|
HC TIBIA FIBULA
|
Facility
|
OP
|
$713.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
909001638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.91 |
| Max. Negotiated Rate |
$606.05 |
| Rate for Payer: Adventist Health Commercial |
$142.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.13
|
| Rate for Payer: Blue Shield of California Commercial |
$300.17
|
| Rate for Payer: Blue Shield of California Commercial |
$454.89
|
| Rate for Payer: Cash Price |
$320.85
|
| Rate for Payer: Cash Price |
$320.85
|
| Rate for Payer: Cigna of CA HMO |
$456.32
|
| Rate for Payer: Cigna of CA PPO |
$527.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$499.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$606.05
|
| Rate for Payer: Global Benefits Group Commercial |
$427.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$452.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$570.40
|
| Rate for Payer: Networks By Design Commercial |
$463.45
|
| Rate for Payer: Prime Health Services Commercial |
$606.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$427.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$427.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC TIBIAL LENGTH SOCK
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT L2840
|
| Hospital Charge Code |
915352840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$26.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Cigna of CA HMO |
$91.70
|
| Rate for Payer: Cigna of CA PPO |
$91.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.40
|
| Rate for Payer: EPIC Health Plan Senior |
$52.40
|
| Rate for Payer: Galaxy Health WC |
$111.35
|
| Rate for Payer: Global Benefits Group Commercial |
$78.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.44
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: Networks By Design Commercial |
$85.15
|
| Rate for Payer: Prime Health Services Commercial |
$111.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.16
|
| Rate for Payer: United Healthcare All Other HMO |
$47.85
|
| Rate for Payer: United Healthcare HMO Rider |
$46.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.90
|
|
|
HC TIBIAL LENGTH SOCK
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT L2840
|
| Hospital Charge Code |
905352840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$111.35 |
| Rate for Payer: Adventist Health Commercial |
$53.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$98.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.29
|
| Rate for Payer: Blue Shield of California Commercial |
$66.42
|
| Rate for Payer: Blue Shield of California Commercial |
$100.74
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Cigna of CA HMO |
$91.70
|
| Rate for Payer: Cigna of CA PPO |
$91.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$111.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$111.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.40
|
| Rate for Payer: EPIC Health Plan Senior |
$52.40
|
| Rate for Payer: Galaxy Health WC |
$111.35
|
| Rate for Payer: Global Benefits Group Commercial |
$78.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$91.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$91.70
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: Networks By Design Commercial |
$65.50
|
| Rate for Payer: Prime Health Services Commercial |
$111.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.16
|
| Rate for Payer: United Healthcare All Other HMO |
$47.85
|
| Rate for Payer: United Healthcare HMO Rider |
$46.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$111.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$111.35
|
| Rate for Payer: Vantage Medical Group Senior |
$111.35
|
|
|
HC TIBIAL LENGTH SOCK
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT L2840
|
| Hospital Charge Code |
905352840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$26.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Cigna of CA HMO |
$91.70
|
| Rate for Payer: Cigna of CA PPO |
$91.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.40
|
| Rate for Payer: EPIC Health Plan Senior |
$52.40
|
| Rate for Payer: Galaxy Health WC |
$111.35
|
| Rate for Payer: Global Benefits Group Commercial |
$78.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.44
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: Networks By Design Commercial |
$85.15
|
| Rate for Payer: Prime Health Services Commercial |
$111.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.16
|
| Rate for Payer: United Healthcare All Other HMO |
$47.85
|
| Rate for Payer: United Healthcare HMO Rider |
$46.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.90
|
|
|
HC TIBIAL LENGTH SOCK
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT L2840
|
| Hospital Charge Code |
915352840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$111.35 |
| Rate for Payer: Vantage Medical Group Senior |
$111.35
|
| Rate for Payer: Adventist Health Commercial |
$53.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$98.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.29
|
| Rate for Payer: Blue Shield of California Commercial |
$66.42
|
| Rate for Payer: Blue Shield of California Commercial |
$100.74
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Cigna of CA HMO |
$91.70
|
| Rate for Payer: Cigna of CA PPO |
$91.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$111.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$111.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.40
|
| Rate for Payer: EPIC Health Plan Senior |
$52.40
|
| Rate for Payer: Galaxy Health WC |
$111.35
|
| Rate for Payer: Global Benefits Group Commercial |
$78.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$91.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$91.70
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: Networks By Design Commercial |
$65.50
|
| Rate for Payer: Prime Health Services Commercial |
$111.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.16
|
| Rate for Payer: United Healthcare All Other HMO |
$47.85
|
| Rate for Payer: United Healthcare HMO Rider |
$46.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$111.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$111.35
|
|
|
HC TIG HUMAN INTRAMUSCULAR USE
