|
HC RESUSCITATOR MANUAL PEDS
|
Facility
|
IP
|
$128.82
|
|
| Hospital Charge Code |
901605544
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.76 |
| Max. Negotiated Rate |
$109.50 |
| Rate for Payer: Adventist Health Commercial |
$25.76
|
| Rate for Payer: Cash Price |
$57.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.53
|
| Rate for Payer: EPIC Health Plan Senior |
$51.53
|
| Rate for Payer: Galaxy Health WC |
$109.50
|
| Rate for Payer: Global Benefits Group Commercial |
$77.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.92
|
| Rate for Payer: Multiplan Commercial |
$103.06
|
| Rate for Payer: Networks By Design Commercial |
$83.73
|
| Rate for Payer: Prime Health Services Commercial |
$109.50
|
|
|
HC RESUSCITATOR PEDS MANUAL
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901698464
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC RESUSCITATOR PEDS MANUAL
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901698464
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.62
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC RESUSCITATOR PEDS SIZE 1 & 2
|
Facility
|
IP
|
$231.70
|
|
| Hospital Charge Code |
901698718
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$46.34 |
| Max. Negotiated Rate |
$196.94 |
| Rate for Payer: Adventist Health Commercial |
$46.34
|
| Rate for Payer: Cash Price |
$104.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.68
|
| Rate for Payer: EPIC Health Plan Senior |
$92.68
|
| Rate for Payer: Galaxy Health WC |
$196.94
|
| Rate for Payer: Global Benefits Group Commercial |
$139.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$136.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.61
|
| Rate for Payer: Multiplan Commercial |
$185.36
|
| Rate for Payer: Networks By Design Commercial |
$150.60
|
| Rate for Payer: Prime Health Services Commercial |
$196.94
|
|
|
HC RESUSCITATOR PEDS SIZE 1 & 2
|
Facility
|
OP
|
$231.70
|
|
| Hospital Charge Code |
901698718
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$46.34 |
| Max. Negotiated Rate |
$196.94 |
| Rate for Payer: Adventist Health Commercial |
$46.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$151.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$196.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.68
|
| Rate for Payer: Cash Price |
$104.26
|
| Rate for Payer: Cigna of CA HMO |
$148.29
|
| Rate for Payer: Cigna of CA PPO |
$171.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$196.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$196.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$196.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.68
|
| Rate for Payer: EPIC Health Plan Senior |
$92.68
|
| Rate for Payer: Galaxy Health WC |
$196.94
|
| Rate for Payer: Global Benefits Group Commercial |
$139.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$136.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.19
|
| Rate for Payer: Multiplan Commercial |
$185.36
|
| Rate for Payer: Networks By Design Commercial |
$150.60
|
| Rate for Payer: Prime Health Services Commercial |
$196.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$115.85
|
| Rate for Payer: United Healthcare All Other HMO |
$115.85
|
| Rate for Payer: United Healthcare HMO Rider |
$115.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$115.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$196.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$196.94
|
| Rate for Payer: Vantage Medical Group Senior |
$196.94
|
|
|
HC RESUSCITATOR PEDS SPUR II
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901698465
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.62
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC RESUSCITATOR PEDS SPUR II
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901698465
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC RETICULOCYTE COUNT, AUTO
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 85046
|
| Hospital Charge Code |
900910088
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.40
|
| Rate for Payer: Blue Shield of California Commercial |
$18.44
|
| Rate for Payer: Blue Shield of California Commercial |
$47.94
|
| Rate for Payer: Blue Shield of California Commercial |
$27.88
|
| Rate for Payer: Blue Shield of California Commercial |
$72.49
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA HMO |
$66.56
|
| Rate for Payer: Cigna of CA PPO |
$76.96
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$72.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.19
|
| Rate for Payer: EPIC Health Plan Senior |
$6.13
|
| Rate for Payer: EPIC Health Plan Senior |
$6.13
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.13
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.46
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Other HMO |
$4.51
|
| Rate for Payer: United Healthcare All Other HMO |
$4.51
|
| Rate for Payer: United Healthcare HMO Rider |
$4.51
|
| Rate for Payer: United Healthcare HMO Rider |
$4.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.57
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Vantage Medical Group Senior |
$5.57
|
| Rate for Payer: Vantage Medical Group Senior |
$5.57
|
|
|
HC RETICULOCYTE COUNT, AUTO
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 85046
|
| Hospital Charge Code |
900910088
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$72.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Senior |
$41.60
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.96
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
|
|
HC RETICULOCYTE COUNT, MANUAL
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 85044
|
| Hospital Charge Code |
900910063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$105.40 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.40
|
| Rate for Payer: Blue Shield of California Commercial |
$10.60
|
| Rate for Payer: Blue Shield of California Commercial |
$57.16
|
| Rate for Payer: Blue Shield of California Commercial |
$16.03
|
| Rate for Payer: Blue Shield of California Commercial |
$86.43
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna of CA HMO |
$14.72
|
| Rate for Payer: Cigna of CA HMO |
$79.36
|
| Rate for Payer: Cigna of CA PPO |
$91.76
|
| Rate for Payer: Cigna of CA PPO |
$17.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.11
|
| Rate for Payer: EPIC Health Plan Senior |
$4.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4.74
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.49
|
| Rate for Payer: United Healthcare All Other HMO |
$3.49
|
