: Networks By Design Commercial |
$353.00
|
| Rate for Payer: Prime Health Services Commercial |
$600.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.96
|
| Rate for Payer: United Healthcare All Other HMO |
$257.90
|
| Rate for Payer: United Healthcare HMO Rider |
$252.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$231.22
|
|
|
HC TC-99 TETROFOSMN/MYOVIEW LT 40MCI
|
Facility
|
IP
|
$587.00
|
|
|
Service Code
|
CPT A9502
|
| Hospital Charge Code |
909301544
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.40 |
| Max. Negotiated Rate |
$498.95 |
| Rate for Payer: Adventist Health Commercial |
$117.40
|
| Rate for Payer: Blue Shield of California Commercial |
$297.61
|
| Rate for Payer: Blue Shield of California Commercial |
$451.40
|
| Rate for Payer: Cash Price |
$264.15
|
| Rate for Payer: Cigna of CA HMO |
$410.90
|
| Rate for Payer: Cigna of CA PPO |
$410.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$410.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.80
|
| Rate for Payer: EPIC Health Plan Senior |
$234.80
|
| Rate for Payer: Galaxy Health WC |
$498.95
|
| Rate for Payer: Global Benefits Group Commercial |
$352.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$372.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$346.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.88
|
| Rate for Payer: Multiplan Commercial |
$469.60
|
| Rate for Payer: Networks By Design Commercial |
$293.50
|
| Rate for Payer: Prime Health Services Commercial |
$498.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$220.30
|
| Rate for Payer: United Healthcare All Other HMO |
$214.43
|
| Rate for Payer: United Healthcare HMO Rider |
$209.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$192.24
|
|
|
HC TC-99 TETROFOSMN/MYOVIEW LT 40MCI
|
Facility
|
OP
|
$587.00
|
|
|
Service Code
|
CPT A9502
|
| Hospital Charge Code |
909301544
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.40 |
| Max. Negotiated Rate |
$498.95 |
| Rate for Payer: Adventist Health Commercial |
$117.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$498.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$322.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$440.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$268.26
|
| Rate for Payer: Cash Price |
$264.15
|
| Rate for Payer: Cash Price |
$264.15
|
| Rate for Payer: Cigna of CA HMO |
$410.90
|
| Rate for Payer: Cigna of CA PPO |
$410.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$498.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$498.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$498.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$410.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.80
|
| Rate for Payer: EPIC Health Plan Senior |
$234.80
|
| Rate for Payer: Galaxy Health WC |
$498.95
|
| Rate for Payer: Global Benefits Group Commercial |
$352.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$162.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$372.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$184.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$346.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.90
|
| Rate for Payer: Multiplan Commercial |
$469.60
|
| Rate for Payer: Networks By Design Commercial |
$293.50
|
| Rate for Payer: Prime Health Services Commercial |
$498.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$352.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$352.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$220.30
|
| Rate for Payer: United Healthcare All Other HMO |
$214.43
|
| Rate for Payer: United Healthcare HMO Rider |
$209.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$192.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$498.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$498.95
|
| Rate for Payer: Vantage Medical Group Senior |
$498.95
|
|
|
HC TC-99 ULTRATAG UP TO 30 MCI
|
Facility
|
OP
|
$806.00
|
|
|
Service Code
|
CPT A9560
|
| Hospital Charge Code |
909301534
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.02 |
| Max. Negotiated Rate |
$685.10 |
| Rate for Payer: Adventist Health Commercial |
$161.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$443.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$604.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$269.68
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Cigna of CA HMO |
$564.20
|
| Rate for Payer: Cigna of CA PPO |
$564.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$685.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$685.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$564.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$322.40
|
| Rate for Payer: Galaxy Health WC |
$685.10
|
| Rate for Payer: Global Benefits Group Commercial |
$483.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$87.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$511.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$475.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$564.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.20
|
| Rate for Payer: Multiplan Commercial |
$644.80
|
| Rate for Payer: Networks By Design Commercial |
$403.00
|
| Rate for Payer: Prime Health Services Commercial |
$685.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$483.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$483.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.49
|
| Rate for Payer: United Healthcare All Other HMO |
$294.43
|
| Rate for Payer: United Healthcare HMO Rider |
$288.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$685.10
|
| Rate for Payer: Vantage Medical Group Senior |
$685.10
|
|
|
HC TC-99 ULTRATAG UP TO 30 MCI
|
Facility
|
IP
|
$806.00
|
|
|
Service Code
|
CPT A9560
|
| Hospital Charge Code |
909301534
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$161.20 |
| Max. Negotiated Rate |
$685.10 |
| Rate for Payer: Adventist Health Commercial |
$161.20
|
| Rate for Payer: Blue Shield of California Commercial |
$408.64
|
| Rate for Payer: Blue Shield of California Commercial |
$619.81
|
| Rate for Payer: Cash Price |
$362.70
|
| Rate for Payer: Cigna of CA HMO |
$564.20
|
| Rate for Payer: Cigna of CA PPO |
$564.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$564.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$322.40
|
| Rate for Payer: Galaxy Health WC |
$685.10
|
| Rate for Payer: Global Benefits Group Commercial |
$483.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$511.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$475.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.44
|
| Rate for Payer: Multiplan Commercial |
$644.80
|
| Rate for Payer: Networks By Design Commercial |
$403.00
|
| Rate for Payer: Prime Health Services Commercial |
$685.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.49
|
| Rate for Payer: United Healthcare All Other HMO |
$294.43
|
| Rate for Payer: United Healthcare HMO Rider |
$288.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.96
|
|
|
HC TCATH RMVL OR DBLK ICAR MASS OR VEG
|
Facility
|
OP
|
$13,755.00
|
|
|
Service Code
|
CPT 0644T
|
| Hospital Charge Code |
906811644
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$594.18 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,751.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,320.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,826.58