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 90389
|
| Hospital Charge Code |
902890180
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$180.20 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$134.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$125.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.88
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Networks By Design Commercial |
$137.80
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
|
|
HC TIG HUMAN INTRAMUSCULAR USE
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 90389
|
| Hospital Charge Code |
902890180
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$4,603.40 |
| Rate for Payer: Adventist Health Commercial |
$86.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,603.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna of CA HMO |
$135.68
|
| Rate for Payer: Cigna of CA PPO |
$156.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$134.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$125.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148.40
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Networks By Design Commercial |
$137.80
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.20
|
| Rate for Payer: Vantage Medical Group Senior |
$180.20
|
|
|
HC TIP ARGYLE YANKAUER SUCTN 12FR
|
Facility
|
OP
|
$4.35
|
|
| Hospital Charge Code |
901698614
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.79
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Cigna of CA HMO |
$2.78
|
| Rate for Payer: Cigna of CA PPO |
$3.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$3.48
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$3.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.17
|
| Rate for Payer: United Healthcare All Other HMO |
$2.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3.70
|
|
|
HC TIP ARGYLE YANKAUER SUCTN 12FR
|
Facility
|
IP
|
$4.35
|
|
| Hospital Charge Code |
901698614
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$3.48
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$3.70
|
|
|
HC TIP DEFLECTING WIRE
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$449.04 |
| Rate for Payer: Adventist Health Commercial |
$39.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$168.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.06
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna of CA HMO |
$126.72
|
| Rate for Payer: Cigna of CA PPO |
$146.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$168.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$168.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$168.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$79.20
|
| Rate for Payer: Galaxy Health WC |
$168.30
|
| Rate for Payer: Global Benefits Group Commercial |
$118.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$138.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$138.60
|
| Rate for Payer: Multiplan Commercial |
$158.40
|
| Rate for Payer: Networks By Design Commercial |
$128.70
|
| Rate for Payer: Prime Health Services Commercial |
$168.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.00
|
| Rate for Payer: United Healthcare All Other HMO |
$99.00
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$168.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$168.30
|
| Rate for Payer: Vantage Medical Group Senior |
$168.30
|
|
|
HC TIP DEFLECTING WIRE
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Adventist Health Commercial |
$39.60
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$79.20
|
| Rate for Payer: Galaxy Health WC |
$168.30
|
| Rate for Payer: Global Benefits Group Commercial |
$118.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.52
|
| Rate for Payer: Multiplan Commercial |
$158.40
|
| Rate for Payer: Networks By Design Commercial |
$128.70
|
| Rate for Payer: Prime Health Services Commercial |
$168.30
|
|
|
HC TIPS CATHETER SET
|
Facility
|
IP
|
$1,062.00
|
|
| Hospital Charge Code |
909081222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$212.40 |
| Max. Negotiated Rate |
$902.70 |
| Rate for Payer: Adventist Health Commercial |
$212.40
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$743.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$424.80
|
| Rate for Payer: EPIC Health Plan Senior |
$424.80
|
| Rate for Payer: Galaxy Health WC |
$902.70
|
| Rate for Payer: Global Benefits Group Commercial |
$637.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$674.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$626.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$254.88
|
| Rate for Payer: Multiplan Commercial |
$849.60
|
| Rate for Payer: Networks By Design Commercial |
$690.30
|
| Rate for Payer: Prime Health Services Commercial |
$902.70
|
|
|
HC TIPS CATHETER SET
|
Facility
|
OP
|
$1,062.00
|
|
| Hospital Charge Code |
909081222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$212.40 |
| Max. Negotiated Rate |
$902.70 |
| Rate for Payer: Adventist Health Commercial |
$212.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$696.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$902.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$584.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$796.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$681.49
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cigna of CA HMO |
$679.68
|
| Rate for Payer: Cigna of CA PPO |
$785.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$902.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$902.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$902.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$743.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$424.80
|
| Rate for Payer: EPIC Health Plan Senior |
$424.80
|
| Rate for Payer: Galaxy Health WC |
$902.70
|
| Rate for Payer: Global Benefits Group Commercial |
$637.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$674.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$385.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$626.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$254.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$743.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$743.40
