|
HC IMMUNOGLOBULIN E
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
900912129
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.33 |
| Max. Negotiated Rate |
$162.65 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.65
|
| Rate for Payer: Blue Shield of California Commercial |
$119.75
|
| Rate for Payer: Blue Shield of California EPN |
$79.12
|
| Rate for Payer: Cash Price |
$98.45
|
| Rate for Payer: Cash Price |
$98.45
|
| Rate for Payer: Cigna of CA HMO |
$114.56
|
| Rate for Payer: Cigna of CA PPO |
$132.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.22
|
| Rate for Payer: EPIC Health Plan Senior |
$16.46
|
| Rate for Payer: Galaxy Health WC |
$152.15
|
| Rate for Payer: Global Benefits Group Commercial |
$107.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.06
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: Networks By Design Commercial |
$116.35
|
| Rate for Payer: Prime Health Services Commercial |
$152.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.33
|
| Rate for Payer: United Healthcare All Other HMO |
$13.33
|
| Rate for Payer: United Healthcare HMO Rider |
$13.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.33
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.11
|
| Rate for Payer: Vantage Medical Group Senior |
$16.46
|
|
|
HC IMMUNOGLOBULIN E
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
900912129
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.80 |
| Max. Negotiated Rate |
$152.15 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Cash Price |
$98.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.60
|
| Rate for Payer: EPIC Health Plan Senior |
$71.60
|
| Rate for Payer: Galaxy Health WC |
$152.15
|
| Rate for Payer: Global Benefits Group Commercial |
$107.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.96
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: Networks By Design Commercial |
$116.35
|
| Rate for Payer: Prime Health Services Commercial |
$152.15
|
|
|
HC IMMUNOGLOBULINS IGA
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900910855
|
|
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 |
$115.50
|
| 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 Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| 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 IMMUNOGLOBULINS IGA
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900910855
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$137.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.54
|
| Rate for Payer: Blue Shield of California Commercial |
$140.49
|
| Rate for Payer: Blue Shield of California EPN |
$92.82
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.55
|
| Rate for Payer: EPIC Health Plan Senior |
$9.30
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.46
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.53
|
| Rate for Payer: United Healthcare All Other HMO |
$7.53
|
| Rate for Payer: United Healthcare HMO Rider |
$7.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Senior |
$9.30
|
|
|
HC IMMUNOGLOBULINS IGG
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900910857
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$151.30 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.72
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
|
|
HC IMMUNOGLOBULINS IGG
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900910857
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$151.30 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.54
|
| Rate for Payer: Blue Shield of California Commercial |
$119.08
|
| Rate for Payer: Blue Shield of California EPN |
$78.68
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Cigna of CA HMO |
$113.92
|
| Rate for Payer: Cigna of CA PPO |
$131.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.55
|
| Rate for Payer: EPIC Health Plan Senior |
$9.30
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.53
|
| Rate for Payer: United Healthcare All Other HMO |
$7.53
|
| Rate for Payer: United Healthcare HMO Rider |
$7.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Senior |
$9.30
|
|
|
HC IMMUNOGLOBULINS IGM
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900910856
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$137.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.54
|
| Rate for Payer: Blue Shield of California Commercial |
$140.49
|
| Rate for Payer: Blue Shield of California EPN |
$92.82
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.55
|
| Rate for Payer: EPIC Health Plan Senior |
$9.30
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.46
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.53
|
| Rate for Payer: United Healthcare All Other HMO |
$7.53
|
| Rate for Payer: United Healthcare HMO Rider |
$7.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Senior |
$9.30
|
|
|
HC IMMUNOGLOBULINS IGM
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900910856
|
|
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 |
$115.50
|
| 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 Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| 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 IMMUNOHISTO ANTIBOD ADD SLID
|
Facility
|
IP
|
$724.00
|
|
|
Service Code
|
CPT 88344
|
| Hospital Charge Code |
903800241
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$144.80 |
| Max. Negotiated Rate |
$615.40 |
| Rate for Payer: Adventist Health Commercial |
$144.80
|
