|
HC CROSSMATCH COMP
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
900904766
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.80 |
| Max. Negotiated Rate |
$228.65 |
| Rate for Payer: Adventist Health Commercial |
$53.80
|
| Rate for Payer: Cash Price |
$121.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$188.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.60
|
| Rate for Payer: EPIC Health Plan Senior |
$107.60
|
| Rate for Payer: Galaxy Health WC |
$228.65
|
| Rate for Payer: Global Benefits Group Commercial |
$161.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$170.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.56
|
| Rate for Payer: Multiplan Commercial |
$215.20
|
| Rate for Payer: Networks By Design Commercial |
$174.85
|
| Rate for Payer: Prime Health Services Commercial |
$228.65
|
|
|
HC CROSSMATCH IS
|
Facility
|
OP
|
$686.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
900904577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.38 |
| Max. Negotiated Rate |
$583.10 |
| Rate for Payer: Adventist Health Commercial |
$137.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$169.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$371.49
|
| Rate for Payer: Blue Shield of California Commercial |
$316.25
|
| Rate for Payer: Blue Shield of California Commercial |
$478.14
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cigna of CA HMO |
$439.04
|
| Rate for Payer: Cigna of CA PPO |
$507.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$480.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.55
|
| Rate for Payer: EPIC Health Plan Senior |
$241.03
|
| Rate for Payer: Galaxy Health WC |
$583.10
|
| Rate for Payer: Global Benefits Group Commercial |
$411.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$359.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$435.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$276.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$548.80
|
| Rate for Payer: Networks By Design Commercial |
$445.90
|
| Rate for Payer: Prime Health Services Commercial |
$583.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$411.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$411.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$219.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC CROSSMATCH IS
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
900904577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$583.10 |
| Rate for Payer: Adventist Health Commercial |
$137.20
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$480.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.40
|
| Rate for Payer: EPIC Health Plan Senior |
$274.40
|
| Rate for Payer: Galaxy Health WC |
$583.10
|
| Rate for Payer: Global Benefits Group Commercial |
$411.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$435.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$404.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.64
|
| Rate for Payer: Multiplan Commercial |
$548.80
|
| Rate for Payer: Networks By Design Commercial |
$445.90
|
| Rate for Payer: Prime Health Services Commercial |
$583.10
|
|
|
HC CROSSMATCH XM
|
Facility
|
IP
|
$761.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
900904551
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$152.20 |
| Max. Negotiated Rate |
$646.85 |
| Rate for Payer: Adventist Health Commercial |
$152.20
|
| Rate for Payer: Cash Price |
$342.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$532.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$304.40
|
| Rate for Payer: EPIC Health Plan Senior |
$304.40
|
| Rate for Payer: Galaxy Health WC |
$646.85
|
| Rate for Payer: Global Benefits Group Commercial |
$456.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$483.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$448.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.64
|
| Rate for Payer: Multiplan Commercial |
$608.80
|
| Rate for Payer: Networks By Design Commercial |
$494.65
|
| Rate for Payer: Prime Health Services Commercial |
$646.85
|
|
|
HC CROSSMATCH XM
|
Facility
|
OP
|
$761.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
900904551
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.38 |
| Max. Negotiated Rate |
$646.85 |
| Rate for Payer: Adventist Health Commercial |
$152.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$181.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$371.49
|
| Rate for Payer: Blue Shield of California Commercial |
$350.82
|
| Rate for Payer: Blue Shield of California Commercial |
$530.42
|
| Rate for Payer: Cash Price |
$342.45
|
| Rate for Payer: Cash Price |
$342.45
|
| Rate for Payer: Cigna of CA HMO |
$487.04
|
| Rate for Payer: Cigna of CA PPO |
$563.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$532.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.55
|
| Rate for Payer: EPIC Health Plan Senior |
$241.03
|
| Rate for Payer: Galaxy Health WC |
$646.85
|
| Rate for Payer: Global Benefits Group Commercial |
$456.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$359.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$483.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$276.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$608.80
|
| Rate for Payer: Networks By Design Commercial |
$494.65
|
| Rate for Payer: Prime Health Services Commercial |
$646.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$456.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$456.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$219.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC CRPRA CVRNSA-CRPS SPNGSM SHNT, UNI OR BI
|
Facility
|
OP
|
$7,632.00
|
|
|
Service Code
|
CPT 54430
|
| Hospital Charge Code |
900504430
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$929.48 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Cash Price |
$3,434.40
|
| Rate for Payer: Cash Price |
$3,434.40
|
| Rate for Payer: Cigna of CA HMO |
$4,884.48
|
| Rate for Payer: Cigna of CA PPO |
$5,647.68
|
| Rate for Payer: Cash Price |
$3,434.40
|
| Rate for Payer: Adventist Health Commercial |