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Cash Price |
$6,189.75
|
| Rate for Payer: Cash Price |
$6,189.75
|
| Rate for Payer: Cash Price |
$6,189.75
|
| Rate for Payer: Cigna of CA HMO |
$8,940.75
|
| Rate for Payer: Cigna of CA PPO |
$10,178.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,052.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,320.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,628.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,078.50
|
| Rate for Payer: EPIC Health Plan Senior |
$8,052.33
|
| Rate for Payer: Galaxy Health WC |
$11,691.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,253.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,005.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,320.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,734.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,993.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,248.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,301.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,223.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,809.20
|
| Rate for Payer: Multiplan Commercial |
$11,004.00
|
| Rate for Payer: Networks By Design Commercial |
$8,940.75
|
| Rate for Payer: Prime Health Services Commercial |
$11,691.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,253.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,253.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,877.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,320.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Vantage Medical Group Senior |
$7,320.30
|
|
|
HC TCATH RMVL OR DBLK ICAR MASS OR VEG
|
Facility
|
IP
|
$13,755.00
|
|
|
Service Code
|
CPT 0644T
|
| Hospital Charge Code |
906811644
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,751.00 |
| Max. Negotiated Rate |
$11,691.75 |
| Rate for Payer: Adventist Health Commercial |
$2,751.00
|
| Rate for Payer: Cash Price |
$6,189.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,628.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,502.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,502.00
|
| Rate for Payer: Galaxy Health WC |
$11,691.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,253.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,734.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,115.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,301.20
|
| Rate for Payer: Multiplan Commercial |
$11,004.00
|
| Rate for Payer: Networks By Design Commercial |
$8,940.75
|
| Rate for Payer: Prime Health Services Commercial |
$11,691.75
|
|
|
HC TCAT IMPL WRLS L ATR PRS SNR
|
Facility
|
IP
|
$8,783.00
|
|
|
Service Code
|
CPT 0933T
|
| Hospital Charge Code |
906811517
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,756.60 |
| Max. Negotiated Rate |
$7,465.55 |
| Rate for Payer: Adventist Health Commercial |
$1,756.60
|
| Rate for Payer: Cash Price |
$3,952.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,148.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,513.20
|
| Rate for Payer: Galaxy Health WC |
$7,465.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,269.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,577.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,181.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,107.92
|
| Rate for Payer: Multiplan Commercial |
$7,026.40
|
| Rate for Payer: Networks By Design Commercial |
$5,708.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,465.55
|
|
|
HC TCAT IMPL WRLS L ATR PRS SNR
|
Facility
|
OP
|
$8,783.00
|
|
|
Service Code
|
CPT 0933T
|
| Hospital Charge Code |
906811517
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$594.18 |
| Max. Negotiated Rate |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,756.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,760.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,169.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Cash Price |
$3,952.35
|
| Rate for Payer: Cash Price |
$3,952.35
|
| Rate for Payer: Cash Price |
$3,952.35
|
| Rate for Payer: Cash Price |
$3,952.35
|
| Rate for Payer: Cigna of CA HMO |
$5,621.12
|
| Rate for Payer: Cigna of CA PPO |
$6,499.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,586.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,169.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,148.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,879.96
|
| Rate for Payer: EPIC Health Plan Senior |
$4,586.64
|
| Rate for Payer: Galaxy Health WC |
$7,465.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,269.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,838.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,169.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,577.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,188.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,837.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,107.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,253.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,587.36
|
| Rate for Payer: Multiplan Commercial |
$7,026.40
|
| Rate for Payer: Networks By Design Commercial |
$5,708.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,465.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,269.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,269.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,169.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4,169.67
|
|
|
HC TCAT IMPL WRLS PUL ART PRS SNR
|
Facility
|
IP
|
$21,440.00
|
|
|
Service Code
|
CPT 33289
|
| Hospital Charge Code |
906811492
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$4,288.00 |
| Max. Negotiated Rate |
$18,224.00 |
| Rate for Payer: Adventist Health Commercial |
$4,288.00
|
| Rate for Payer: Cash Price |
$9,648.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,008.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,576.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,576.00
|
| Rate for Payer: Galaxy Health WC |
$18,224.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12,864.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13,614.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,649.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,145.60
|
| Rate for Payer: Multiplan Commercial |
$17,152.00
|
| Rate for Payer: Networks By Design Commercial |
$13,936.00
|
| Rate for Payer: Prime Health Services Commercial |
$18,224.00
|
|
|
HC TCAT IMPL WRLS PUL ART PRS SNR
|
Facility
|
OP
|
$21,440.00
|
|
|
Service Code
|
CPT 33289
|
| Hospital Charge Code |
906811492
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$463.46 |
| Max. Negotiated Rate |
$60,871.12 |
| Rate for Payer: Adventist Health Commercial |
$4,288.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55,337.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40,580.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,891.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,678.72
|
| Rate for Payer: Blue Shield of California Commercial |
$9,026.24
|
| Rate for Payer: Cash Price |
$9,648.00
|
| Rate for Payer: Cash Price |
$9,648.00
|
| Rate for Payer: Cash Price |
$9,648.00
|
| Rate for Payer: Cash Price |