| Rate for Payer: Cash Price |
$398.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.60
|
| Rate for Payer: EPIC Health Plan Senior |
$289.60
|
| Rate for Payer: Galaxy Health WC |
$615.40
|
| Rate for Payer: Global Benefits Group Commercial |
$434.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$482.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$275.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$448.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.76
|
| Rate for Payer: Multiplan Commercial |
$579.20
|
| Rate for Payer: Networks By Design Commercial |
$470.60
|
| Rate for Payer: Prime Health Services Commercial |
$615.40
|
|
|
HC IMMUNOHISTO ANTIBOD ADD SLID
|
Facility
|
OP
|
$724.00
|
|
|
Service Code
|
CPT 88344
|
| Hospital Charge Code |
903800241
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$144.80 |
| Max. Negotiated Rate |
$749.58 |
| Rate for Payer: Adventist Health Commercial |
$144.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$474.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$738.05
|
| Rate for Payer: Blue Shield of California Commercial |
$484.36
|
| Rate for Payer: Blue Shield of California EPN |
$320.01
|
| Rate for Payer: Cash Price |
$398.20
|
| Rate for Payer: Cash Price |
$398.20
|
| Rate for Payer: Cigna of CA HMO |
$463.36
|
| Rate for Payer: Cigna of CA PPO |
$535.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$457.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.03
|
| Rate for Payer: EPIC Health Plan Senior |
$457.06
|
| Rate for Payer: Galaxy Health WC |
$615.40
|
| Rate for Payer: Global Benefits Group Commercial |
$434.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$749.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$176.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$457.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$482.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$457.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$575.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.46
|
| Rate for Payer: Multiplan Commercial |
$579.20
|
| Rate for Payer: Networks By Design Commercial |
$470.60
|
| Rate for Payer: Prime Health Services Commercial |
$615.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$434.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$434.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$457.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Vantage Medical Group Senior |
$457.06
|
|
|
HC IMMUNOHISTOCHEM OR IMMUNOCYTOCHEM EA ABY STAIN
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
903800031
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$90.37 |
| Max. Negotiated Rate |
$538.90 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$415.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.16
|
| Rate for Payer: Blue Shield of California Commercial |
$424.15
|
| Rate for Payer: Blue Shield of California EPN |
$280.23
|
| Rate for Payer: Cash Price |
$348.70
|
| Rate for Payer: Cash Price |
$348.70
|
| Rate for Payer: Cigna of CA HMO |
$405.76
|
| Rate for Payer: Cigna of CA PPO |
$469.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$538.90
|
| Rate for Payer: Global Benefits Group Commercial |
$380.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$90.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$422.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$507.20
|
| Rate for Payer: Networks By Design Commercial |
$412.10
|
| Rate for Payer: Prime Health Services Commercial |
$538.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$380.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$380.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC IMMUNOHISTOCHEM OR IMMUNOCYTOCHEM EA ABY STAIN
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
903800031
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$126.80 |
| Max. Negotiated Rate |
$538.90 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Cash Price |
$348.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.60
|
| Rate for Payer: EPIC Health Plan Senior |
$253.60
|
| Rate for Payer: Galaxy Health WC |
$538.90
|
| Rate for Payer: Global Benefits Group Commercial |
$380.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$422.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.16
|
| Rate for Payer: Multiplan Commercial |
$507.20
|
| Rate for Payer: Networks By Design Commercial |
$412.10
|
| Rate for Payer: Prime Health Services Commercial |
$538.90
|
|
|
HC IMMUNOHISTOCHEM OR IMMUNOCYTOCHEM EA ADDITIONAL ABY STAIN
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
903800252
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$49.90 |
| Max. Negotiated Rate |
$438.68 |
| Rate for Payer: Adventist Health Commercial |
$95.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$407.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$263.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$359.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$438.68
|
| Rate for Payer: Blue Shield of California Commercial |
$320.45
|
| Rate for Payer: Blue Shield of California EPN |
$211.72
|
| Rate for Payer: Cash Price |
$263.45
|
| Rate for Payer: Cash Price |
$263.45
|
| Rate for Payer: Cigna of CA HMO |
$306.56
|
| Rate for Payer: Cigna of CA PPO |
$354.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$407.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$407.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.60
|