$1,526.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,487.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,197.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,724.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,487.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,487.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,487.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,342.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,052.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,052.80
|
| Rate for Payer: Galaxy Health WC |
$6,487.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,579.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,846.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$929.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,502.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,831.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,342.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,342.40
|
| Rate for Payer: Multiplan Commercial |
$6,105.60
|
| Rate for Payer: Networks By Design Commercial |
$4,960.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,487.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,579.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,816.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,816.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,816.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,816.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,487.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,487.20
|
| Rate for Payer: Vantage Medical Group Senior |
$6,487.20
|
|
|
HC CRPRA CVRNSA-CRPS SPNGSM SHNT, UNI OR BI
|
Facility
|
IP
|
$7,632.00
|
|
|
Service Code
|
CPT 54430
|
| Hospital Charge Code |
900504430
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,526.40 |
| Max. Negotiated Rate |
$6,487.20 |
| Rate for Payer: Adventist Health Commercial |
$1,526.40
|
| Rate for Payer: Cash Price |
$3,434.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,342.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,052.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,052.80
|
| Rate for Payer: Galaxy Health WC |
$6,487.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,579.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,846.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,502.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,831.68
|
| Rate for Payer: Multiplan Commercial |
$6,105.60
|
| Rate for Payer: Networks By Design Commercial |
$4,960.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,487.20
|
|
|
HC CRYABLATION BONE
|
Facility
|
OP
|
$15,488.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
909020151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$317.26 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,097.60
|
| 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 |
$9,938.65
|
| 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 |
$6,969.60
|
| Rate for Payer: Cash Price |
$6,969.60
|
| Rate for Payer: Cash Price |
$6,969.60
|
| Rate for Payer: Cigna of CA HMO |
$9,912.32
|
| Rate for Payer: Cigna of CA PPO |
$11,461.12
|
| 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 |
$10,841.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$13,164.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,292.80
|
| 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 |
$9,834.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$444.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,717.12
|
| 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 |
$12,390.40
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$10,067.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,164.80
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,292.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,744.00
|
| 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 CRYABLATION BONE
|
Facility
|
IP
|
$15,488.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
909020151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,097.60 |
| Max. Negotiated Rate |
$13,164.80 |
| Rate for Payer: Adventist Health Commercial |
$3,097.60
|
| Rate for Payer: Cash Price |
$6,969.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,841.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,195.20
|
| Rate for Payer: Galaxy Health WC |
$13,164.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,292.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,834.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,137.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,717.12
|
| Rate for Payer: Multiplan Commercial |
$12,390.40
|
| Rate for Payer: Networks By Design Commercial |
$10,067.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,164.80
|
|
|
HC CRYABLATION BONE
|
Facility
|
OP
|
$15,488.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
909020151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.26 |
| Max. Negotiated Rate |
$13,164.80 |
| Rate for Payer: Adventist Health Commercial |
$3,097.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| 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 |
$2,601.00
|
| Rate for Payer: Cash Price |
$6,969.60
|
| Rate for Payer: Cash Price |
$6,969.60
|
| Rate for Payer: Cash Price |
$6,969.60
|
| Rate for Payer: Cigna of CA HMO |
$9,912.32
|
| Rate for Payer: Cigna of CA PPO |
$11,461.12
|
| 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 |
$10,841.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$13,164.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,292.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,834.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,717.12
|
| 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 |
$12,390.40
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$10,067.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,164.80
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,292.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,744.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,744.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,744.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,744.00
|
| 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 CRYABLATION BONE
|
Facility
|
IP
|
$15,488.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
