|
HC NEUROSTIM REMOVAL SENS LEAD
|
Facility
|
IP
|
$7,841.00
|
|
|
Service Code
|
CPT 0429T
|
| Hospital Charge Code |
906810429
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,568.20 |
| Max. Negotiated Rate |
$6,664.85 |
| Rate for Payer: Adventist Health Commercial |
$1,568.20
|
| Rate for Payer: Cash Price |
$3,528.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,488.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,136.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,136.40
|
| Rate for Payer: Galaxy Health WC |
$6,664.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,704.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,979.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,626.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,881.84
|
| Rate for Payer: Multiplan Commercial |
$6,272.80
|
| Rate for Payer: Networks By Design Commercial |
$5,096.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,664.85
|
|
|
HC NEUROSTIM REMOVAL SENS LEAD
|
Facility
|
OP
|
$7,841.00
|
|
|
Service Code
|
CPT 0429T
|
| Hospital Charge Code |
906810429
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,568.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,568.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,664.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,312.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,880.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$3,528.45
|
| Rate for Payer: Cash Price |
$3,528.45
|
| Rate for Payer: Cigna of CA HMO |
$5,018.24
|
| Rate for Payer: Cigna of CA PPO |
$5,802.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,664.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,664.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,664.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,488.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,136.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,136.40
|
| Rate for Payer: Galaxy Health WC |
$6,664.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,704.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,979.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,846.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,626.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,881.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,488.70
|
| Rate for Payer: Multiplan Commercial |
$6,272.80
|
| Rate for Payer: Networks By Design Commercial |
$5,096.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,664.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,704.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,920.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,664.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,664.85
|
| Rate for Payer: Vantage Medical Group Senior |
$6,664.85
|
|
|
HC NEWBORN CAP LINER PADS
|
Facility
|
OP
|
$106.40
|
|
| Hospital Charge Code |
901608015
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$90.44 |
| Rate for Payer: Adventist Health Commercial |
$21.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.28
|
| Rate for Payer: Cash Price |
$47.88
|
| Rate for Payer: Cigna of CA HMO |
$68.10
|
| Rate for Payer: Cigna of CA PPO |
$78.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.56
|
| Rate for Payer: EPIC Health Plan Senior |
$42.56
|
| Rate for Payer: Galaxy Health WC |
$90.44
|
| Rate for Payer: Global Benefits Group Commercial |
$63.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.48
|
| Rate for Payer: Multiplan Commercial |
$85.12
|
| Rate for Payer: Networks By Design Commercial |
$69.16
|
| Rate for Payer: Prime Health Services Commercial |
$90.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.20
|
| Rate for Payer: United Healthcare All Other HMO |
$53.20
|
| Rate for Payer: United Healthcare HMO Rider |
$53.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.44
|
| Rate for Payer: Vantage Medical Group Senior |
$90.44
|
|
|
HC NEWBORN CAP LINER PADS
|
Facility
|
IP
|
$106.40
|
|
| Hospital Charge Code |
901608015
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$90.44 |
| Rate for Payer: Adventist Health Commercial |
$21.28
|
| Rate for Payer: Cash Price |
$47.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.56
|
| Rate for Payer: EPIC Health Plan Senior |
$42.56
|
| Rate for Payer: Galaxy Health WC |
$90.44
|
| Rate for Payer: Global Benefits Group Commercial |
$63.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.54
|
| Rate for Payer: Multiplan Commercial |
$85.12
|
| Rate for Payer: Networks By Design Commercial |
$69.16
|
| Rate for Payer: Prime Health Services Commercial |
$90.44
|
|
|
HC NEWBORN HEARING RESCREENING OP
|
Facility
|
IP
|
$320.00
|
|
| Hospital Charge Code |
903100102
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$272.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$224.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Senior |
$128.00
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$203.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.80
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
|
|
HC NEWBORN HEARING RESCREENING OP
|
Facility
|
OP
|
$320.00
|
|
| Hospital Charge Code |
903100102
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$272.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$209.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$272.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$240.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.34
|
| Rate for Payer: Blue Shield of California Commercial |
$204.16
|
| Rate for Payer: Blue Shield of California Commercial |
$134.72
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna of CA HMO |
$204.80
|
| Rate for Payer: Cigna of CA PPO |
$236.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$272.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$272.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$272.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$224.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Senior |
$128.00
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$203.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$224.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$224.00
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$192.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$272.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.00
|
| Rate for Payer: Vantage Medical Group Senior |
$272.00
|
|
|
HC NEWBORN HEARING SCREENING IP
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100100
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$157.25 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$129.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.00
|
| Rate for Payer: EPIC Health Plan Senior |
$74.00
|
| Rate for Payer: Galaxy Health WC |
$157.25
|
| Rate for Payer: Global Benefits Group Commercial |
$111.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$117.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$109.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: Networks By Design Commercial |
$120.25
|
| Rate for Payer: Prime Health Services Commercial |
$157.25
|
|
|
HC NEWBORN HEARING SCREENING IP