| Rate for Payer: EPIC Health Plan Senior |
$191.60
|
| Rate for Payer: Galaxy Health WC |
$407.15
|
| Rate for Payer: Global Benefits Group Commercial |
$287.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$101.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$319.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$296.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.30
|
| Rate for Payer: Multiplan Commercial |
$383.20
|
| Rate for Payer: Networks By Design Commercial |
$311.35
|
| Rate for Payer: Prime Health Services Commercial |
$407.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$287.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$287.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.90
|
| Rate for Payer: United Healthcare All Other HMO |
$49.90
|
| Rate for Payer: United Healthcare HMO Rider |
$49.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$407.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.15
|
| Rate for Payer: Vantage Medical Group Senior |
$407.15
|
|
|
HC IMMUNOHISTOCHEM OR IMMUNOCYTOCHEM EA ADDITIONAL ABY STAIN
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
903800252
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$407.15 |
| Rate for Payer: Cash Price |
$263.45
|
| Rate for Payer: Adventist Health Commercial |
$95.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.60
|
| Rate for Payer: EPIC Health Plan Senior |
$191.60
|
| Rate for Payer: Galaxy Health WC |
$407.15
|
| Rate for Payer: Global Benefits Group Commercial |
$287.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$319.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$296.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.96
|
| Rate for Payer: Multiplan Commercial |
$383.20
|
| Rate for Payer: Networks By Design Commercial |
$311.35
|
| Rate for Payer: Prime Health Services Commercial |
$407.15
|
|
|
HC IMMUNOHISTOCHEM STAIN ER/PR
|
Facility
|
OP
|
$777.00
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
903800179
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$95.32 |
| Max. Negotiated Rate |
$660.45 |
| Rate for Payer: Adventist Health Commercial |
$155.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$509.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$367.99
|
| Rate for Payer: Blue Shield of California Commercial |
$519.81
|
| Rate for Payer: Blue Shield of California EPN |
$343.43
|
| Rate for Payer: Cash Price |
$427.35
|
| Rate for Payer: Cash Price |
$427.35
|
| Rate for Payer: Cigna of CA HMO |
$497.28
|
| Rate for Payer: Cigna of CA PPO |
$574.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$660.45
|
| Rate for Payer: Global Benefits Group Commercial |
$466.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$95.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$518.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$621.60
|
| Rate for Payer: Networks By Design Commercial |
$505.05
|
| Rate for Payer: Prime Health Services Commercial |
$660.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$466.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$466.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC IMMUNOHISTOCHEM STAIN ER/PR
|
Facility
|
IP
|
$777.00
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
903800179
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$155.40 |
| Max. Negotiated Rate |
$660.45 |
| Rate for Payer: Adventist Health Commercial |
$155.40
|
| Rate for Payer: Cash Price |
$427.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$310.80
|
| Rate for Payer: EPIC Health Plan Senior |
$310.80
|
| Rate for Payer: Galaxy Health WC |
$660.45
|
| Rate for Payer: Global Benefits Group Commercial |
$466.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$518.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$296.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.48
|
| Rate for Payer: Multiplan Commercial |
$621.60
|
| Rate for Payer: Networks By Design Commercial |
$505.05
|
| Rate for Payer: Prime Health Services Commercial |
$660.45
|
|
|
HC IMMUNOTYPING ELECTROPHORESIS
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
900913611
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$286.45 |
| Rate for Payer: Adventist Health Commercial |
$67.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$221.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$220.64
|
| Rate for Payer: Blue Shield of California Commercial |
$225.45
|
| Rate for Payer: Blue Shield of California EPN |
$148.95
|
| Rate for Payer: Cash Price |
$185.35
|
| Rate for Payer: Cash Price |
$185.35
|
| Rate for Payer: Cigna of CA HMO |
$215.68
|
| Rate for Payer: Cigna of CA PPO |
$249.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.16
|
| Rate for Payer: EPIC Health Plan Senior |
$22.34
|
| Rate for Payer: Galaxy Health WC |
$286.45
|
| Rate for Payer: Global Benefits Group Commercial |
$202.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.94
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: Networks By Design Commercial |
$219.05
|
| Rate for Payer: Prime Health Services Commercial |
$286.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$202.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$202.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.10
|
| Rate for Payer: United Healthcare All Other HMO |
$18.10
|
| Rate for Payer: United Healthcare HMO Rider |
$18.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: Vantage Medical Group Senior |