|
| Rate for Payer: Multiplan Commercial |
$849.60
|
| Rate for Payer: Networks By Design Commercial |
$690.30
|
| Rate for Payer: Prime Health Services Commercial |
$902.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$637.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$637.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$531.00
|
| Rate for Payer: United Healthcare All Other HMO |
$531.00
|
| Rate for Payer: United Healthcare HMO Rider |
$531.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$531.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$902.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$902.70
|
| Rate for Payer: Vantage Medical Group Senior |
$902.70
|
|
|
HC T.I.P.S. (PORTOCAVAL SHUNT)
|
Facility
|
IP
|
$12,362.00
|
|
|
Service Code
|
CPT 37182
|
| Hospital Charge Code |
909081331
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,472.40 |
| Max. Negotiated Rate |
$10,507.70 |
| Rate for Payer: Adventist Health Commercial |
$2,472.40
|
| Rate for Payer: Cash Price |
$5,562.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,653.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,944.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,944.80
|
| Rate for Payer: Galaxy Health WC |
$10,507.70
|
| Rate for Payer: Global Benefits Group Commercial |
$7,417.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,849.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,293.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,966.88
|
| Rate for Payer: Multiplan Commercial |
$9,889.60
|
| Rate for Payer: Networks By Design Commercial |
$8,035.30
|
| Rate for Payer: Prime Health Services Commercial |
$10,507.70
|
|
|
HC T.I.P.S. (PORTOCAVAL SHUNT)
|
Facility
|
OP
|
$12,362.00
|
|
|
Service Code
|
CPT 37182
|
| Hospital Charge Code |
909081331
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$183.25 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$2,472.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$5,562.90
|
| Rate for Payer: Cash Price |
$5,562.90
|
| Rate for Payer: Cash Price |
$5,562.90
|
| Rate for Payer: Cigna of CA HMO |
$7,911.68
|
| Rate for Payer: Cigna of CA PPO |
$9,147.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,653.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$10,507.70
|
| Rate for Payer: Global Benefits Group Commercial |
$7,417.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,849.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$207.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,966.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,707.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$9,889.60
|
| Rate for Payer: Networks By Design Commercial |
$8,035.30
|
| Rate for Payer: Prime Health Services Commercial |
$10,507.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,417.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,181.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC TIPS TX SHEATH
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.20 |
| Max. Negotiated Rate |
$247.35 |
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$203.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.40
|
| Rate for Payer: EPIC Health Plan Senior |
$116.40
|
| Rate for Payer: Galaxy Health WC |
$247.35
|
| Rate for Payer: Global Benefits Group Commercial |
$174.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$184.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$171.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.84
|
| Rate for Payer: Multiplan Commercial |
$232.80
|
| Rate for Payer: Networks By Design Commercial |
$189.15
|
| Rate for Payer: Prime Health Services Commercial |
$247.35
|
|
|
HC TIPS TX SHEATH
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.20 |
| Max. Negotiated Rate |
$266.83 |
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$266.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$247.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$160.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$218.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$186.73
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cigna of CA HMO |
$186.24
|
| Rate for Payer: Cigna of CA PPO |
$215.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$247.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$247.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$247.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$203.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.40
|
| Rate for Payer: EPIC Health Plan Senior |
$116.40
|
| Rate for Payer: Galaxy Health WC |
$247.35
|
| Rate for Payer: Global Benefits Group Commercial |
$174.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$184.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$105.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$171.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.70
|
| Rate for Payer: Multiplan Commercial |
$232.80
|
| Rate for Payer: Networks By Design Commercial |
$189.15
|
| Rate for Payer: Prime Health Services Commercial |
$247.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$145.50
|
| Rate for Payer: United Healthcare All Other HMO |
$145.50
|
| Rate for Payer: United Healthcare HMO Rider |
$145.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$247.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$247.35
|
| Rate for Payer: Vantage Medical Group Senior |
$247.35
|
|
|
HC TIP SUCTION YANKAUER REG CAP
|
Facility
|
IP
|
$4.10
|
|
| Hospital Charge Code |
901605747
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$3.28
|
| Rate for Payer: Networks By Design Commercial |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
|
|
HC TIP SUCTION YANKAUER REG CAP
|
Facility
|
OP
|
$4.10
|
|
| Hospital Charge Code |
901605747
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.63
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Cigna of CA HMO |
$2.62
|
| Rate for Payer: Cigna of CA PPO |
$3.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$3.28
|
| Rate for Payer: Networks By Design Commercial |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2.05
|
| Rate for Payer: United Healthcare HMO Rider |
$2.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.48
