|
HC HAND WRIST BOTH 1 VIEW
|
Facility
|
IP
|
$1,095.00
|
|
|
Service Code
|
CPT 73120 50
|
| Hospital Charge Code |
909073120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$930.75 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$766.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$695.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$646.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.80
|
| Rate for Payer: Multiplan Commercial |
$876.00
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
|
|
HC HAND WRIST BOTH 1 VIEW
|
Facility
|
OP
|
$1,095.00
|
|
|
Service Code
|
CPT 73120 50
|
| Hospital Charge Code |
909073120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$930.75 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$602.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$821.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.65
|
| Rate for Payer: Blue Shield of California Commercial |
$698.61
|
| Rate for Payer: Blue Shield of California Commercial |
$461.00
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cigna of CA HMO |
$700.80
|
| Rate for Payer: Cigna of CA PPO |
$810.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$930.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$930.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$930.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$766.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$695.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$646.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$766.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$766.50
|
| Rate for Payer: Multiplan Commercial |
$876.00
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$657.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$930.75
|
| Rate for Payer: Vantage Medical Group Senior |
$930.75
|
|
|
HC HAPTOGLOBIN
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
900910844
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
|
|
HC HAPTOGLOBIN
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
900910844
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$129.81 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$104.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$104.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.81
|
| Rate for Payer: Blue Shield of California Commercial |
$146.37
|
| Rate for Payer: Blue Shield of California Commercial |
$48.41
|
| Rate for Payer: Blue Shield of California Commercial |
$96.81
|
| Rate for Payer: Blue Shield of California Commercial |
$73.19
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$77.70
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.76
|
| Rate for Payer: EPIC Health Plan Senior |
$13.84
|
| Rate for Payer: EPIC Health Plan Senior |
$13.84
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.63
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.86
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.19
|
| Rate for Payer: United Healthcare All Other HMO |
$10.19
|
| Rate for Payer: United Healthcare All Other HMO |
$10.19
|
| Rate for Payer: United Healthcare HMO Rider |
$10.19
|
| Rate for Payer: United Healthcare HMO Rider |
$10.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.84
|
| Rate for Payer: Vantage Medical Group Senior |
$12.58
|
| Rate for Payer: Vantage Medical Group Senior |
$12.58
|
|
|
HC HARD PROTECT HELMET CUSTOM
|
Facility
|
OP
|
$4,460.00
|
|
|
Service Code
|
CPT A8003
|
| Hospital Charge Code |
915350101
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$892.00 |
| Max. Negotiated Rate |
$3,791.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$1,784.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,784.00
|
| Rate for Payer: Adventist Health Commercial |
$892.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,668.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,791.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,453.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,345.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,861.98
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: Cigna of CA HMO |
$2,854.40
|
| Rate for Payer: Cigna of CA PPO |
$3,300.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,791.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,791.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,791.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,122.00
|
| Rate for Payer: Galaxy Health WC |
$3,791.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,676.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,832.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,631.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,070.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,122.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,122.00
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: Networks By Design Commercial |
$2,899.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,791.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,676.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,791.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,791.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,791.00
|
|
|
HC HARD PROTECT HELMET CUSTOM
|
Facility
|
OP
|
$4,460.00
|
|
|
Service Code
|
CPT A8003
|
| Hospital Charge Code |
905350101
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$892.00 |
| Max. Negotiated Rate |
$3,791.00 |
| Rate for Payer: Adventist Health Commercial |
$892.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,668.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,791.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,453.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,345.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,861.98
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: Cigna of CA HMO |
$2,854.40
|
| Rate for Payer: Cigna of CA PPO |
$3,300.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,791.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,791.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,791.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,122.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,784.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,784.00
|
| Rate for Payer: Galaxy Health WC |
$3,791.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,676.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,832.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,631.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,070.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,122.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,122.00
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: Networks By Design Commercial |
$2,899.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,791.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,676.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,791.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,791.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,791.00
|
|
|
HC HARD PROTECT HELMET CUSTOM
|
Facility
|
IP
|
