|
HC CDIFF NUCLEIC ACID TEST
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
900912489
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$444.31 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$444.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$444.31
|
| Rate for Payer: Blue Shield of California Commercial |
$135.22
|
| Rate for Payer: Blue Shield of California Commercial |
$100.37
|
| Rate for Payer: Blue Shield of California Commercial |
$89.43
|
| Rate for Payer: Blue Shield of California Commercial |
$66.38
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna of CA HMO |
$124.16
|
| Rate for Payer: Cigna of CA HMO |
$92.16
|
| Rate for Payer: Cigna of CA PPO |
$106.56
|
| Rate for Payer: Cigna of CA PPO |
$143.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$100.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$135.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.50
|
| Rate for Payer: EPIC Health Plan Senior |
$41.00
|
| Rate for Payer: EPIC Health Plan Senior |
$41.00
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$91.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$123.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.94
|
| Rate for Payer: Multiplan Commercial |
$155.20
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: Networks By Design Commercial |
$126.10
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$116.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$116.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.19
|
| Rate for Payer: United Healthcare All Other HMO |
$30.19
|
| Rate for Payer: United Healthcare All Other HMO |
$30.19
|
| Rate for Payer: United Healthcare HMO Rider |
$30.19
|
| Rate for Payer: United Healthcare HMO Rider |
$30.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.00
|
| Rate for Payer: Vantage Medical Group Senior |
$37.27
|
| Rate for Payer: Vantage Medical Group Senior |
$37.27
|
|
|
HC CEFINASE
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 87185
|
| Hospital Charge Code |
900912424
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$87.55 |
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.74
|
| Rate for Payer: Blue Shield of California Commercial |
$11.06
|
| Rate for Payer: Blue Shield of California Commercial |
$47.48
|
| Rate for Payer: Blue Shield of California Commercial |
$16.73
|
| Rate for Payer: Blue Shield of California Commercial |
$71.79
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA HMO |
$65.92
|
| Rate for Payer: Cigna of CA PPO |
$76.22
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$72.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.84
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$87.55
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$61.80
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$65.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Networks By Design Commercial |
$66.95
|
| Rate for Payer: Prime Health Services Commercial |
$87.55
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC CEFINASE
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 87185
|
| Hospital Charge Code |
900912424
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.60 |
| Max. Negotiated Rate |
$87.55 |
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$72.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.20
|
| Rate for Payer: EPIC Health Plan Senior |
$41.20
|
| Rate for Payer: Galaxy Health WC |
$87.55
|
| Rate for Payer: Global Benefits Group Commercial |
$61.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$65.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.72
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: Networks By Design Commercial |
$66.95
|
| Rate for Payer: Prime Health Services Commercial |
$87.55
|
|
|
HC CELIAC BLOCK INJECTION
|
Facility
|
OP
|
$5,112.00
|
|
|
Service Code
|
CPT 64620
|
| Hospital Charge Code |
906764620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$166.99 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,022.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$2,300.40
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cigna of CA HMO |
$3,271.68
|
| Rate for Payer: Cigna of CA PPO |
$3,782.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,578.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| Rate for Payer: Galaxy Health WC |
$4,345.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,067.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,246.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,226.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,433.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$4,089.60
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$3,322.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,345.20
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,067.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,556.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC CELIAC BLOCK INJECTION
|
Facility
|
IP
|
$5,112.00
|
|
|
Service Code
|
CPT 64620
|
| Hospital Charge Code |
906764620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,022.40 |
| Max. Negotiated Rate |
$4,345.20 |
| Rate for Payer: Adventist Health Commercial |
$1,022.40
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,578.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,044.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,044.80
|
| Rate for Payer: Galaxy Health WC |
$4,345.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,067.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,246.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,016.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,226.88
|
| Rate for Payer: Multiplan Commercial |
$4,089.60
|
| Rate for Payer: Networks By Design Commercial |
$3,322.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,345.20
|
|
|
HC CELL COUNT & DIFF
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
900910124
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$243.10 |
| Rate for Payer: EPIC Health Plan Senior |
$6.16
|