$22.34
|
|
|
HC IMMUNOTYPING ELECTROPHORESIS
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
900913611
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.40 |
| Max. Negotiated Rate |
$286.45 |
| Rate for Payer: Adventist Health Commercial |
$67.40
|
| Rate for Payer: Cash Price |
$185.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.80
|
| Rate for Payer: EPIC Health Plan Senior |
$134.80
|
| Rate for Payer: Galaxy Health WC |
$286.45
|
| Rate for Payer: Global Benefits Group Commercial |
$202.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$208.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.88
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: Networks By Design Commercial |
$219.05
|
| Rate for Payer: Prime Health Services Commercial |
$286.45
|
|
|
HC IMPEDANCE TESTING
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
908710301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.87 |
| Max. Negotiated Rate |
$248.20 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$191.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.32
|
| Rate for Payer: Cash Price |
$160.60
|
| Rate for Payer: Cash Price |
$160.60
|
| Rate for Payer: Cigna of CA HMO |
$186.88
|
| Rate for Payer: Cigna of CA PPO |
$216.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.32
|
| Rate for Payer: EPIC Health Plan Senior |
$49.87
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$194.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.83
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: Networks By Design Commercial |
$189.80
|
| Rate for Payer: Prime Health Services Commercial |
$248.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$175.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$175.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$146.00
|
| Rate for Payer: United Healthcare All Other HMO |
$146.00
|
| Rate for Payer: United Healthcare HMO Rider |
$146.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$146.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$49.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Vantage Medical Group Senior |
$49.87
|
|
|
HC IMPEDANCE TESTING
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
908710301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$248.20 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Cash Price |
$160.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$116.80
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$194.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.08
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: Networks By Design Commercial |
$189.80
|
| Rate for Payer: Prime Health Services Commercial |
$248.20
|
|
|
HC IMPELLA LT ART VEN TRANS
|
Facility
|
IP
|
$14,691.00
|
|
|
Service Code
|
CPT 33991
|
| Hospital Charge Code |
906811991
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,938.20 |
| Max. Negotiated Rate |
$12,487.35 |
| Rate for Payer: Adventist Health Commercial |
$2,938.20
|
| Rate for Payer: Cash Price |
$8,080.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,876.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,876.40
|
| Rate for Payer: Galaxy Health WC |
$12,487.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,814.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,798.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,597.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,093.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,525.84
|
| Rate for Payer: Multiplan Commercial |
$11,752.80
|
| Rate for Payer: Networks By Design Commercial |
$9,549.15
|
| Rate for Payer: Prime Health Services Commercial |
$12,487.35
|
|
|
HC IMPELLA LT ART VEN TRANS
|
Facility
|
OP
|
$14,691.00
|
|
|
Service Code
|
CPT 33991
|
| Hospital Charge Code |
906811991
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$171.38 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,938.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,487.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,080.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,018.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,369.02
|
| Rate for Payer: Cash Price |
$8,080.05
|
| Rate for Payer: Cash Price |
$8,080.05
|
| Rate for Payer: Cash Price |
$8,080.05
|
| Rate for Payer: Cigna of CA HMO |
$9,402.24
|
| Rate for Payer: Cigna of CA PPO |
$10,871.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,487.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,487.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,487.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,876.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,876.40
|
| Rate for Payer: Galaxy Health WC |
$12,487.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,814.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$171.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,798.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,093.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,525.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,283.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,283.70
|
| Rate for Payer: Multiplan Commercial |
$11,752.80
|
| Rate for Payer: Networks By Design Commercial |
$9,549.15
|
| Rate for Payer: Prime Health Services Commercial |
$12,487.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,814.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,487.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,487.35