$4,460.00
|
|
|
Service Code
|
CPT A8003
|
| Hospital Charge Code |
905350101
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$892.00 |
| Max. Negotiated Rate |
$3,791.00 |
| Rate for Payer: Adventist Health Commercial |
$892.00
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,122.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,784.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,784.00
|
| Rate for Payer: Galaxy Health WC |
$3,791.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,676.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,832.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,631.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,070.40
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: Networks By Design Commercial |
$2,899.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,791.00
|
|
|
HC HARD PROTECT HELMET CUSTOM
|
Facility
|
IP
|
$4,460.00
|
|
|
Service Code
|
CPT A8003
|
| Hospital Charge Code |
915350101
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$892.00 |
| Max. Negotiated Rate |
$3,791.00 |
| Rate for Payer: Adventist Health Commercial |
$892.00
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,122.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,784.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,784.00
|
| Rate for Payer: Galaxy Health WC |
$3,791.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,676.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,832.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,631.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,070.40
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: Networks By Design Commercial |
$2,899.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,791.00
|
|
|
HC HARVEST THAW WO WASHING
|
Facility
|
IP
|
$666.00
|
|
|
Service Code
|
CPT 38208
|
| Hospital Charge Code |
900904699
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$566.10 |
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$466.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.40
|
| Rate for Payer: EPIC Health Plan Senior |
$266.40
|
| Rate for Payer: Galaxy Health WC |
$566.10
|
| Rate for Payer: Global Benefits Group Commercial |
$399.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$422.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$392.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.84
|
| Rate for Payer: Multiplan Commercial |
$532.80
|
| Rate for Payer: Networks By Design Commercial |
$432.90
|
| Rate for Payer: Prime Health Services Commercial |
$566.10
|
|
|
HC HARVEST THAW WO WASHING
|
Facility
|
OP
|
$666.00
|
|
|
Service Code
|
CPT 38208
|
| Hospital Charge Code |
900904699
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: United Healthcare HMO Rider |
$333.00
|
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$195.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$464.20
|
| Rate for Payer: Blue Shield of California Commercial |
$307.03
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna of CA HMO |
$426.24
|
| Rate for Payer: Cigna of CA PPO |
$492.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$466.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.24
|
| Rate for Payer: EPIC Health Plan Senior |
$624.16
|
| Rate for Payer: Galaxy Health WC |
$566.10
|
| Rate for Payer: Global Benefits Group Commercial |
$399.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$930.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$422.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$714.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$760.34
|
| Rate for Payer: Multiplan Commercial |
$532.80
|
| Rate for Payer: Networks By Design Commercial |
$432.90
|
| Rate for Payer: Prime Health Services Commercial |
$566.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$399.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$399.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$333.00
|
| Rate for Payer: United Healthcare All Other HMO |
$333.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$333.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$567.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC HAST
|
Facility
|
IP
|
$1,003.00
|
|
|
Service Code
|
CPT 94452
|
| Hospital Charge Code |
900801034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$200.60 |
| Max. Negotiated Rate |
$852.55 |
| Rate for Payer: Adventist Health Commercial |
$200.60
|
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$702.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.20
|
| Rate for Payer: EPIC Health Plan Senior |
$401.20
|
| Rate for Payer: Galaxy Health WC |
$852.55
|
| Rate for Payer: Global Benefits Group Commercial |
$601.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$636.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.72
|
| Rate for Payer: Multiplan Commercial |
$802.40
|
| Rate for Payer: Networks By Design Commercial |
$651.95
|
| Rate for Payer: Prime Health Services Commercial |
$852.55
|
|
|
HC HAST
|
Facility
|
OP
|
$1,003.00
|
|
|
Service Code
|
CPT 94452
|
| Hospital Charge Code |
900801034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$171.12 |
| Max. Negotiated Rate |
$852.55 |
| Rate for Payer: Adventist Health Commercial |
$200.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$317.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$643.63
|
| Rate for Payer: Blue Shield of California Commercial |
$422.26
|
| Rate for Payer: Blue Shield of California Commercial |
$639.91
|
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: Cigna of CA HMO |
$641.92
|
| Rate for Payer: Cigna of CA PPO |
$742.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$702.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$852.55
|
| Rate for Payer: Global Benefits Group Commercial |
$601.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$636.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$364.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$802.40
|
| Rate for Payer: Networks By Design Commercial |
$651.95
|
| Rate for Payer: Prime Health Services Commercial |
$852.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$601.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$601.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC HAST W/02 TITRATE
|
Facility
|
OP
|
$943.00
|
|
|
Service Code
|
CPT 94453
|
| Hospital Charge Code |
900801035
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$171.12 |
| Max. Negotiated Rate |
$801.55 |
| Rate for Payer: Adventist Health Commercial |
$188.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$435.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$605.12
|
| Rate for Payer: Blue Shield of California Commercial |
$397.00
|
| Rate for Payer: Blue Shield of California Commercial |
$601.63
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Cigna of CA HMO |
$603.52
|
| Rate for Payer: Cigna of CA PPO |
$697.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$660.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$801.55
|
| Rate for Payer: Global Benefits Group Commercial |