| Rate for Payer: Galaxy Health WC |
$243.10
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: EPIC Health Plan Senior |
$6.16
|
| Rate for Payer: Adventist Health Commercial |
$57.20
|
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.91
|
| Rate for Payer: Blue Shield of California Commercial |
$27.20
|
| Rate for Payer: Blue Shield of California Commercial |
$131.85
|
| Rate for Payer: Blue Shield of California Commercial |
$41.12
|
| Rate for Payer: Blue Shield of California Commercial |
$199.34
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Cigna of CA HMO |
$37.76
|
| Rate for Payer: Cigna of CA HMO |
$183.04
|
| Rate for Payer: Cigna of CA PPO |
$211.64
|
| Rate for Payer: Cigna of CA PPO |
$43.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$200.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.24
|
| Rate for Payer: Global Benefits Group Commercial |
$171.60
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$181.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: Networks By Design Commercial |
$185.90
|
| Rate for Payer: Prime Health Services Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$171.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$171.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.54
|
| Rate for Payer: United Healthcare All Other HMO |
$4.54
|
| Rate for Payer: United Healthcare All Other HMO |
$4.54
|
| Rate for Payer: United Healthcare HMO Rider |
$4.54
|
| Rate for Payer: United Healthcare HMO Rider |
$4.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.16
|
| Rate for Payer: Vantage Medical Group Senior |
$5.60
|
| Rate for Payer: Vantage Medical Group Senior |
$5.60
|
|
|
HC CELL COUNT & DIFF
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
900910124
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$243.10 |
| Rate for Payer: Adventist Health Commercial |
$57.20
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$200.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.40
|
| Rate for Payer: EPIC Health Plan Senior |
$114.40
|
| Rate for Payer: Galaxy Health WC |
$243.10
|
| Rate for Payer: Global Benefits Group Commercial |
$171.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$181.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$168.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.64
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: Networks By Design Commercial |
$185.90
|
| Rate for Payer: Prime Health Services Commercial |
$243.10
|
|
|
HC CELL EXPANSION
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900912601
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$407.15 |
| Rate for Payer: Adventist Health Commercial |
$95.80
|
| Rate for Payer: Cash Price |
$215.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$335.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.60
|
| Rate for Payer: EPIC Health Plan Senior |
$191.60
|
| Rate for Payer: Galaxy Health WC |
$407.15
|
| Rate for Payer: Global Benefits Group Commercial |
$287.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$304.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$282.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.96
|
| Rate for Payer: Multiplan Commercial |
$383.20
|
| Rate for Payer: Networks By Design Commercial |
$311.35
|
| Rate for Payer: Prime Health Services Commercial |
$407.15
|
|
|
HC CELL EXPANSION
|
Facility
|
IP
|
$384.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900918001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$76.80 |
| Max. Negotiated Rate |
$326.40 |
| Rate for Payer: Adventist Health Commercial |
$76.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$268.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.60
|
| Rate for Payer: EPIC Health Plan Senior |
$153.60
|
| Rate for Payer: Galaxy Health WC |
$326.40
|
| Rate for Payer: Global Benefits Group Commercial |
$230.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$243.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$226.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.16
|
| Rate for Payer: Multiplan Commercial |
$307.20
|
| Rate for Payer: Networks By Design Commercial |
$249.60
|
| Rate for Payer: Prime Health Services Commercial |
$326.40
|
|
|
HC CELL EXPANSION
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900912601
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$66.80 |
| Max. Negotiated Rate |
$1,233.08 |
| Rate for Payer: Adventist Health Commercial |
$66.80
|
| Rate for Payer: Adventist Health Commercial |
$95.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,170.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,170.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,233.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,233.08
|
| Rate for Payer: Blue Shield of California Commercial |
$220.82
|
| Rate for Payer: Blue Shield of California Commercial |
$153.97
|
| Rate for Payer: Blue Shield of California Commercial |
$333.86
|
| Rate for Payer: Blue Shield of California Commercial |
$232.80
|
| Rate for Payer: Cash Price |
$215.55
|
| Rate for Payer: Cash Price |
$215.55
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna of CA HMO |
$306.56
|
| Rate for Payer: Cigna of CA HMO |
$213.76
|
| Rate for Payer: Cigna of CA PPO |
$247.16
|
| Rate for Payer: Cigna of CA PPO |
$354.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$140.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$140.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$233.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$335.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.20
|
| Rate for Payer: EPIC Health Plan Senior |
$154.80
|
| Rate for Payer: EPIC Health Plan Senior |
$154.80
|
| Rate for Payer: Galaxy Health WC |
$283.90
|
| Rate for Payer: Galaxy Health WC |
$407.15
|
| Rate for Payer: Global Benefits Group Commercial |
$200.40
|
| Rate for Payer: Global Benefits Group Commercial |
