|
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 |
$771.26 |
| Rate for Payer: Adventist Health Commercial |
$144.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$526.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$771.26
|
| Rate for Payer: Blue Shield of California Commercial |
$333.76
|
| Rate for Payer: Blue Shield of California Commercial |
$504.63
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| 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 |
$691.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$461.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$506.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$760.68
|
| Rate for Payer: EPIC Health Plan Senior |
$507.12
|
| Rate for Payer: Galaxy Health WC |
$615.40
|
| Rate for Payer: Global Benefits Group Commercial |
$434.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$756.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$176.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$459.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$199.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$645.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$580.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$617.77
|
| 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 |
$461.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Vantage Medical Group Senior |
$461.02
|
|
|
HC IMMUNOHISTOCHEM OR IMMUNOCYTOCHEM EA ABY STAIN
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
903800031
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.80 |
| Max. Negotiated Rate |
$452.17 |
| Rate for Payer: Adventist Health Commercial |
$34.80
|
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$452.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$452.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.40
|
| Rate for Payer: Blue Shield of California Commercial |
$292.27
|
| Rate for Payer: Blue Shield of California Commercial |
$121.28
|
| Rate for Payer: Blue Shield of California Commercial |
$441.90
|
| Rate for Payer: Blue Shield of California Commercial |
$80.21
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna of CA HMO |
$405.76
|
| Rate for Payer: Cigna of CA HMO |
$111.36
|
| Rate for Payer: Cigna of CA PPO |
$128.76
|
| Rate for Payer: Cigna of CA PPO |
$469.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$121.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.55
|
| Rate for Payer: EPIC Health Plan Senior |
$241.03
|
| Rate for Payer: EPIC Health Plan Senior |
$241.03
|
| Rate for Payer: Galaxy Health WC |
$147.90
|
| Rate for Payer: Galaxy Health WC |
$538.90
|
| Rate for Payer: Global Benefits Group Commercial |
$104.40
|
| Rate for Payer: Global Benefits Group Commercial |
$380.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$359.36
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$359.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$90.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$90.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$110.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$402.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$276.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$276.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$293.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$507.20
|
| Rate for Payer: Multiplan Commercial |
$139.20
|
| Rate for Payer: Networks By Design Commercial |
$412.10
|
| Rate for Payer: Networks By Design Commercial |
$113.10
|
| Rate for Payer: Prime Health Services Commercial |
$147.90
|
| Rate for Payer: Prime Health Services Commercial |
$538.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$104.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$380.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$104.40
|
| 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 Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$219.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$219.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
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 |
$285.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$402.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$374.06
|
| 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 |
$458.42 |
| Rate for Payer: Adventist Health Commercial |
$95.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$313.47
|
| 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 |
$458.42
|
| Rate for Payer: Blue Shield of California Commercial |
$333.86
|
| Rate for Payer: Blue Shield of California Commercial |
$220.82
|
| Rate for Payer: Cash Price |
$215.55
|
| Rate for Payer: Cash Price |
$215.55
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$335.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.60
|
| Rate for Payer: EPIC Health Plan Senior |
$191.60
|
| Rate for Payer: Galaxy Health WC |
$407.15
|
| Rate for Payer: Global Benefits Group Commercial |
$287.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$101.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$304.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$115.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$282.61
|
| 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: Adventist Health Commercial |
$95.80
|
| Rate for Payer: Cash Price |
$215.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$335.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.60
|
| Rate for Payer: EPIC Health Plan Senior |
$191.60
|
| Rate for Payer: Galaxy Health WC |
$407.15
|
| Rate for Payer: Global Benefits Group Commercial |
$287.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$304.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$282.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.96
|
| Rate for Payer: Multiplan Commercial |
$383.20
|
| Rate for Payer: Networks By Design Commercial |
$311.35
|
| Rate for Payer: Prime Health Services Commercial |
$407.15
|
|
|
HC IMMUNOHISTOCHEM STAIN ER/PR
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
903800179
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$510.92 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Adventist Health Commercial |
$155.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$510.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$510.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$384.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$384.55
|
| Rate for Payer: Blue Shield of California Commercial |
$358.20
|
| Rate for Payer: Blue Shield of California Commercial |
$133.82
|
| Rate for Payer: Blue Shield of California Commercial |
$541.57
|
| Rate for Payer: Blue Shield of California Commercial |
$88.51
|
| Rate for Payer: Cash Price |
$349.65
|
| Rate for Payer: Cash Price |
$349.65