$565.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$598.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$342.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$754.40
|
| Rate for Payer: Networks By Design Commercial |
$612.95
|
| Rate for Payer: Prime Health Services Commercial |
$801.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$565.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$565.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC HAST W/02 TITRATE
|
Facility
|
IP
|
$943.00
|
|
|
Service Code
|
CPT 94453
|
| Hospital Charge Code |
900801035
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$188.60 |
| Max. Negotiated Rate |
$801.55 |
| Rate for Payer: Adventist Health Commercial |
$188.60
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$660.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.20
|
| Rate for Payer: EPIC Health Plan Senior |
$377.20
|
| Rate for Payer: Galaxy Health WC |
$801.55
|
| Rate for Payer: Global Benefits Group Commercial |
$565.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$598.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$556.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.32
|
| Rate for Payer: Multiplan Commercial |
$754.40
|
| Rate for Payer: Networks By Design Commercial |
$612.95
|
| Rate for Payer: Prime Health Services Commercial |
$801.55
|
|
|
HC HBO THERAPY INTL 15 MIN INCREM
|
Facility
|
IP
|
$682.00
|
|
| Hospital Charge Code |
900803110
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$579.70 |
| Rate for Payer: Adventist Health Commercial |
$136.40
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$477.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.80
|
| Rate for Payer: EPIC Health Plan Senior |
$272.80
|
| Rate for Payer: Galaxy Health WC |
$579.70
|
| Rate for Payer: Global Benefits Group Commercial |
$409.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$433.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$402.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.68
|
| Rate for Payer: Multiplan Commercial |
$545.60
|
| Rate for Payer: Networks By Design Commercial |
$443.30
|
| Rate for Payer: Prime Health Services Commercial |
$579.70
|
|
|
HC HBO THERAPY INTL 15 MIN INCREM
|
Facility
|
OP
|
$682.00
|
|
| Hospital Charge Code |
900803110
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$3,863.00 |
| Rate for Payer: Adventist Health Commercial |
$136.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$447.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$375.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$511.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cigna of CA HMO |
$436.48
|
| Rate for Payer: Cigna of CA PPO |
$504.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$579.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$579.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$477.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.80
|
| Rate for Payer: EPIC Health Plan Senior |
$272.80
|
| Rate for Payer: Galaxy Health WC |
$579.70
|
| Rate for Payer: Global Benefits Group Commercial |
$409.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$433.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$247.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$402.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$477.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$477.40
|
| Rate for Payer: Multiplan Commercial |
$545.60
|
| Rate for Payer: Networks By Design Commercial |
$443.30
|
| Rate for Payer: Prime Health Services Commercial |
$579.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$409.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$409.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,863.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,314.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,510.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$579.70
|
| Rate for Payer: Vantage Medical Group Senior |
$579.70
|
|
|
HC HBO THERAPY PER 30 MINUTES
|
Facility
|
OP
|
$1,448.00
|
|
|
Service Code
|
CPT G0277
|
| Hospital Charge Code |
900803100
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$176.99 |
| Max. Negotiated Rate |
$3,863.00 |
| Rate for Payer: Adventist Health Commercial |
$289.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$303.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$194.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$176.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna of CA HMO |
$926.72
|
| Rate for Payer: Cigna of CA PPO |
$1,071.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$176.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,013.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.03
|
| Rate for Payer: EPIC Health Plan Senior |
$194.69
|
| Rate for Payer: Galaxy Health WC |
$1,230.80
|
| Rate for Payer: Global Benefits Group Commercial |
$868.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$290.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$176.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$919.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$525.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$247.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$223.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.17
|
| Rate for Payer: Multiplan Commercial |
$1,158.40
|
| Rate for Payer: Networks By Design Commercial |
$941.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,230.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$868.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$868.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,863.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,314.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,510.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,298.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$176.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.69
|
| Rate for Payer: Vantage Medical Group Senior |
$176.99
|
|
|
HC HBO THERAPY PER 30 MINUTES
|
Facility
|
IP
|
$1,448.00
|
|
|
Service Code
|
CPT G0277
|
| Hospital Charge Code |
900803100
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$289.60 |
| Max. Negotiated Rate |
$1,230.80 |
| Rate for Payer: Adventist Health Commercial |
$289.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,013.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$579.20
|
| Rate for Payer: EPIC Health Plan Senior |
$579.20
|
| Rate for Payer: Galaxy Health WC |
$1,230.80
|
| Rate for Payer: Global Benefits Group Commercial |
$868.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$919.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$854.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.52
|
| Rate for Payer: Multiplan Commercial |
$1,158.40
|
| Rate for Payer: Networks By Design Commercial |
$941.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,230.80
|
|
|
HC HBO THERAPY SUB 15 MIN INCREM
|
Facility
|
OP
|
$682.00
|
|
| Hospital Charge Code |
900803111
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$3,863.00 |