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100100
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$18.61 |
| Max. Negotiated Rate |
$282.35 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$187.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.71
|
| Rate for Payer: Blue Shield of California Commercial |
$118.03
|
| Rate for Payer: Blue Shield of California Commercial |
$77.89
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cigna of CA HMO |
$118.40
|
| Rate for Payer: Cigna of CA PPO |
$136.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$129.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$157.25
|
| Rate for Payer: Global Benefits Group Commercial |
$111.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$117.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: Networks By Design Commercial |
$120.25
|
| Rate for Payer: Prime Health Services Commercial |
$157.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.00
|
| 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 |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC NEWBORN HEARING SCREENING OP
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100101
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$157.25 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$129.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.00
|
| Rate for Payer: EPIC Health Plan Senior |
$74.00
|
| Rate for Payer: Galaxy Health WC |
$157.25
|
| Rate for Payer: Global Benefits Group Commercial |
$111.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$117.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$109.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: Networks By Design Commercial |
$120.25
|
| Rate for Payer: Prime Health Services Commercial |
$157.25
|
|
|
HC NEWBORN HEARING SCREENING OP
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100101
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$18.61 |
| Max. Negotiated Rate |
$282.35 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$187.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.71
|
| Rate for Payer: Blue Shield of California Commercial |
$118.03
|
| Rate for Payer: Blue Shield of California Commercial |
$77.89
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cigna of CA HMO |
$118.40
|
| Rate for Payer: Cigna of CA PPO |
$136.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$129.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$157.25
|
| Rate for Payer: Global Benefits Group Commercial |
$111.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$117.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: Networks By Design Commercial |
$120.25
|
| Rate for Payer: Prime Health Services Commercial |
$157.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.00
|
| 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 |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC NEWBORN SCREENING PANEL
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT S3620
|
| Hospital Charge Code |
903100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$400.90 |
| Rate for Payer: Adventist Health Commercial |
$46.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.87
|
| Rate for Payer: Blue Shield of California Commercial |
$161.70
|
| Rate for Payer: Blue Shield of California Commercial |
$106.95
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna of CA HMO |
$148.48
|
| Rate for Payer: Cigna of CA PPO |
$171.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.80
|
| Rate for Payer: EPIC Health Plan Senior |
$92.80
|
| Rate for Payer: Galaxy Health WC |
$197.20
|
| Rate for Payer: Global Benefits Group Commercial |
$139.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$354.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$400.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$136.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.40
|
| Rate for Payer: Multiplan Commercial |
$185.60
|
| Rate for Payer: Networks By Design Commercial |
$150.80
|
| Rate for Payer: Prime Health Services Commercial |
$197.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.00
|
| Rate for Payer: United Healthcare All Other HMO |
$116.00
|
| Rate for Payer: United Healthcare HMO Rider |
$116.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.20
|
| Rate for Payer: Vantage Medical Group Senior |
$197.20
|
|
|
HC NEWBORN SCREENING PANEL
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT S3620
|
| Hospital Charge Code |
903100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$197.20 |
| Rate for Payer: Adventist Health Commercial |
$46.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.80
|
| Rate for Payer: EPIC Health Plan Senior |
$92.80
|
| Rate for Payer: Galaxy Health WC |
$197.20
|
| Rate for Payer: Global Benefits Group Commercial |
$139.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$136.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.68
|
| Rate for Payer: Multiplan Commercial |
$185.60
|
| Rate for Payer: Networks By Design Commercial |
$150.80
|
| Rate for Payer: Prime Health Services Commercial |
$197.20
|
|
|
HC N GONNORHOEAE AMPLIFICATION
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912305
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.50
|
| Rate for Payer: Blue Shield of California Commercial |
$216.67
|
| Rate for Payer: Blue Shield of California Commercial |
$62.70
|
| Rate for Payer: Blue Shield of California Commercial |
$327.59
|
| Rate for Payer: Blue Shield of California Commercial |
$94.79
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna of CA HMO |
$300.80
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Cigna of CA PPO |
$347.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$329.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$282.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$282.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC N GONNORHOEAE AMPLIFICATION
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912305
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$399.50 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$329.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$188.00
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.80
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
|
|
HC NGS POST TX CD3 ENGRAFTMENT
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
CPT 81268
|
| Hospital Charge Code |
903902026
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$2,657.40 |
| Rate for Payer: Adventist Health Commercial |
$158.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,261.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$391.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,657.40
|
| Rate for Payer: Blue Shield of California Commercial |
$366.03
|
| Rate for Payer: Blue Shield of California Commercial |
$553.42
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cigna of CA HMO |
$508.16
|
| Rate for Payer: Cigna of CA PPO |
$587.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$391.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$555.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$430.30
|
