|
HC TCATH RMVL OR DBLK ICAR MASS OR VEG
|
Facility
|
IP
|
$14,072.00
|
|
|
Service Code
|
CPT 0644T
|
| Hospital Charge Code |
906811644
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,377.28 |
| Max. Negotiated Rate |
$11,961.20 |
| Rate for Payer: Cash Price |
$6,332.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,628.80
|
| Rate for Payer: Galaxy Health WC |
$11,961.20
|
| Rate for Payer: Global Benefits Group Commercial |
$8,443.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,386.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,361.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,377.28
|
| Rate for Payer: Multiplan Commercial |
$11,257.60
|
| Rate for Payer: Networks By Design Commercial |
$9,146.80
|
| Rate for Payer: Prime Health Services Commercial |
$11,961.20
|
|
|
HC TCAT IMPL WRLS PUL ART PRS SNR
|
Facility
|
OP
|
$21,934.00
|
|
|
Service Code
|
CPT 33289
|
| Hospital Charge Code |
906811492
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$524.15 |
| Max. Negotiated Rate |
$59,555.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14,112.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54,471.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39,945.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,314.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: Blue Distinction Transplant |
$13,160.40
|
| Rate for Payer: Blue Shield of California Commercial |
$12,962.99
|
| Rate for Payer: Blue Shield of California EPN |
$10,287.05
|
| Rate for Payer: Cash Price |
$9,870.30
|
| Rate for Payer: Cash Price |
$9,870.30
|
| Rate for Payer: Cash Price |
$9,870.30
|
| Rate for Payer: Cigna of CA HMO |
$14,037.76
|
| Rate for Payer: Cigna of CA PPO |
$16,231.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54,471.36
|
| Rate for Payer: Dignity Health Media |
$36,314.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$39,945.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$49,024.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$36,314.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$36,314.24
|
| Rate for Payer: Galaxy Health WC |
$18,643.90
|
| Rate for Payer: Global Benefits Group Commercial |
$13,160.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16,450.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$59,555.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$59,555.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58,829.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$58,829.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36,314.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,629.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$524.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36,314.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,264.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45,755.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48,661.08
|
| Rate for Payer: Multiplan Commercial |
$17,547.20
|
| Rate for Payer: Networks By Design Commercial |
$14,257.10
|
| Rate for Payer: Prime Health Services Commercial |
$18,643.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,160.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,160.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54,471.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39,945.66
|
| Rate for Payer: Vantage Medical Group Senior |
$36,314.24
|
|
|
HC TCAT IMPL WRLS PUL ART PRS SNR
|
Facility
|
IP
|
$21,934.00
|
|
|
Service Code
|
CPT 33289
|
| Hospital Charge Code |
906811492
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$5,264.16 |
| Max. Negotiated Rate |
$18,643.90 |
| Rate for Payer: Cash Price |
$9,870.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,773.60
|
| Rate for Payer: Galaxy Health WC |
$18,643.90
|
| Rate for Payer: Global Benefits Group Commercial |
$13,160.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,629.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,356.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,264.16
|
| Rate for Payer: Multiplan Commercial |
$17,547.20
|
| Rate for Payer: Networks By Design Commercial |
$14,257.10
|
| Rate for Payer: Prime Health Services Commercial |
$18,643.90
|
|
|
HC TCAT PLMT AND OR RMVL CEREBRAL EMOLIC
|
Facility
|
OP
|
$69,981.00
|
|
|
Service Code
|
CPT 33370
|
| Hospital Charge Code |
906813370
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$209.38 |
| Max. Negotiated Rate |
$59,483.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59,483.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38,489.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38,489.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$41,988.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$31,491.45
|
| Rate for Payer: Cash Price |
$31,491.45
|
| Rate for Payer: Cash Price |
$31,491.45
|
| Rate for Payer: Cigna of CA PPO |
$51,785.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59,483.85
|
| Rate for Payer: Dignity Health Media |
$59,483.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$59,483.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$27,992.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$27,992.40
|
| Rate for Payer: Galaxy Health WC |
$59,483.85
|
| Rate for Payer: Global Benefits Group Commercial |
$41,988.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$52,485.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46,677.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16,795.44
|
| Rate for Payer: Multiplan Commercial |
$55,984.80
|
| Rate for Payer: Networks By Design Commercial |
$45,487.65
|
| Rate for Payer: Prime Health Services Commercial |