909020151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,097.60 |
| Max. Negotiated Rate |
$13,164.80 |
| Rate for Payer: Adventist Health Commercial |
$3,097.60
|
| Rate for Payer: Cash Price |
$6,969.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,841.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,195.20
|
| Rate for Payer: Galaxy Health WC |
$13,164.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,292.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,834.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,137.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,717.12
|
| Rate for Payer: Multiplan Commercial |
$12,390.40
|
| Rate for Payer: Networks By Design Commercial |
$10,067.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,164.80
|
|
|
HC CRYOABLATION-LUNG
|
Facility
|
OP
|
$8,155.00
|
|
|
Service Code
|
CPT 32994
|
| Hospital Charge Code |
909020150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,631.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,631.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,038.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,671.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,759.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Cash Price |
$3,669.75
|
| Rate for Payer: Cash Price |
$3,669.75
|
| Rate for Payer: Cash Price |
$3,669.75
|
| Rate for Payer: Cigna of CA HMO |
$5,219.20
|
| Rate for Payer: Cigna of CA PPO |
$6,034.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,038.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,671.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,708.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,558.37
|
| Rate for Payer: EPIC Health Plan Senior |
$15,038.91
|
| Rate for Payer: Galaxy Health WC |
$6,931.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,893.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22,421.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,674.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,671.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,178.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,940.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,140.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,957.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,226.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,320.13
|
| Rate for Payer: Multiplan Commercial |
$6,524.00
|
| Rate for Payer: Multiplan WC |
$21,077.25
|
| Rate for Payer: Networks By Design Commercial |
$5,300.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,931.75
|
| Rate for Payer: Prime Health Services WC |
$20,862.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,893.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,077.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$13,671.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,038.91
|
| Rate for Payer: Vantage Medical Group Senior |
$13,671.74
|
|
|
HC CRYOABLATION-LUNG
|
Facility
|
IP
|
$8,155.00
|
|
|
Service Code
|
CPT 32994
|
| Hospital Charge Code |
909020150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,631.00 |
| Max. Negotiated Rate |
$6,931.75 |
| Rate for Payer: Adventist Health Commercial |
$1,631.00
|
| Rate for Payer: Cash Price |
$3,669.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,708.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,262.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,262.00
|
| Rate for Payer: Galaxy Health WC |
$6,931.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,893.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,178.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,811.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,957.20
|
| Rate for Payer: Multiplan Commercial |
$6,524.00
|
| Rate for Payer: Networks By Design Commercial |
$5,300.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,931.75
|
|
|
HC CRYOABLATION PROBE
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C2618
|
| Hospital Charge Code |
909020059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$5,128.78 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,128.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,502.63
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,415.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC CRYOABLATION PROBE
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C2618
|
| Hospital Charge Code |
909020059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC CRYO ABLAT LIVER TUMOR
|
Facility
|
OP
|
$7,918.00
|
|
|
Service Code
|
CPT 47381
|
| Hospital Charge Code |
909000269
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$309.61 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,583.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,730.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,354.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,938.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$3,563.10
|
| Rate for Payer: Cash Price |
$3,563.10
|
| Rate for Payer: Cash Price |
$3,563.10
|
| Rate for Payer: Cigna of CA HMO |
$5,067.52
|
| Rate for Payer: Cigna of CA PPO |
$5,859.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,730.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,730.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,730.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,542.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,167.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,167.20
|
| Rate for Payer: Galaxy Health WC |
$6,730.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,750.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$309.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,027.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$350.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,671.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,900.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,542.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,542.60
|
| Rate for Payer: Multiplan Commercial |
$6,334.40
|
| Rate for Payer: Networks By Design Commercial |
$5,146.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,730.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,750.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,959.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,730.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,730.30