| Rate for Payer: EPIC Health Plan Senior |
$286.87
|
| Rate for Payer: Galaxy Health WC |
$674.90
|
| Rate for Payer: Global Benefits Group Commercial |
$476.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$427.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$201.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$260.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$504.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$227.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$365.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$328.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$349.46
|
| Rate for Payer: Multiplan Commercial |
$635.20
|
| Rate for Payer: Networks By Design Commercial |
$516.10
|
| Rate for Payer: Prime Health Services Commercial |
$674.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$476.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$476.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$211.24
|
| Rate for Payer: United Healthcare All Other HMO |
$211.24
|
| Rate for Payer: United Healthcare HMO Rider |
$211.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$260.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$391.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.87
|
| Rate for Payer: Vantage Medical Group Senior |
$260.79
|
|
|
HC NGS POST TX CD3 ENGRAFTMENT
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
CPT 81268
|
| Hospital Charge Code |
903902026
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$674.90 |
| Rate for Payer: Adventist Health Commercial |
$158.80
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$555.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.60
|
| Rate for Payer: EPIC Health Plan Senior |
$317.60
|
| Rate for Payer: Galaxy Health WC |
$674.90
|
| Rate for Payer: Global Benefits Group Commercial |
$476.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$504.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$468.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.56
|
| Rate for Payer: Multiplan Commercial |
$635.20
|
| Rate for Payer: Networks By Design Commercial |
$516.10
|
| Rate for Payer: Prime Health Services Commercial |
$674.90
|
|
|
HC NGS POST TX ENGRAFTMENT
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
CPT 81267
|
| Hospital Charge Code |
903902025
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$168.04 |
| Max. Negotiated Rate |
$5,655.99 |
| Rate for Payer: Adventist Health Commercial |
$250.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,275.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$311.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,655.99
|
| Rate for Payer: Blue Shield of California Commercial |
$576.25
|
| Rate for Payer: Blue Shield of California Commercial |
$871.25
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna of CA HMO |
$800.00
|
| Rate for Payer: Cigna of CA PPO |
$925.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$311.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$228.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$207.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$875.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.31
|
| Rate for Payer: EPIC Health Plan Senior |
$228.21
|
| Rate for Payer: Galaxy Health WC |
$1,062.50
|
| Rate for Payer: Global Benefits Group Commercial |
$750.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$340.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$201.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$207.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$793.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$227.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$290.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$278.00
|
| Rate for Payer: Multiplan Commercial |
$1,000.00
|
| Rate for Payer: Networks By Design Commercial |
$812.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,062.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$750.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$750.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.04
|
| Rate for Payer: United Healthcare All Other HMO |
$168.04
|
| Rate for Payer: United Healthcare HMO Rider |
$168.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$207.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$311.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$228.21
|
| Rate for Payer: Vantage Medical Group Senior |
$207.46
|
|
|
HC NGS POST TX ENGRAFTMENT
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
CPT 81267
|
| Hospital Charge Code |
903902025
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,062.50 |
| Rate for Payer: Adventist Health Commercial |
$250.00
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$875.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$500.00
|
| Rate for Payer: Galaxy Health WC |
$1,062.50
|
| Rate for Payer: Global Benefits Group Commercial |
$750.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$793.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$737.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.00
|
| Rate for Payer: Multiplan Commercial |
$1,000.00
|
| Rate for Payer: Networks By Design Commercial |
$812.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,062.50
|
|
|
HC NGS POST TX MYELOID ENGRAFTMENT
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
CPT 81268
|
| Hospital Charge Code |
903902027
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$674.90 |
| Rate for Payer: Adventist Health Commercial |
$158.80
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$555.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.60
|
| Rate for Payer: EPIC Health Plan Senior |
$317.60
|
| Rate for Payer: Galaxy Health WC |
$674.90
|
| Rate for Payer: Global Benefits Group Commercial |
$476.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$504.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$468.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.56
|
| Rate for Payer: Multiplan Commercial |
$635.20
|
| Rate for Payer: Networks By Design Commercial |
$516.10
|
| Rate for Payer: Prime Health Services Commercial |
$674.90
|
|
|
HC NGS POST TX MYELOID ENGRAFTMENT
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
CPT 81268
|
| Hospital Charge Code |
903902027
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$2,657.40 |
| Rate for Payer: Galaxy Health WC |
$674.90
|
| Rate for Payer: Adventist Health Commercial |
$158.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,261.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$391.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,657.40
|
| Rate for Payer: Blue Shield of California Commercial |
$366.03
|
| Rate for Payer: Blue Shield of California Commercial |
$553.42
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cigna of CA HMO |
$508.16
|
| Rate for Payer: Cigna of CA PPO |
$587.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$391.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$555.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$430.30
|
| Rate for Payer: EPIC Health Plan Senior |
$286.87
|
| Rate for Payer: Global Benefits Group Commercial |