|
| Rate for Payer: Vantage Medical Group Senior |
$12,487.35
|
|
|
HC IMPL AGA DUCT OCCLUDER II
|
Facility
|
IP
|
$11,408.00
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,281.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,281.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$6,274.40
|
| Rate for Payer: Cash Price |
$6,274.40
|
| Rate for Payer: Cigna of CA HMO |
$7,985.60
|
| Rate for Payer: Cigna of CA PPO |
$7,985.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,563.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,563.20
|
| Rate for Payer: Galaxy Health WC |
$9,696.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,844.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,609.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,346.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,061.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,737.92
|
| Rate for Payer: Multiplan Commercial |
$9,126.40
|
| Rate for Payer: Networks By Design Commercial |
$5,704.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,696.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,281.42
|
| Rate for Payer: United Healthcare All Other HMO |
$4,167.34
|
| Rate for Payer: United Healthcare HMO Rider |
$4,077.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,736.12
|
|
|
HC IMPL AGA DUCT OCCLUDER II
|
Facility
|
OP
|
$11,408.00
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,281.60 |
| Max. Negotiated Rate |
$9,696.80 |
| Rate for Payer: Adventist Health Commercial |
$2,281.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,274.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,556.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,607.51
|
| Rate for Payer: Blue Shield of California Commercial |
$8,419.10
|
| Rate for Payer: Blue Shield of California EPN |
$5,544.29
|
| Rate for Payer: Cash Price |
$6,274.40
|
| Rate for Payer: Cigna of CA HMO |
$7,985.60
|
| Rate for Payer: Cigna of CA PPO |
$7,985.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,696.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,696.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,563.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,563.20
|
| Rate for Payer: Galaxy Health WC |
$9,696.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,844.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,609.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,346.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,061.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,737.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,985.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,985.60
|
| Rate for Payer: Multiplan Commercial |
$9,126.40
|
| Rate for Payer: Networks By Design Commercial |
$5,704.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,696.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,844.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,844.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,281.42
|
| Rate for Payer: United Healthcare All Other HMO |
$4,167.34
|
| Rate for Payer: United Healthcare HMO Rider |
$4,077.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,736.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,696.80
|
| Rate for Payer: Vantage Medical Group Senior |
$9,696.80
|
|
|
HC IMPL AGA VAS PLUG II OCCL
|
Facility
|
OP
|
$3,244.80
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$648.96 |
| Max. Negotiated Rate |
$2,758.08 |
| Rate for Payer: Adventist Health Commercial |
$648.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,758.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,784.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,433.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,879.39
|
| Rate for Payer: Blue Shield of California Commercial |
$2,394.66
|
| Rate for Payer: Blue Shield of California EPN |
$1,576.97
|
| Rate for Payer: Cash Price |
$1,784.64
|
| Rate for Payer: Cigna of CA HMO |
$2,271.36
|
| Rate for Payer: Cigna of CA PPO |
$2,271.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,758.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,758.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,758.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,297.92
|
| Rate for Payer: EPIC Health Plan Senior |
$1,297.92
|
| Rate for Payer: Galaxy Health WC |
$2,758.08
|
| Rate for Payer: Global Benefits Group Commercial |
$1,946.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,164.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,236.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$778.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,271.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,271.36
|
| Rate for Payer: Multiplan Commercial |
$2,595.84
|
| Rate for Payer: Networks By Design Commercial |
$1,622.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,758.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,946.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,946.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,217.77
|
| Rate for Payer: United Healthcare All Other HMO |
$1,185.33
|
| Rate for Payer: United Healthcare HMO Rider |
$1,159.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,062.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,758.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,758.08
|
| Rate for Payer: Vantage Medical Group Senior |
$2,758.08
|
|