| Rate for Payer: Adventist Health Commercial |
$136.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$447.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$375.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$511.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cigna of CA HMO |
$436.48
|
| Rate for Payer: Cigna of CA PPO |
$504.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$579.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$579.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$477.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.80
|
| Rate for Payer: EPIC Health Plan Senior |
$272.80
|
| Rate for Payer: Galaxy Health WC |
$579.70
|
| Rate for Payer: Global Benefits Group Commercial |
$409.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$433.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$247.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$402.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$477.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$477.40
|
| Rate for Payer: Multiplan Commercial |
$545.60
|
| Rate for Payer: Networks By Design Commercial |
$443.30
|
| Rate for Payer: Prime Health Services Commercial |
$579.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$409.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$409.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,863.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,314.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,510.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$579.70
|
| Rate for Payer: Vantage Medical Group Senior |
$579.70
|
|
|
HC HBO THERAPY SUB 15 MIN INCREM
|
Facility
|
IP
|
$682.00
|
|
| Hospital Charge Code |
900803111
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$579.70 |
| Rate for Payer: Adventist Health Commercial |
$136.40
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$477.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.80
|
| Rate for Payer: EPIC Health Plan Senior |
$272.80
|
| Rate for Payer: Galaxy Health WC |
$579.70
|
| Rate for Payer: Global Benefits Group Commercial |
$409.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$433.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$402.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.68
|
| Rate for Payer: Multiplan Commercial |
$545.60
|
| Rate for Payer: Networks By Design Commercial |
$443.30
|
| Rate for Payer: Prime Health Services Commercial |
$579.70
|
|
|
HC HCV RNA QUANT
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
900913610
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$128.60 |
| Max. Negotiated Rate |
$546.55 |
| Rate for Payer: Adventist Health Commercial |
$128.60
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$450.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.20
|
| Rate for Payer: EPIC Health Plan Senior |
$257.20
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$408.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$379.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.32
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
|
|
HC HCV RNA QUANT
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
900913610
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$356.23 |
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Adventist Health Commercial |
$128.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$356.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$356.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.05
|
| Rate for Payer: Blue Shield of California Commercial |
$296.42
|
| Rate for Payer: Blue Shield of California Commercial |
$104.19
|
| Rate for Payer: Blue Shield of California Commercial |
$448.17
|
| Rate for Payer: Blue Shield of California Commercial |
$157.52
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna of CA HMO |
$411.52
|
| Rate for Payer: Cigna of CA HMO |
$144.64
|
| Rate for Payer: Cigna of CA PPO |
$167.24
|
| Rate for Payer: Cigna of CA PPO |
$475.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$158.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$450.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: Galaxy Health WC |
$192.10
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$135.60
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$143.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$408.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: Multiplan Commercial |
$180.80
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Networks By Design Commercial |
$146.90
|
| Rate for Payer: Prime Health Services Commercial |
$192.10
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$385.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$385.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC HCV RNA QUANT PCR TEST
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
900913694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$356.23 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$356.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$356.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.05
|
| Rate for Payer: Blue Shield of California Commercial |
$111.52
|
| Rate for Payer: Blue Shield of California Commercial |
$64.54
|
| Rate for Payer: Blue Shield of California Commercial |
$73.76
|
| Rate for Payer: Blue Shield of California Commercial |
$97.58
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna of CA HMO |
$102.40
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$103.60
|
| Rate for Payer: Cigna of CA PPO |
$118.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$88.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$101.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC HCV RNA QUANT PCR TEST
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
900913694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$101.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
|
|
HC HD ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
IP
|
$3,193.00
|
|
|
Service Code
|
CPT L5960
|
| Hospital Charge Code |
915355960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$638.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$638.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Cigna of CA HMO |
$2,235.10
|
| Rate for Payer: Cigna of CA PPO |
$2,235.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,235.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,277.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,277.20
|
| Rate for Payer: Galaxy Health WC |
$2,714.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,027.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,883.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$766.32
|
| Rate for Payer: Multiplan Commercial |
$2,554.40
|
| Rate for Payer: Networks By Design Commercial |
$2,075.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,714.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,198.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1,166.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1,141.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,045.71
|
|