$287.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$230.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$230.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$210.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$210.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$140.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$140.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$212.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$304.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$237.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$237.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$197.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$197.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$177.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$177.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$188.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$188.58
|
| Rate for Payer: Multiplan Commercial |
$383.20
|
| Rate for Payer: Multiplan Commercial |
$267.20
|
| Rate for Payer: Networks By Design Commercial |
$311.35
|
| Rate for Payer: Networks By Design Commercial |
$217.10
|
| Rate for Payer: Prime Health Services Commercial |
$283.90
|
| Rate for Payer: Prime Health Services Commercial |
$407.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$200.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$287.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$200.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$287.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.99
|
| Rate for Payer: United Healthcare All Other HMO |
$113.99
|
| Rate for Payer: United Healthcare All Other HMO |
$113.99
|
| Rate for Payer: United Healthcare HMO Rider |
$113.99
|
| Rate for Payer: United Healthcare HMO Rider |
$113.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$140.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$140.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
|
|
HC CELL EXPANSION
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900918001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$69.20 |
| Max. Negotiated Rate |
$1,233.08 |
| Rate for Payer: Adventist Health Commercial |
$69.20
|
| Rate for Payer: Adventist Health Commercial |
$76.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,170.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,170.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,233.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,233.08
|
| Rate for Payer: Blue Shield of California Commercial |
$177.02
|
| Rate for Payer: Blue Shield of California Commercial |
$159.51
|
| Rate for Payer: Blue Shield of California Commercial |
$267.65
|
| Rate for Payer: Blue Shield of California Commercial |
$241.16
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna of CA HMO |
$245.76
|
| Rate for Payer: Cigna of CA HMO |
$221.44
|
| Rate for Payer: Cigna of CA PPO |
$256.04
|
| Rate for Payer: Cigna of CA PPO |
$284.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$140.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$140.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$242.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$268.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.20
|
| Rate for Payer: EPIC Health Plan Senior |
$154.80
|
| Rate for Payer: EPIC Health Plan Senior |
$154.80
|
| Rate for Payer: Galaxy Health WC |
$294.10
|
| Rate for Payer: Galaxy Health WC |
$326.40
|
| Rate for Payer: Global Benefits Group Commercial |
$207.60
|
| Rate for Payer: Global Benefits Group Commercial |
$230.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$230.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$230.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$210.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$210.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$140.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$140.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$219.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$243.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$237.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$237.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$197.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$197.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$177.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$177.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$188.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$188.58
|
| Rate for Payer: Multiplan Commercial |
$307.20
|
| Rate for Payer: Multiplan Commercial |
$276.80
|
| Rate for Payer: Networks By Design Commercial |
$249.60
|
| Rate for Payer: Networks By Design Commercial |
$224.90
|
| Rate for Payer: Prime Health Services Commercial |
$294.10
|
| Rate for Payer: Prime Health Services Commercial |
$326.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$207.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$230.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$207.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$230.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.99
|
| Rate for Payer: United Healthcare All Other HMO |
$113.99
|
| Rate for Payer: United Healthcare All Other HMO |
$113.99
|
| Rate for Payer: United Healthcare HMO Rider |
$113.99
|
| Rate for Payer: United Healthcare HMO Rider |
$113.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$140.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$140.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
|
|
HC CELL MORPHOLOGY (VISUAL)
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
900910073
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$105.40 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.51
|
| Rate for Payer: Blue Shield of California Commercial |
$11.53
|
| Rate for Payer: Blue Shield of California Commercial |
$57.16
|
| Rate for Payer: Blue Shield of California Commercial |
$17.43
|
| Rate for Payer: Blue Shield of California Commercial |
$86.43
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$79.36
|
| Rate for Payer: Cigna of CA PPO |
$91.76
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.27
|
| Rate for Payer: EPIC Health Plan Senior |