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC TISS CUL NEO BONE MARROW BLD
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900918003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$116.44 |
| Max. Negotiated Rate |
$1,106.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,050.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Vantage Medical Group Senior |
$143.75
|
| Rate for Payer: Vantage Medical Group Senior |
$143.75
|
| Rate for Payer: Adventist Health Commercial |
$129.60
|
| Rate for Payer: Adventist Health Commercial |
$149.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,050.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,106.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,106.75
|
| Rate for Payer: Blue Shield of California Commercial |
$343.91
|
| Rate for Payer: Blue Shield of California Commercial |
$298.73
|
| Rate for Payer: Blue Shield of California Commercial |
$519.96
|
| Rate for Payer: Blue Shield of California Commercial |
$451.66
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna of CA HMO |
$477.44
|
| Rate for Payer: Cigna of CA HMO |
$414.72
|
| Rate for Payer: Cigna of CA PPO |
$479.52
|
| Rate for Payer: Cigna of CA PPO |
$552.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$143.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$143.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$453.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$522.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.19
|
| Rate for Payer: EPIC Health Plan Senior |
$158.12
|
| Rate for Payer: EPIC Health Plan Senior |
$158.12
|
| Rate for Payer: Galaxy Health WC |
$550.80
|
| Rate for Payer: Galaxy Health WC |
$634.10
|
| Rate for Payer: Global Benefits Group Commercial |
$388.80
|
| Rate for Payer: Global Benefits Group Commercial |
$447.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$235.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$235.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$167.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$167.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$143.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$143.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$411.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$473.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$201.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$201.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$192.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$192.62
|
| Rate for Payer: Multiplan Commercial |
$596.80
|
| Rate for Payer: Multiplan Commercial |
$518.40
|
| Rate for Payer: Networks By Design Commercial |
$484.90
|
| Rate for Payer: Networks By Design Commercial |
$421.20
|
| Rate for Payer: Prime Health Services Commercial |
$550.80
|
| Rate for Payer: Prime Health Services Commercial |
$634.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$388.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$447.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$388.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$447.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.44
|
| Rate for Payer: United Healthcare All Other HMO |
$116.44
|
| Rate for Payer: United Healthcare All Other HMO |
$116.44
|
| Rate for Payer: United Healthcare HMO Rider |
$116.44
|
| Rate for Payer: United Healthcare HMO Rider |
$116.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$143.75
|
| Rate for Payer: Upland Medical Group Pediatric |
$143.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.62
|
|
|
HC TISS CUL NEO BONE MARROW BLD
|
Facility
|
IP
|
$746.00
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900918003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$149.20 |
| Max. Negotiated Rate |
$634.10 |
| Rate for Payer: Adventist Health Commercial |
$149.20
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$522.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.40
|
| Rate for Payer: EPIC Health Plan Senior |
$298.40
|
| Rate for Payer: Galaxy Health WC |
$634.10
|
| Rate for Payer: Global Benefits Group Commercial |
$447.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$473.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$440.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.04
|
| Rate for Payer: Multiplan Commercial |
$596.80
|
| Rate for Payer: Networks By Design Commercial |
$484.90
|
| Rate for Payer: Prime Health Services Commercial |
$634.10
|
|
|
HC TISS CUL NEOÂ SOLID TUMOR
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900918002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$82.00 |
| Max. Negotiated Rate |
$348.50 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$287.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Senior |
$164.00
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$260.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$241.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.40
|
| Rate for Payer: Multiplan Commercial |
$328.00
|
| Rate for Payer: Networks By Design Commercial |
$266.50
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
|
|
HC TISS CUL NEOÂ SOLID TUMOR
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900918002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$59.00 |
| Max. Negotiated Rate |
$1,473.44 |
| Rate for Payer: Cigna of CA HMO |
$262.40
|
| Rate for Payer: Cigna of CA HMO |
$188.80
|
| Rate for Payer: Cigna of CA PPO |
$218.30
|
| Rate for Payer: Cigna of CA PPO |
$303.40
|
| Rate for Payer: Adventist Health Commercial |
$59.00
|
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,226.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,226.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,473.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,473.44
|
| Rate for Payer: Blue Shield of California Commercial |
$189.01
|
| Rate for Payer: Blue Shield of California Commercial |
$136.00
|
| Rate for Payer: Blue Shield of California Commercial |
$285.77
|
| Rate for Payer: Blue Shield of California Commercial |
$205.62
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$147.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$147.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$206.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$287.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.41