$59,483.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41,988.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59,483.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59,483.85
|
| Rate for Payer: Vantage Medical Group Senior |
$59,483.85
|
|
|
HC TCAT PLMT AND OR RMVL CEREBRAL EMOLIC
|
Facility
|
IP
|
$69,981.00
|
|
|
Service Code
|
CPT 33370
|
| Hospital Charge Code |
906813370
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$16,795.44 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$31,491.45
|
| Rate for Payer: Cash Price |
$31,491.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$27,992.40
|
| Rate for Payer: Galaxy Health WC |
$59,483.85
|
| Rate for Payer: Global Benefits Group Commercial |
$41,988.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46,677.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26,662.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16,795.44
|
| Rate for Payer: Multiplan Commercial |
$55,984.80
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$59,483.85
|
|
|
HC TCAT RMVL PERM LDLS PM R VENTR
|
Facility
|
OP
|
$8,080.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
906833275
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$838.24 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,201.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,848.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,104.87
|
| Rate for Payer: Blue Shield of California EPN |
$3,322.54
|
| Rate for Payer: Cash Price |
$3,636.00
|
| Rate for Payer: Cash Price |
$3,636.00
|
| Rate for Payer: Cash Price |
$3,636.00
|
| Rate for Payer: Cigna of CA PPO |
$5,979.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$6,868.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,848.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,060.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,389.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,939.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$6,464.00
|
| Rate for Payer: Networks By Design Commercial |
$5,252.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,868.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,848.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC TCAT RMVL PERM LDLS PM R VENTR
|
Facility
|
IP
|
$8,080.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
906833275
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,939.20 |
| Max. Negotiated Rate |
$6,868.00 |
| Rate for Payer: Cash Price |
$3,636.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,232.00
|
| Rate for Payer: Galaxy Health WC |
$6,868.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,848.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,389.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,078.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,939.20
|
| Rate for Payer: Multiplan Commercial |
$6,464.00
|
| Rate for Payer: Networks By Design Commercial |
$5,252.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,868.00
|
|
|
HC TCELL ABSOLUTE CD4
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
903900104
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$245.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$222.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.70
|
| Rate for Payer: Blue Distinction Transplant |
$42.60
|
| Rate for Payer: Blue Shield of California Commercial |
$45.87
|
| Rate for Payer: Blue Shield of California EPN |
$36.35
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cigna of CA HMO |
$45.44
|
| Rate for Payer: Cigna of CA PPO |
$52.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.17
|
| Rate for Payer: Dignity Health Media |
$26.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.15
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$26.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.78
|
| Rate for Payer: Galaxy Health WC |
$60.35
|
| Rate for Payer: Global Benefits Group Commercial |
$42.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$53.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$43.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$43.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.89
|
| Rate for Payer: Multiplan Commercial |
$56.80
|
| Rate for Payer: Networks By Design Commercial |
$46.15
|
| Rate for Payer: Prime Health Services Commercial |
$60.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.69
|
| Rate for Payer: United Healthcare All Other HMO |
$21.69
|
| Rate for Payer: United Healthcare HMO Rider |
$21.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Vantage Medical Group Senior |
$26.78
|
|
|
HC TCELL ABSOLUTE CD4
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
903900104
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$288.15 |
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.36
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: Networks By Design Commercial |
$220.35
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
|
|
HC TCELL ABSOLUTE CD8
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
903900105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$390.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$390.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$360.01
|
| Rate for Payer: Blue Distinction Transplant |
$42.60
|
| Rate for Payer: Blue Shield of California Commercial |
$45.87
|
| Rate for Payer: Blue Shield of California EPN |
$36.35
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cigna of CA HMO |
$45.44
|
| Rate for Payer: Cigna of CA PPO |
$52.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.47
|
| Rate for Payer: Dignity Health Media |
$46.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$46.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$46.98