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna of CA HMO |
$497.28
|
| Rate for Payer: Cigna of CA HMO |
$122.88
|
| Rate for Payer: Cigna of CA PPO |
$142.08
|
| Rate for Payer: Cigna of CA PPO |
$574.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$543.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.55
|
| Rate for Payer: EPIC Health Plan Senior |
$241.03
|
| Rate for Payer: EPIC Health Plan Senior |
$241.03
|
| Rate for Payer: Galaxy Health WC |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$660.45
|
| Rate for Payer: Global Benefits Group Commercial |
$115.20
|
| Rate for Payer: Global Benefits Group Commercial |
$466.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$359.36
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$359.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$95.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$95.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$493.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$276.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$276.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$293.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$621.60
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: Networks By Design Commercial |
$505.05
|
| Rate for Payer: Networks By Design Commercial |
$124.80
|
| Rate for Payer: Prime Health Services Commercial |
$163.20
|
| Rate for Payer: Prime Health Services Commercial |
$660.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$466.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.20
|
| 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 Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$219.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$219.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
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 |
$349.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$543.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$493.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$458.43
|
| 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
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
900913720
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$230.56 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$185.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$185.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.51
|
| 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 Medi-Cal |
$24.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$230.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$230.56
|
| Rate for Payer: Blue Shield of California Commercial |
$12.91
|
| Rate for Payer: Blue Shield of California Commercial |
$10.60
|
| Rate for Payer: Blue Shield of California Commercial |
$19.52
|
| Rate for Payer: Blue Shield of California Commercial |
$16.03
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA HMO |
$14.72
|
| Rate for Payer: Cigna of CA PPO |
$17.02
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.86
|
| Rate for Payer: EPIC Health Plan Senior |
$24.57
|
| Rate for Payer: EPIC Health Plan Senior |
$24.57
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.64
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.36
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.94
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.10
|
| 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 All Other HMO |
$18.10
|
| Rate for Payer: United Healthcare HMO Rider |
$18.10
|
| Rate for Payer: United Healthcare HMO Rider |
$18.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.34
|
| 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 Commercial/Exchange |
$33.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: Vantage Medical Group Senior |
$22.34
|
| Rate for Payer: Vantage Medical Group Senior |
$22.34
|
|
|
HC IMMUNOTYPING
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
900913720
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$23.80 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11.20
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
|
|
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 |
$151.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$214.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.83
|
| 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 IMMUNOTYPING ELECTROPHORESIS
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
900913611
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$230.56 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Adventist Health Commercial |
$67.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$185.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$185.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.51
|
| 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 Medi-Cal |
$24.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$230.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$230.56
|
| Rate for Payer: Blue Shield of California Commercial |
$155.36
|
| Rate for Payer: Blue Shield of California Commercial |
$136.61
|
| Rate for Payer: Blue Shield of California Commercial |
$234.89
|
| Rate for Payer: Blue Shield of California Commercial |
$90.36
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna of CA HMO |
$215.68
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Cigna of CA PPO |
$249.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.86
|
| Rate for Payer: EPIC Health Plan Senior |
$24.57
|
| Rate for Payer: EPIC Health Plan Senior |
$24.57
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Galaxy Health WC |
$286.45
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Global Benefits Group Commercial |
$202.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.64
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.36
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$124.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$214.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.04
|
| 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 Medi-Cal |
$28.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.94
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Networks By Design Commercial |
$219.05
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Prime Health Services Commercial |
$286.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$202.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| 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 Commercial |
$18.10
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$18.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.34
|
| 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 Commercial/Exchange |
$33.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: Vantage Medical Group Senior |
$22.34
|
| Rate for Payer: Vantage Medical Group Senior |