|
| Rate for Payer: EPIC Health Plan Senior |
$162.27
|
| Rate for Payer: EPIC Health Plan Senior |
$162.27
|
| Rate for Payer: Galaxy Health WC |
$250.75
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$177.00
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$241.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$241.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$220.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$220.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$147.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$147.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$260.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$249.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$249.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$197.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$197.68
|
| Rate for Payer: Multiplan Commercial |
$328.00
|
| Rate for Payer: Multiplan Commercial |
$236.00
|
| Rate for Payer: Networks By Design Commercial |
$266.50
|
| Rate for Payer: Networks By Design Commercial |
$191.75
|
| Rate for Payer: Prime Health Services Commercial |
$250.75
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$177.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$246.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$177.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$246.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$119.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$119.49
|
| Rate for Payer: United Healthcare All Other HMO |
$119.49
|
| Rate for Payer: United Healthcare All Other HMO |
$119.49
|
| Rate for Payer: United Healthcare HMO Rider |
$119.49
|
| Rate for Payer: United Healthcare HMO Rider |
$119.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$147.52
|
| Rate for Payer: Upland Medical Group Pediatric |
$147.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Vantage Medical Group Senior |
$147.52
|
| Rate for Payer: Vantage Medical Group Senior |
$147.52
|
|
|
HC TISS CUL NON-NEO AMNIO/CHOR
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900918004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.20 |
| Max. Negotiated Rate |
$1,224.56 |
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Adventist Health Commercial |
$80.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,224.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,224.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,139.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,139.62
|
| Rate for Payer: Blue Shield of California Commercial |
$185.78
|
| Rate for Payer: Blue Shield of California Commercial |
$134.15
|
| Rate for Payer: Blue Shield of California Commercial |
$280.89
|
| Rate for Payer: Blue Shield of California Commercial |
$202.83
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cigna of CA HMO |
$257.92
|
| Rate for Payer: Cigna of CA HMO |
$186.24
|
| Rate for Payer: Cigna of CA PPO |
$215.34
|
| Rate for Payer: Cigna of CA PPO |
$298.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$203.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$282.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$165.33
|
| Rate for Payer: EPIC Health Plan Senior |
$165.33
|
| Rate for Payer: Galaxy Health WC |
$247.35
|
| Rate for Payer: Galaxy Health WC |
$342.55
|
| Rate for Payer: Global Benefits Group Commercial |
$174.60
|
| Rate for Payer: Global Benefits Group Commercial |
$241.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$246.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$246.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$184.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$255.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$210.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$210.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.40
|
| Rate for Payer: Multiplan Commercial |
$322.40
|
| Rate for Payer: Multiplan Commercial |
$232.80
|
| Rate for Payer: Networks By Design Commercial |
$261.95
|
| Rate for Payer: Networks By Design Commercial |
$189.15
|
| Rate for Payer: Prime Health Services Commercial |
$247.35
|
| Rate for Payer: Prime Health Services Commercial |
$342.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$241.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$241.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.74
|
| Rate for Payer: United Healthcare All Other HMO |
$121.74
|
| Rate for Payer: United Healthcare All Other HMO |
$121.74
|
| Rate for Payer: United Healthcare HMO Rider |
$121.74
|
| Rate for Payer: United Healthcare HMO Rider |
$121.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$150.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$150.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Vantage Medical Group Senior |
$150.30
|
| Rate for Payer: Vantage Medical Group Senior |
$150.30
|
|
|
HC TISS CUL NON-NEO AMNIO/CHOR
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
910408235
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$1,224.56 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,224.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,139.62
|
| Rate for Payer: Blue Shield of California Commercial |
$126.16
|
| Rate for Payer: Blue Shield of California Commercial |
$83.44
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cigna of CA HMO |
$115.84
|
| Rate for Payer: Cigna of CA PPO |
$133.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$126.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$165.33
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$246.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$210.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.40
|
| Rate for Payer: Multiplan Commercial |
$144.80
|
| Rate for Payer: Networks By Design Commercial |
$117.65
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.74
|
| Rate for Payer: United Healthcare All Other HMO |
$121.74
|
| Rate for Payer: United Healthcare HMO Rider |
$121.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$150.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Vantage Medical Group Senior |
$150.30
|
|