|
| Rate for Payer: Galaxy Health WC |
$60.35
|
| Rate for Payer: Global Benefits Group Commercial |
$42.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$53.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$77.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$76.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$46.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.95
|
| Rate for Payer: Multiplan Commercial |
$56.80
|
| Rate for Payer: Networks By Design Commercial |
$46.15
|
| Rate for Payer: Prime Health Services Commercial |
$60.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.05
|
| Rate for Payer: United Healthcare All Other HMO |
$38.05
|
| Rate for Payer: United Healthcare HMO Rider |
$38.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.68
|
| Rate for Payer: Vantage Medical Group Senior |
$46.98
|
|
|
HC TCELL ABSOLUTE CD8
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
903900105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$101.52 |
| Max. Negotiated Rate |
$359.55 |
| Rate for Payer: Cash Price |
$190.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.20
|
| Rate for Payer: Galaxy Health WC |
$359.55
|
| Rate for Payer: Global Benefits Group Commercial |
$253.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.52
|
| Rate for Payer: Multiplan Commercial |
$338.40
|
| Rate for Payer: Networks By Design Commercial |
$274.95
|
| Rate for Payer: Prime Health Services Commercial |
$359.55
|
|
|
HC TCELL TOTAL COUNT CD2/CD3
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
903900101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.56 |
| Max. Negotiated Rate |
$344.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$313.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$344.77
|
| Rate for Payer: Blue Distinction Transplant |
$86.40
|
| Rate for Payer: Blue Shield of California Commercial |
$93.02
|
| Rate for Payer: Blue Shield of California EPN |
$73.73
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna of CA HMO |
$92.16
|
| Rate for Payer: Cigna of CA PPO |
$106.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.60
|
| Rate for Payer: Dignity Health Media |
$37.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.73
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.88
|
| Rate for Payer: Heritage Provider Network Transplant |
$61.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$61.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$61.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.56
|
| Rate for Payer: United Healthcare All Other HMO |
$30.56
|
| Rate for Payer: United Healthcare HMO Rider |
$30.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC TCELL TOTAL COUNT CD2/CD3
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
903900101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$101.52 |
| Max. Negotiated Rate |
$359.55 |
| Rate for Payer: Cash Price |
$190.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.20
|
| Rate for Payer: Galaxy Health WC |
$359.55
|
| Rate for Payer: Global Benefits Group Commercial |
$253.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.52
|
| Rate for Payer: Multiplan Commercial |
$338.40
|
| Rate for Payer: Networks By Design Commercial |
$274.95
|
| Rate for Payer: Prime Health Services Commercial |
$359.55
|
|
|
HC TDT EACH MARKER
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
903901932
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$319.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$319.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$208.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.87
|
| Rate for Payer: Blue Distinction Transplant |
$147.00
|
| Rate for Payer: Blue Shield of California Commercial |
$158.27
|
| Rate for Payer: Blue Shield of California EPN |
$125.44
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cigna of CA HMO |
$156.80
|
| Rate for Payer: Cigna of CA PPO |
$181.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$208.25
|
| Rate for Payer: Dignity Health Media |
$208.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$208.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$183.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.95
|
| Rate for Payer: United Healthcare All Other HMO |
$17.95
|
| Rate for Payer: United Healthcare HMO Rider |
$17.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$208.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$208.25
|
| Rate for Payer: Vantage Medical Group Senior |
$208.25
|
|
|
HC TDT EACH MARKER
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
903901932
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$208.25 |
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
|
|
HC TD VACCINE NO PRSRV GT/= 7YR IM
|
Facility
|
IP
|
$104.69
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
900501450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$88.99 |
| Rate for Payer: Cash Price |
$47.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.88
|
| Rate for Payer: Galaxy Health WC |
$88.99
|
| Rate for Payer: Global Benefits Group Commercial |
$62.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.13
|
| Rate for Payer: Multiplan Commercial |
$83.75
|
| Rate for Payer: Networks By Design Commercial |
$68.05
|
| Rate for Payer: Prime Health Services Commercial |
$88.99
|
|
|
HC TD VACCINE NO PRSRV GT/= 7YR IM
|
Facility
|
OP
|
$104.69
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
900501450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$88.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$62.81
|
| Rate for Payer: Cash Price |
$47.11
|
| Rate for Payer: Cash Price |
$47.11
|