$4.18
|
| Rate for Payer: EPIC Health Plan Senior |
$4.18
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.23
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.09
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3.08
|
| Rate for Payer: United Healthcare HMO Rider |
$3.08
|
| Rate for Payer: United Healthcare HMO Rider |
$3.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.18
|
| Rate for Payer: Vantage Medical Group Senior |
$3.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3.80
|
|
|
HC CELL MORPHOLOGY (VISUAL)
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
900910073
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$105.40 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.60
|
| Rate for Payer: EPIC Health Plan Senior |
$49.60
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.76
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
|
|
HC CELL MORPHOLOGY VISUAL INDIVIDUAL
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
900912021
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$105.40 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.60
|
| Rate for Payer: EPIC Health Plan Senior |
$49.60
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.76
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
|
|
HC CELL MORPHOLOGY VISUAL INDIVIDUAL
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
900912021
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$105.40 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.51
|
| Rate for Payer: Blue Shield of California Commercial |
$11.06
|
| Rate for Payer: Blue Shield of California Commercial |
$57.16
|
| Rate for Payer: Blue Shield of California Commercial |
$16.73
|
| Rate for Payer: Blue Shield of California Commercial |
$86.43
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA HMO |
$79.36
|
| Rate for Payer: Cigna of CA PPO |
$91.76
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.27
|
| Rate for Payer: EPIC Health Plan Senior |
$4.18
|
| Rate for Payer: EPIC Health Plan Senior |
$4.18
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.23
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.09
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3.08
|
| Rate for Payer: United Healthcare HMO Rider |
$3.08
|
| Rate for Payer: United Healthcare HMO Rider |
$3.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.18
|
| Rate for Payer: Vantage Medical Group Senior |
$3.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3.80
|
|
|
HC CELLULAR THERAPY RECEIPT AND HANDLING
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.29
|
| Rate for Payer: Blue Shield of California Commercial |
$56.24
|
| Rate for Payer: Blue Shield of California Commercial |
$85.03
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cigna of CA HMO |
$78.08
|
| Rate for Payer: Cigna of CA PPO |
$90.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.38
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC CELLULAR THERAPY RECEIPT AND HANDLING
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
|
|
HC CEMENTOPLASTY
|
Facility
|
IP
|
$536.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
909080999
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$107.20 |
| Max. Negotiated Rate |
$455.60 |
| Rate for Payer: Adventist Health Commercial |
$107.20
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$375.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.40
|
| Rate for Payer: EPIC Health Plan Senior |
$214.40
|
| Rate for Payer: Galaxy Health WC |
$455.60
|
| Rate for Payer: Global Benefits Group Commercial |
$321.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$340.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$316.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.64
|
| Rate for Payer: Multiplan Commercial |
$428.80
|
| Rate for Payer: Networks By Design Commercial |
$348.40
|
| Rate for Payer: Prime Health Services Commercial |
$455.60
|
|
|
HC CEMENTOPLASTY
|
Facility
|
OP
|
$536.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
909080999
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$107.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$107.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.95
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cigna of CA HMO |
$343.04
|
| Rate for Payer: Cigna of CA PPO |
$396.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$375.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$455.60
|
| Rate for Payer: Global Benefits Group Commercial |
$321.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$340.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$444.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$428.80
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$348.40
|
| Rate for Payer: Prime Health Services Commercial |
$455.60
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$268.00
|
| 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: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CENTRL MOTR STDY UPPER & LOWER
|
Facility
|
IP
|
$1,854.00
|
|
|
Service Code
|
CPT 95939
|
| Hospital Charge Code |
900600322
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$370.80 |
| Max. Negotiated Rate |
$1,575.90 |
| Rate for Payer: Adventist Health Commercial |
$370.80
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,297.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$741.60
|
| Rate for Payer: EPIC Health Plan Senior |
$741.60
|
| Rate for Payer: Galaxy Health WC |
$1,575.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,112.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,177.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,093.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.96
|
| Rate for Payer: Multiplan Commercial |
$1,483.20
|
| Rate for Payer: Networks By Design Commercial |
$1,205.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,575.90
|
|
|
HC CENTRL MOTR STDY UPPER & LOWER
|
Facility
|
OP
|
$1,854.00
|
|
|
Service Code
|
CPT 95939
|
| Hospital Charge Code |
900600322
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$370.80 |