$22.34
|
|
|
HC IMPEDANCE TESTING
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
908710301
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$248.20 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$204.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$185.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$172.28
|
| 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 IMPEDANCE TESTING
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
908710301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.04 |
| Max. Negotiated Rate |
$248.20 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$187.38
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| 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 |
$72.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$204.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.27
|
| Rate for Payer: EPIC Health Plan Senior |
$52.84
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$185.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.37
|
| 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 |
$48.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Vantage Medical Group Senior |
$48.04
|
|
|
HC IMPEDANCE TESTING
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
908710301
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$48.04 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$119.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| 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 |
$72.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$204.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.27
|
| Rate for Payer: EPIC Health Plan Senior |
$52.84
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$185.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.37
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: Multiplan WC |
$79.47
|
| Rate for Payer: Networks By Design Commercial |
$189.80
|
| Rate for Payer: Prime Health Services Commercial |
$248.20
|
| Rate for Payer: Prime Health Services WC |
$78.66
|
| 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 |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Vantage Medical Group Senior |
$48.04
|
|
|
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 |
$131.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$204.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$185.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$172.28
|
| 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 IMPEDANCE TESTING
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
908710301
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$248.20 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$204.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$185.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$172.28
|
| 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 IMPEDANCE TESTING
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
908710301
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$48.04 |
| Max. Negotiated Rate |
$248.20 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$187.38
|
| Rate for Payer: Blue Shield of California Commercial |
$122.93
|
| Rate for Payer: Blue Shield of California Commercial |
$186.30
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| 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 |
$72.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$204.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.27
|
| Rate for Payer: EPIC Health Plan Senior |
$52.84
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$185.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.37
|
| 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 |
$233.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$184.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Vantage Medical Group Senior |
$48.04
|
|
|
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 |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,472.51
|
| Rate for Payer: Blue Shield of California Commercial |
$5,596.61
|
| Rate for Payer: Cash Price |
$6,610.95
|
| Rate for Payer: Cash Price |
$6,610.95
|
| Rate for Payer: Cash Price |
$6,610.95
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,283.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9,328.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$193.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,667.69
|
| 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 |
$7,345.50
|
| 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 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 |
$6,610.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,283.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9,328.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,667.69
|
| 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 IMPLANTABLE PORT FOR MEDS
|
Facility
|
OP
|
$1,620.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$891.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,215.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$980.59
|
| Rate for Payer: Blue Shield of California Commercial |
$1,245.78
|
| Rate for Payer: Blue Shield of California Commercial |
$821.34
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cigna of CA HMO |
$1,134.00
|
| Rate for Payer: Cigna of CA PPO |
$1,134.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,377.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,377.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,134.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$648.00
|
| Rate for Payer: Galaxy Health WC |
$1,377.00
|
| Rate for Payer: Global Benefits Group Commercial |
$972.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,028.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$588.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$955.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,134.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,134.00
|
| Rate for Payer: Multiplan Commercial |
$1,296.00
|
| Rate for Payer: Networks By Design Commercial |
$810.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$972.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$972.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$607.99
|
| Rate for Payer: United Healthcare All Other HMO |
$591.79
|
| Rate for Payer: United Healthcare HMO Rider |
$578.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,377.00
|
|
|
HC IMPLANTABLE PORT FOR MEDS
|
Facility
|
IP
|
$1,620.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cigna of CA HMO |
$1,134.00
|
| Rate for Payer: Cigna of CA PPO |
$1,134.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,134.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$648.00
|
| Rate for Payer: Galaxy Health WC |
$1,377.00