$9,648.00
|
| Rate for Payer: Cigna of CA HMO |
$13,721.60
|
| Rate for Payer: Cigna of CA PPO |
$15,865.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55,337.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$40,580.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36,891.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,008.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60,871.12
|
| Rate for Payer: EPIC Health Plan Senior |
$40,580.75
|
| Rate for Payer: Galaxy Health WC |
$18,224.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12,864.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$60,502.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$463.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36,891.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13,614.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$524.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51,648.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,145.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46,483.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49,434.73
|
| Rate for Payer: Multiplan Commercial |
$17,152.00
|
| Rate for Payer: Networks By Design Commercial |
$13,936.00
|
| Rate for Payer: Prime Health Services Commercial |
$18,224.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,864.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12,864.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$968.00
|
| Rate for Payer: United Healthcare All Other HMO |
$982.00
|
| Rate for Payer: United Healthcare HMO Rider |
$832.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$762.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$36,891.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55,337.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40,580.75
|
| Rate for Payer: Vantage Medical Group Senior |
$36,891.59
|
|
|
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 |
$1,344.36
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,466.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,330.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$760.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,236.05
|
| 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 |
$1,047.50
|
| 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 INTRA COR INFUS SUPSAT OXY
|
Facility
|
IP
|
$2,095.00
|
|
|
Service Code
|
CPT 0659T
|
| Hospital Charge Code |
906810659
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$419.00 |
| Max. Negotiated Rate |
$1,780.75 |
| Rate for Payer: Adventist Health Commercial |
$419.00
|
| Rate for Payer: Cash Price |
$942.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,466.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,330.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,236.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$502.80
|
| 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
|
|
|
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 |
$32,312.00
|
| 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 |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$47,884.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$43,437.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$209.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40,359.54
|
| 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 |
$34,203.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$47,884.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$43,437.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40,359.54
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,528.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$5,015.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,659.82
|
| 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
|
$7,898.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
906833275
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$741.18 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,579.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,934.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| 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 |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,528.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| 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/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$741.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,015.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$838.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,895.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| 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 |
$3,949.00
|
| 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 |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
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 |
$277.96 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Adventist Health Commercial |
$78.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$222.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$222.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.17
|
| 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 Medi-Cal |
$29.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$277.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$277.96
|
| Rate for Payer: Blue Shield of California Commercial |
$179.79
|
| Rate for Payer: Blue Shield of California Commercial |
$65.46
|
| Rate for Payer: Blue Shield of California Commercial |
$271.83
|
| Rate for Payer: Blue Shield of California Commercial |
$98.97
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna of CA HMO |
$249.60
|
| Rate for Payer: Cigna of CA HMO |
$90.88
|
| Rate for Payer: Cigna of CA PPO |
$105.08
|
| Rate for Payer: Cigna of CA PPO |
$288.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$273.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.19
|
| Rate for Payer: EPIC Health Plan Senior |
$29.46
|
| Rate for Payer: EPIC Health Plan Senior |
$29.46
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Galaxy Health WC |
$331.50
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Global Benefits Group Commercial |
$234.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$43.92
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$43.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.98
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$247.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.89
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: Networks By Design Commercial |
$253.50
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Prime Health Services Commercial |
$331.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$234.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$234.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.69
|
| 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 All Other HMO |
$21.69
|
| Rate for Payer: United Healthcare HMO Rider |
$21.69
|
| Rate for Payer: United Healthcare HMO Rider |
$21.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.78
|
| 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 Commercial/Exchange |
$40.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Vantage Medical Group Senior |
$26.78