| Max. Negotiated Rate |
$2,426.18 |
| Rate for Payer: Adventist Health Commercial |
$370.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,426.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,214.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,104.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,189.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,182.85
|
| Rate for Payer: Blue Shield of California Commercial |
$780.53
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cigna of CA HMO |
$1,186.56
|
| Rate for Payer: Cigna of CA PPO |
$1,371.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,214.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,104.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,297.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,822.39
|
| Rate for Payer: EPIC Health Plan Senior |
$1,214.93
|
| Rate for Payer: Galaxy Health WC |
$1,575.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,112.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,811.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$698.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,104.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,177.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$789.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,546.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,391.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,480.00
|
| Rate for Payer: Multiplan Commercial |
$1,483.20
|
| Rate for Payer: Networks By Design Commercial |
$1,205.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,575.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,112.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,112.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,021.00
|
| Rate for Payer: United Healthcare All Other HMO |
$803.00
|
| Rate for Payer: United Healthcare HMO Rider |
$608.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,104.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,214.93
|
| Rate for Payer: Vantage Medical Group Senior |
$1,104.48
|
|
|
HC CENTROMERE AB
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900913527
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$158.10 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.45
|
| Rate for Payer: Blue Shield of California Commercial |
$29.50
|
| Rate for Payer: Blue Shield of California Commercial |
$129.64
|
| Rate for Payer: Blue Shield of California Commercial |
$44.61
|
| Rate for Payer: Blue Shield of California Commercial |
$85.75
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA HMO |
$119.04
|
| Rate for Payer: Cigna of CA PPO |
$137.64
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$130.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC CENTROMERE AB
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900913527
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$158.10 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$130.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.40
|
| Rate for Payer: EPIC Health Plan Senior |
$74.40
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$109.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.64
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
|
|
HC CEREBRAL BLOOD FLOW
|
Facility
|
IP
|
$3,136.00
|
|
|
Service Code
|
CPT 78610
|
| Hospital Charge Code |
909301412
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$627.20 |
| Max. Negotiated Rate |
$2,665.60 |
| Rate for Payer: Adventist Health Commercial |
$627.20
|
| Rate for Payer: Cash Price |
$1,411.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,195.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,254.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,254.40
|
| Rate for Payer: Galaxy Health WC |
$2,665.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,881.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,991.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,850.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$752.64
|
| Rate for Payer: Multiplan Commercial |
$2,508.80
|
| Rate for Payer: Networks By Design Commercial |
$2,038.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,665.60
|
|
|
HC CEREBRAL BLOOD FLOW
|
Facility
|
OP
|
$3,136.00
|
|
|
Service Code
|
CPT 78610
|
| Hospital Charge Code |
909301412
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$67.57 |
| Max. Negotiated Rate |
$2,665.60 |
| Rate for Payer: Adventist Health Commercial |
$627.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,167.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,012.37
|
| Rate for Payer: Blue Shield of California Commercial |
$2,000.77
|
| Rate for Payer: Blue Shield of California Commercial |
$1,320.26
|
| Rate for Payer: Cash Price |
$1,411.20
|
| Rate for Payer: Cash Price |
$1,411.20
|
| Rate for Payer: Cigna of CA HMO |
$2,007.04
|
| Rate for Payer: Cigna of CA PPO |
$2,320.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,195.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.28
|
| Rate for Payer: EPIC Health Plan Senior |
$768.18
|
| Rate for Payer: Galaxy Health WC |
$2,665.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,881.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,145.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,991.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$752.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$879.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$2,508.80
|
| Rate for Payer: Networks By Design Commercial |
$2,038.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,665.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,881.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,881.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$616.06
|
| Rate for Payer: United Healthcare All Other HMO |
$616.06
|
| Rate for Payer: United Healthcare HMO Rider |
$616.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$616.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$698.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