$476.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$427.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$201.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$260.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$504.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$227.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$365.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$328.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$349.46
|
| Rate for Payer: Multiplan Commercial |
$635.20
|
| Rate for Payer: Networks By Design Commercial |
$516.10
|
| Rate for Payer: Prime Health Services Commercial |
$674.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$476.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$476.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$211.24
|
| Rate for Payer: United Healthcare All Other HMO |
$211.24
|
| Rate for Payer: United Healthcare HMO Rider |
$211.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$260.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$391.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.87
|
| Rate for Payer: Vantage Medical Group Senior |
$260.79
|
|
|
HC NGS PRE TX ENGRAFTMENT SCREEN
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT 81265
|
| Hospital Charge Code |
903902024
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$633.25 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$521.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$473.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$439.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: Networks By Design Commercial |
$484.25
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
|
|
HC NGS PRE TX ENGRAFTMENT SCREEN
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT 81265
|
| Hospital Charge Code |
903902024
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$2,462.00 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,877.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$349.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$256.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$233.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,462.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.44
|
| Rate for Payer: Blue Shield of California Commercial |
$519.26
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cigna of CA HMO |
$476.80
|
| Rate for Payer: Cigna of CA PPO |
$551.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$349.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$256.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$233.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$521.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.57
|
| Rate for Payer: EPIC Health Plan Senior |
$256.38
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$382.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$321.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$233.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$473.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$363.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$326.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$293.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$312.31
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: Networks By Design Commercial |
$484.25
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$447.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$447.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.78
|
| Rate for Payer: United Healthcare All Other HMO |
$188.78
|
| Rate for Payer: United Healthcare HMO Rider |
$188.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$233.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$349.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$256.38
|
| Rate for Payer: Vantage Medical Group Senior |
$233.07
|
|
|
HC NICU BACK TRANSPORT PER HOUR
|
Facility
|
IP
|
$7,426.00
|
|
| Hospital Charge Code |
905200004
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$6,312.10 |
| Rate for Payer: Adventist Health Commercial |
$1,485.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,661.00
|
| Rate for Payer: Cash Price |
$3,341.70
|
| Rate for Payer: Cash Price |
$3,341.70
|
| Rate for Payer: Cash Price |
$3,341.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,198.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,970.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,970.40
|
| Rate for Payer: Galaxy Health WC |
$6,312.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,455.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$334.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,715.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,381.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,782.24
|
| Rate for Payer: Multiplan Commercial |
$5,940.80
|
| Rate for Payer: Networks By Design Commercial |
$4,826.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,312.10
|
|
|
HC NICU TRANSPORT CASE RATE
|
Facility
|
IP
|
$2,832.00
|
|
| Hospital Charge Code |
905200005
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$5,661.00 |
| Rate for Payer: Adventist Health Commercial |
$566.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,661.00
|
| Rate for Payer: Cash Price |
$1,274.40
|
| Rate for Payer: Cash Price |
$1,274.40
|
| Rate for Payer: Cash Price |
$1,274.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,982.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,132.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,132.80
|
| Rate for Payer: Galaxy Health WC |
$2,407.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,699.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$334.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,798.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,670.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$679.68
|
| Rate for Payer: Multiplan Commercial |
$2,265.60
|
| Rate for Payer: Networks By Design Commercial |
$1,840.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,407.20
|
|
|
HC NICU TRANSPORT PER HOUR
|
Facility
|
IP
|
$5,594.00
|
|
| Hospital Charge Code |
905200001
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$5,661.00 |
| Rate for Payer: Adventist Health Commercial |
$1,118.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,661.00
|
| Rate for Payer: Cash Price |
$2,517.30
|
| Rate for Payer: Cash Price |
$2,517.30
|
| Rate for Payer: Cash Price |
$2,517.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,915.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,237.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,237.60
|
| Rate for Payer: Galaxy Health WC |
$4,754.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,356.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$334.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,552.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,300.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,342.56
|
| Rate for Payer: Multiplan Commercial |
$4,475.20
|
| Rate for Payer: Networks By Design Commercial |
$3,636.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,754.90
|
|