|
| Rate for Payer: Vantage Medical Group Senior |
$6,730.30
|
|
|
HC CRYO ABLAT LIVER TUMOR
|
Facility
|
IP
|
$7,918.00
|
|
|
Service Code
|
CPT 47381
|
| Hospital Charge Code |
909000269
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,583.60 |
| Max. Negotiated Rate |
$6,730.30 |
| Rate for Payer: EPIC Health Plan Commercial |
$3,167.20
|
| Rate for Payer: Adventist Health Commercial |
$1,583.60
|
| Rate for Payer: Cash Price |
$3,563.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,542.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,167.20
|
| Rate for Payer: Galaxy Health WC |
$6,730.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,750.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,027.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,671.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,900.32
|
| Rate for Payer: Multiplan Commercial |
$6,334.40
|
| Rate for Payer: Networks By Design Commercial |
$5,146.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,730.30
|
|
|
HC CRYO ABLAT RENAL TUMOR
|
Facility
|
OP
|
$19,652.00
|
|
|
Service Code
|
CPT 50593
|
| Hospital Charge Code |
909000268
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,942.61 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,930.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,038.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,671.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,323.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Cash Price |
$8,843.40
|
| Rate for Payer: Cash Price |
$8,843.40
|
| Rate for Payer: Cash Price |
$8,843.40
|
| Rate for Payer: Cigna of CA HMO |
$12,577.28
|
| Rate for Payer: Cigna of CA PPO |
$14,542.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,038.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,671.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,756.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,558.37
|
| Rate for Payer: EPIC Health Plan Senior |
$15,038.91
|
| Rate for Payer: Galaxy Health WC |
$16,704.20
|
| Rate for Payer: Global Benefits Group Commercial |
$11,791.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22,421.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,544.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,671.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,479.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,401.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,140.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,716.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,226.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,320.13
|
| Rate for Payer: Multiplan Commercial |
$15,721.60
|
| Rate for Payer: Multiplan WC |
$21,077.25
|
| Rate for Payer: Networks By Design Commercial |
$12,773.80
|
| Rate for Payer: Prime Health Services Commercial |
$16,704.20
|
| Rate for Payer: Prime Health Services WC |
$20,862.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,791.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,826.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$13,671.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,038.91
|
| Rate for Payer: Vantage Medical Group Senior |
$13,671.74
|
|
|
HC CRYO ABLAT RENAL TUMOR
|
Facility
|
IP
|
$19,652.00
|
|
|
Service Code
|
CPT 50593
|
| Hospital Charge Code |
909000268
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,930.40 |
| Max. Negotiated Rate |
$16,704.20 |
| Rate for Payer: Adventist Health Commercial |
$3,930.40
|
| Rate for Payer: Cash Price |
$8,843.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,756.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,860.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,860.80
|
| Rate for Payer: Galaxy Health WC |
$16,704.20
|
| Rate for Payer: Global Benefits Group Commercial |
$11,791.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,479.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,594.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,716.48
|
| Rate for Payer: Multiplan Commercial |
$15,721.60
|
| Rate for Payer: Networks By Design Commercial |
$12,773.80
|
| Rate for Payer: Prime Health Services Commercial |
$16,704.20
|
|
|
HC CRYOCAUTERY OF CERVIX
|
Facility
|
IP
|
$1,111.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
900501637
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$222.20 |
| Max. Negotiated Rate |
$944.35 |
| Rate for Payer: Adventist Health Commercial |
$222.20
|
| Rate for Payer: Cash Price |
$499.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$777.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$444.40
|
| Rate for Payer: EPIC Health Plan Senior |
$444.40
|
| Rate for Payer: Galaxy Health WC |
$944.35
|
| Rate for Payer: Global Benefits Group Commercial |
$666.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$705.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$655.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$266.64
|
| Rate for Payer: Multiplan Commercial |
$888.80
|
| Rate for Payer: Networks By Design Commercial |
$722.15
|
| Rate for Payer: Prime Health Services Commercial |
$944.35
|
|
|
HC CRYOCAUTERY OF CERVIX
|
Facility
|
OP
|
$1,111.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
900501637
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$222.20 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$222.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$499.95
|
| Rate for Payer: Cash Price |
$499.95
|
| Rate for Payer: Cash Price |
$499.95
|
| Rate for Payer: Cigna of CA HMO |
$711.04
|
| Rate for Payer: Cigna of CA PPO |
$822.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$777.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.68
|
| Rate for Payer: EPIC Health Plan Senior |
$431.12
|
| Rate for Payer: Galaxy Health WC |
$944.35
|
| Rate for Payer: Global Benefits Group Commercial |
$666.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$642.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$705.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$351.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$421.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$266.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$493.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.19