|
| Rate for Payer: Global Benefits Group Commercial |
$972.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,028.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$955.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.80
|
| Rate for Payer: Multiplan Commercial |
$1,296.00
|
| Rate for Payer: Networks By Design Commercial |
$810.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$607.99
|
| Rate for Payer: United Healthcare All Other HMO |
$591.79
|
| Rate for Payer: United Healthcare HMO Rider |
$578.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.55
|
|
|
HC IMPLANTED GRID/DEPTH
|
Facility
|
IP
|
$2,172.00
|
|
| Hospital Charge Code |
900600801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$434.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$977.40
|
| Rate for Payer: Cash Price |
$977.40
|
| Rate for Payer: Cigna of CA HMO |
$1,520.40
|
| Rate for Payer: Cigna of CA PPO |
$1,520.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,520.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$868.80
|
| Rate for Payer: EPIC Health Plan Senior |
$868.80
|
| Rate for Payer: Galaxy Health WC |
$1,846.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,303.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,379.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,281.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$521.28
|
| Rate for Payer: Multiplan Commercial |
$1,737.60
|
| Rate for Payer: Networks By Design Commercial |
$1,086.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,846.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.15
|
| Rate for Payer: United Healthcare All Other HMO |
$793.43
|
| Rate for Payer: United Healthcare HMO Rider |
$776.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.33
|
|
|
HC IMPLANTED GRID/DEPTH
|
Facility
|
OP
|
$2,172.00
|
|
| Hospital Charge Code |
900600801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.40 |
| Max. Negotiated Rate |
$1,846.20 |
| Rate for Payer: Adventist Health Commercial |
$434.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,846.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,194.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,629.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,314.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,101.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,670.27
|
| Rate for Payer: Cash Price |
$977.40
|
| Rate for Payer: Cigna of CA HMO |
$1,520.40
|
| Rate for Payer: Cigna of CA PPO |
$1,520.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,846.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,846.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,846.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,520.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$868.80
|
| Rate for Payer: EPIC Health Plan Senior |
$868.80
|
| Rate for Payer: Galaxy Health WC |
$1,846.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,303.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,379.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$788.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,281.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$521.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,520.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,520.40
|
| Rate for Payer: Multiplan Commercial |
$1,737.60
|
| Rate for Payer: Networks By Design Commercial |
$1,086.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,846.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,303.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,303.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.15
|
| Rate for Payer: United Healthcare All Other HMO |
$793.43
|
| Rate for Payer: United Healthcare HMO Rider |
$776.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,846.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,846.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,846.20
|
|
|
HC IMPLANTED PERIONEAL PORT
|
Facility
|
IP
|
$21,327.00
|
|
|
Service Code
|
CPT 49419
|
| Hospital Charge Code |
909001457
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,265.40 |
| Max. Negotiated Rate |
$18,127.95 |
| Rate for Payer: Adventist Health Commercial |
$4,265.40
|
| Rate for Payer: Cash Price |
$9,597.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,928.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,530.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8,530.80
|
| Rate for Payer: Galaxy Health WC |
$18,127.95
|
| Rate for Payer: Global Benefits Group Commercial |
$12,796.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13,542.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,582.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,118.48
|
| Rate for Payer: Multiplan Commercial |
$17,061.60
|
| Rate for Payer: Networks By Design Commercial |
$13,862.55
|
| Rate for Payer: Prime Health Services Commercial |
$18,127.95
|
|
|
HC IMPLANTED PERIONEAL PORT
|
Facility
|
OP
|
$21,327.00
|
|
|
Service Code
|
CPT 49419
|
| Hospital Charge Code |
909001457
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$356.51 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$4,265.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,702.17
|
| Rate for Payer: Blue Shield of California Commercial |
$7,730.00
|
| Rate for Payer: Cash Price |
$9,597.15
|
| Rate for Payer: Cash Price |
$9,597.15
|
| Rate for Payer: Cash Price |
$9,597.15
|
| Rate for Payer: Cigna of CA HMO |
$13,649.28
|
| Rate for Payer: Cigna of CA PPO |
$15,781.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,928.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,808.82
|
| Rate for Payer: EPIC Health Plan Senior |
$7,872.55
|
| Rate for Payer: Galaxy Health WC |
$18,127.95
|
| Rate for Payer: Global Benefits Group Commercial |
$12,796.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,737.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$356.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13,542.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$403.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,019.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,118.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,017.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,590.19
|
| Rate for Payer: Multiplan Commercial |
$17,061.60
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: Networks By Design Commercial |
$13,862.55
|
| Rate for Payer: Prime Health Services Commercial |
$18,127.95
|
| Rate for Payer: Prime Health Services WC |
$10,832.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,796.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,663.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,156.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