| Rate for Payer: Cash Price |
$47.11
|
| Rate for Payer: Cigna of CA PPO |
$77.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$88.99
|
| Rate for Payer: Dignity Health Media |
$88.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$41.88
|
| Rate for Payer: Galaxy Health WC |
$88.99
|
| Rate for Payer: Global Benefits Group Commercial |
$62.81
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$78.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.13
|
| Rate for Payer: Multiplan Commercial |
$83.75
|
| Rate for Payer: Networks By Design Commercial |
$68.05
|
| Rate for Payer: Prime Health Services Commercial |
$88.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.34
|
| Rate for Payer: United Healthcare All Other HMO |
$52.34
|
| Rate for Payer: United Healthcare HMO Rider |
$52.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$88.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.99
|
| Rate for Payer: Vantage Medical Group Senior |
$88.99
|
|
|
HC TEAR DUCT(LACRIM)SCN
|
Facility
|
OP
|
$1,388.00
|
|
|
Service Code
|
CPT 78660
|
| Hospital Charge Code |
909301418
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$164.39 |
| Max. Negotiated Rate |
$1,179.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$953.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$826.97
|
| Rate for Payer: Blue Distinction Transplant |
$832.80
|
| Rate for Payer: Blue Shield of California Commercial |
$820.31
|
| Rate for Payer: Blue Shield of California EPN |
$650.97
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cigna of CA HMO |
$888.32
|
| Rate for Payer: Cigna of CA PPO |
$1,027.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,179.80
|
| Rate for Payer: Global Benefits Group Commercial |
$832.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,041.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$925.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,110.40
|
| Rate for Payer: Networks By Design Commercial |
$902.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,179.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$832.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$832.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC TEAR DUCT(LACRIM)SCN
|
Facility
|
IP
|
$1,388.00
|
|
|
Service Code
|
CPT 78660
|
| Hospital Charge Code |
909301418
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$333.12 |
| Max. Negotiated Rate |
$1,179.80 |
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$555.20
|
| Rate for Payer: Galaxy Health WC |
$1,179.80
|
| Rate for Payer: Global Benefits Group Commercial |
$832.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$925.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$528.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.12
|
| Rate for Payer: Multiplan Commercial |
$1,110.40
|
| Rate for Payer: Networks By Design Commercial |
$902.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,179.80
|
|
|
HC TELETHERAPY ISODOSE PLAN COMPLEX
|
Facility
|
IP
|
$2,386.00
|
|
|
Service Code
|
CPT 77307
|
| Hospital Charge Code |
909177307
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$572.64 |
| Max. Negotiated Rate |
$2,028.10 |
| Rate for Payer: Cash Price |
$1,073.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$954.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$954.40
|
| Rate for Payer: Galaxy Health WC |
$2,028.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,431.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,591.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$909.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$572.64
|
| Rate for Payer: Multiplan Commercial |
$1,908.80
|
| Rate for Payer: Networks By Design Commercial |
$1,550.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,028.10
|
|
|
HC TELETHERAPY ISODOSE PLAN COMPLEX
|
Facility
|
OP
|
$2,386.00
|
|
|
Service Code
|
CPT 77307
|
| Hospital Charge Code |
909177307
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$461.66 |
| Max. Negotiated Rate |
$2,028.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$857.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,215.89
|
| Rate for Payer: Blue Distinction Transplant |
$1,431.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,410.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,119.03
|
| Rate for Payer: Cash Price |
$1,073.70
|
| Rate for Payer: Cash Price |
$1,073.70
|
| Rate for Payer: Cash Price |
$1,073.70
|
| Rate for Payer: Cigna of CA HMO |
$1,527.04
|
| Rate for Payer: Cigna of CA PPO |
$1,765.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$692.49
|
| Rate for Payer: Dignity Health Media |
$461.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$623.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$461.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$461.66
|
| Rate for Payer: Galaxy Health WC |
$2,028.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,431.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,789.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$757.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$757.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$747.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$747.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,591.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$477.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$572.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$581.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$618.62
|
| Rate for Payer: Multiplan Commercial |
$1,908.80
|
| Rate for Payer: Networks By Design Commercial |