|
| Rate for Payer: Multiplan Commercial |
$888.80
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: Networks By Design Commercial |
$722.15
|
| Rate for Payer: Prime Health Services Commercial |
$944.35
|
| Rate for Payer: Prime Health Services WC |
$609.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$666.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$555.50
|
| Rate for Payer: United Healthcare All Other HMO |
$555.50
|
| Rate for Payer: United Healthcare HMO Rider |
$555.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$555.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$391.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
HC CRYOGLOBULINS QUAL
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
900910978
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$130.05 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.04
|
| Rate for Payer: Blue Shield of California Commercial |
$28.58
|
| Rate for Payer: Blue Shield of California Commercial |
$106.64
|
| Rate for Payer: Blue Shield of California Commercial |
$43.21
|
| Rate for Payer: Blue Shield of California Commercial |
$70.53
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Cigna of CA HMO |
$39.68
|
| Rate for Payer: Cigna of CA HMO |
$97.92
|
| Rate for Payer: Cigna of CA PPO |
$113.22
|
| Rate for Payer: Cigna of CA PPO |
$45.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.12
|
| Rate for Payer: EPIC Health Plan Senior |
$7.12
|
| Rate for Payer: Galaxy Health WC |
$130.05
|
| Rate for Payer: Galaxy Health WC |
$52.70
|
| Rate for Payer: Global Benefits Group Commercial |
$91.80
|
| Rate for Payer: Global Benefits Group Commercial |
$37.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$97.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$49.60
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: Networks By Design Commercial |
$40.30
|
| Rate for Payer: Networks By Design Commercial |
$99.45
|
| Rate for Payer: Prime Health Services Commercial |
$130.05
|
| Rate for Payer: Prime Health Services Commercial |
$52.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CRYOGLOBULINS QUAL
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
900910978
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$130.05 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.20
|
| Rate for Payer: EPIC Health Plan Senior |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$130.05
|
| Rate for Payer: Global Benefits Group Commercial |
$91.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$97.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.72
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: Networks By Design Commercial |
$99.45
|
| Rate for Payer: Prime Health Services Commercial |
$130.05
|
|
|
HC CSF LEAKAGE
|
Facility
|
IP
|
$1,761.00
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
909301416
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$352.20 |
| Max. Negotiated Rate |
$1,496.85 |
| Rate for Payer: Adventist Health Commercial |
$352.20
|
| Rate for Payer: Cash Price |
$792.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,232.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$704.40
|
| Rate for Payer: EPIC Health Plan Senior |
$704.40
|
| Rate for Payer: Galaxy Health WC |
$1,496.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,056.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,118.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,038.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$422.64
|
| Rate for Payer: Multiplan Commercial |
$1,408.80
|
| Rate for Payer: Networks By Design Commercial |
$1,144.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,496.85
|
|
|
HC CSF LEAKAGE
|
Facility
|
OP
|
$1,761.00
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
909301416
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$248.56 |
| Max. Negotiated Rate |
$2,747.46 |
| Rate for Payer: Adventist Health Commercial |
$352.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,155.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,831.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,665.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,130.03
|
| Rate for Payer: Blue Shield of California Commercial |
$741.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1,123.52
|
| Rate for Payer: Cash Price |
$792.45
|
| Rate for Payer: Cash Price |
$792.45
|
| Rate for Payer: Cigna of CA HMO |
$1,127.04
|
| Rate for Payer: Cigna of CA PPO |
$1,303.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,831.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,665.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,232.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,747.46
|
| Rate for Payer: EPIC Health Plan Senior |
$1,831.64
|
| Rate for Payer: Galaxy Health WC |
$1,496.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,056.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,730.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$248.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,665.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,118.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$281.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,331.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$422.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,098.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,231.27
|
| Rate for Payer: Multiplan Commercial |
$1,408.80
|
| Rate for Payer: Networks By Design Commercial |
$1,144.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,496.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,056.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,056.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,570.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1,570.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,570.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,665.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,831.64
|
| Rate for Payer: Vantage Medical Group Senior |
$1,665.13
|
|