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$273.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$247.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$230.10
|
| 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 CD4 AND CD8
|
Facility
|
IP
|
$813.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
903900105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$162.60 |
| Max. Negotiated Rate |
$691.05 |
| Rate for Payer: Adventist Health Commercial |
$162.60
|
| Rate for Payer: Cash Price |
$365.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$569.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.20
|
| Rate for Payer: EPIC Health Plan Senior |
$325.20
|
| Rate for Payer: Galaxy Health WC |
$691.05
|
| Rate for Payer: Global Benefits Group Commercial |
$487.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$516.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$479.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.12
|
| Rate for Payer: Multiplan Commercial |
$650.40
|
| Rate for Payer: Networks By Design Commercial |
$528.45
|
| Rate for Payer: Prime Health Services Commercial |
$691.05
|
|
|
HC TCELL ABSOLUTE CD4 AND 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 |
$407.28 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Adventist Health Commercial |
$162.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$390.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$390.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.47
|
| 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 Medi-Cal |
$51.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$407.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$407.28
|
| Rate for Payer: Blue Shield of California Commercial |
$374.79
|
| Rate for Payer: Blue Shield of California Commercial |
$65.46
|
| Rate for Payer: Blue Shield of California Commercial |
$566.66
|
| Rate for Payer: Blue Shield of California Commercial |
$98.97
|
| Rate for Payer: Cash Price |
$365.85
|
| Rate for Payer: Cash Price |
$365.85
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna of CA HMO |
$520.32
|
| Rate for Payer: Cigna of CA HMO |
$90.88
|
| Rate for Payer: Cigna of CA PPO |
$105.08
|
| Rate for Payer: Cigna of CA PPO |
$601.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$569.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.52
|
| Rate for Payer: EPIC Health Plan Senior |
$51.68
|
| Rate for Payer: EPIC Health Plan Senior |
$51.68
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Galaxy Health WC |
$691.05
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Global Benefits Group Commercial |
$487.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$77.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$77.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.16
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$46.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$516.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.95
|
| Rate for Payer: Multiplan Commercial |
$650.40
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: Networks By Design Commercial |
$528.45
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Prime Health Services Commercial |
$691.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$487.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$487.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.05
|
| 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 All Other HMO |
$38.05
|
| Rate for Payer: United Healthcare HMO Rider |
$38.05
|
| Rate for Payer: United Healthcare HMO Rider |
$38.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$46.98
|
| 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 Commercial/Exchange |
$70.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.68
|
| Rate for Payer: Vantage Medical Group Senior |
$46.98
|
| Rate for Payer: Vantage Medical Group Senior |
$46.98
|
|
|
HC TCELL TOTAL COUNT CD2/CD3
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
903900101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.56 |
| Max. Negotiated Rate |
$390.04 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Adventist Health Commercial |
$84.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$313.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$313.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| 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 Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$390.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$390.04
|
| Rate for Payer: Blue Shield of California Commercial |
$195.00
|
| Rate for Payer: Blue Shield of California Commercial |
$126.85
|
| Rate for Payer: Blue Shield of California Commercial |
$294.83
|
| Rate for Payer: Blue Shield of California Commercial |
$83.90
|
| Rate for Payer: Cash Price |
$190.35
|
| Rate for Payer: Cash Price |
$190.35
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cigna of CA HMO |
$270.72
|
| Rate for Payer: Cigna of CA HMO |
$116.48
|
| Rate for Payer: Cigna of CA PPO |
$134.68
|
| Rate for Payer: Cigna of CA PPO |
$313.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$127.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$296.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.25
|
| Rate for Payer: EPIC Health Plan Senior |
$41.50
|
| Rate for Payer: EPIC Health Plan Senior |
$41.50
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Galaxy Health WC |
$359.55
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Global Benefits Group Commercial |
$253.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.33
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$115.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$268.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$338.40
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Networks By Design Commercial |
$274.95
|
| Rate for Payer: Networks By Design Commercial |
$118.30
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: Prime Health Services Commercial |
$359.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$253.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$253.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.56
|
| 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 All Other HMO |
$30.56
|
| Rate for Payer: United Healthcare HMO Rider |
$30.56
|
| Rate for Payer: United Healthcare HMO Rider |
$30.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.73
|
| 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 Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$296.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$268.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$249.57
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$690.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,193.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,037.86
|
| 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 |
$2,245.10
|
| 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 |
905357045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$690.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$690.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,193.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,037.86
|
| 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 |
$2,245.10
|
| 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
|
|