$1,550.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,028.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,431.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Vantage Medical Group Senior |
$461.66
|
|
|
HC TELETHERAPY ISODOSE PLANSIMPLE
|
Facility
|
OP
|
$1,303.00
|
|
|
Service Code
|
CPT 77306
|
| Hospital Charge Code |
909177306
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$244.51 |
| Max. Negotiated Rate |
$1,675.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$468.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$663.75
|
| Rate for Payer: Blue Distinction Transplant |
$781.80
|
| Rate for Payer: Blue Shield of California Commercial |
$770.07
|
| Rate for Payer: Blue Shield of California EPN |
$611.11
|
| Rate for Payer: Cash Price |
$586.35
|
| Rate for Payer: Cash Price |
$586.35
|
| Rate for Payer: Cash Price |
$586.35
|
| Rate for Payer: Cigna of CA HMO |
$833.92
|
| Rate for Payer: Cigna of CA PPO |
$964.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$692.49
|
| Rate for Payer: Dignity Health Media |
$461.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$623.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$461.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$461.66
|
| Rate for Payer: Galaxy Health WC |
$1,107.55
|
| Rate for Payer: Global Benefits Group Commercial |
$781.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$977.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$757.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$757.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$747.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$747.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$869.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$581.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$618.62
|
| Rate for Payer: Multiplan Commercial |
$1,042.40
|
| Rate for Payer: Networks By Design Commercial |
$846.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,107.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$781.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Vantage Medical Group Senior |
$461.66
|
|
|
HC TELETHERAPY ISODOSE PLANSIMPLE
|
Facility
|
IP
|
$1,303.00
|
|
|
Service Code
|
CPT 77306
|
| Hospital Charge Code |
909177306
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$312.72 |
| Max. Negotiated Rate |
$1,107.55 |
| Rate for Payer: Cash Price |
$586.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$521.20
|
| Rate for Payer: Galaxy Health WC |
$1,107.55
|
| Rate for Payer: Global Benefits Group Commercial |
$781.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$869.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$496.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.72
|
| Rate for Payer: Multiplan Commercial |
$1,042.40
|
| Rate for Payer: Networks By Design Commercial |
$846.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,107.55
|
|
|
HC TEMP CLOSURE/EYELIDS BY SUTURE
|
Facility
|
IP
|
$4,271.00
|
|
|
Service Code
|
CPT 67875
|
| Hospital Charge Code |
900501425
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,025.04 |
| Max. Negotiated Rate |
$3,630.35 |
| Rate for Payer: Cash Price |
$1,921.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,708.40
|
| Rate for Payer: Galaxy Health WC |
$3,630.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,562.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,848.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,627.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,025.04
|
| Rate for Payer: Multiplan Commercial |
$3,416.80
|
| Rate for Payer: Networks By Design Commercial |
$2,776.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,630.35
|
|
|
HC TEMP CLOSURE/EYELIDS BY SUTURE
|
Facility
|
OP
|
$4,271.00
|
|
|
Service Code
|
CPT 67875
|
| Hospital Charge Code |
900501425
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.37 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,391.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,264.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,562.60
|
| Rate for Payer: Cash Price |
$1,921.95
|
| Rate for Payer: Cash Price |
$1,921.95
|
| Rate for Payer: Cash Price |
$1,921.95
|
| Rate for Payer: Cigna of CA PPO |
$3,160.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Dignity Health Media |
$1,264.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,391.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,707.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,264.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,264.97
|
| Rate for Payer: Galaxy Health WC |
$3,630.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,562.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,203.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,074.55
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,074.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,264.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,848.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,264.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,025.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,593.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,695.06
|
| Rate for Payer: Multiplan Commercial |
$3,416.80
|
| Rate for Payer: Networks By Design Commercial |
$2,776.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,630.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,562.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,135.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,135.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,135.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,135.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,391.47
|
| Rate for Payer: Vantage Medical Group Senior |
$1,264.97
|
|