| Rate for Payer: United Healthcare All Other HMO |
$3.49
|
| Rate for Payer: United Healthcare HMO Rider |
$3.49
|
| Rate for Payer: United Healthcare HMO Rider |
$3.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Vantage Medical Group Senior |
$4.31
|
| Rate for Payer: Vantage Medical Group Senior |
$4.31
|
|
|
HC RETICULOCYTE COUNT, MANUAL
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 85044
|
| Hospital Charge Code |
900910063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$105.40 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.60
|
| Rate for Payer: EPIC Health Plan Senior |
$49.60
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.76
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
|
|
HC RETINAL REPAIR LASER, PHOTOCOAG
|
Facility
|
IP
|
$5,964.00
|
|
|
Service Code
|
CPT 67105
|
| Hospital Charge Code |
988167105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,192.80 |
| Max. Negotiated Rate |
$5,069.40 |
| Rate for Payer: Adventist Health Commercial |
$1,192.80
|
| Rate for Payer: Cash Price |
$2,683.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,174.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,385.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,385.60
|
| Rate for Payer: Galaxy Health WC |
$5,069.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,578.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,787.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,518.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.36
|
| Rate for Payer: Multiplan Commercial |
$4,771.20
|
| Rate for Payer: Networks By Design Commercial |
$3,876.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,069.40
|
|
|
HC RETINAL REPAIR LASER, PHOTOCOAG
|
Facility
|
OP
|
$5,964.00
|
|
|
Service Code
|
CPT 67105
|
| Hospital Charge Code |
988167105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$441.57 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,192.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,061.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$778.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$707.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$2,683.80
|
| Rate for Payer: Cash Price |
$2,683.80
|
| Rate for Payer: Cash Price |
$2,683.80
|
| Rate for Payer: Cigna of CA HMO |
$3,816.96
|
| Rate for Payer: Cigna of CA PPO |
$4,413.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,061.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$778.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$707.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,174.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,167.19
|
| Rate for Payer: EPIC Health Plan Senior |
$778.13
|
| Rate for Payer: Galaxy Health WC |
$5,069.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,578.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,160.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$441.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$707.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,787.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$499.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$990.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$891.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$947.90
|
| Rate for Payer: Multiplan Commercial |
$4,771.20
|
| Rate for Payer: Multiplan WC |
$1,110.63
|
| Rate for Payer: Networks By Design Commercial |
$3,876.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,069.40
|
| Rate for Payer: Prime Health Services WC |
$1,099.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,578.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,982.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$707.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,061.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$778.13
|
| Rate for Payer: Vantage Medical Group Senior |
$707.39
|
|
|
HC RETROBULBAR INJECTION
|
Facility
|
OP
|
$719.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
900567500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$143.80 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: EPIC Health Plan Senior |
$449.06
|
| Rate for Payer: Galaxy Health WC |
$611.15
|
| Rate for Payer: Adventist Health Commercial |
$143.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$323.55
|
| Rate for Payer: Cash Price |
$323.55
|
| Rate for Payer: Cash Price |
$323.55
|
| Rate for Payer: Cigna of CA HMO |
$460.16
|
| Rate for Payer: Cigna of CA PPO |
$532.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$503.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$673.60
|
| Rate for Payer: Global Benefits Group Commercial |
$431.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$669.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$408.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$456.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$283.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$438.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$514.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$547.04
|
| Rate for Payer: Multiplan Commercial |
$575.20
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$467.35
|
| Rate for Payer: Prime Health Services Commercial |
$611.15
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$431.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$359.50
|
| Rate for Payer: United Healthcare All Other HMO |
$359.50
|
| Rate for Payer: United Healthcare HMO Rider |
$359.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$359.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$408.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Vantage Medical Group Senior |
$408.24
|
|
|
HC RETROBULBAR INJECTION
|
Facility
|
IP
|
$719.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
900567500
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$143.80 |
| Max. Negotiated Rate |
$611.15 |
| Rate for Payer: Adventist Health Commercial |
$143.80
|
| Rate for Payer: Cash Price |
$323.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$503.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$287.60
|
| Rate for Payer: EPIC Health Plan Senior |
$287.60
|
| Rate for Payer: Galaxy Health WC |
$611.15
|
| Rate for Payer: Global Benefits Group Commercial |
$431.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$456.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.56
|
| Rate for Payer: Multiplan Commercial |
$575.20
|
| Rate for Payer: Networks By Design Commercial |
$467.35
|
| Rate for Payer: Prime Health Services Commercial |
$611.15
|
|
|
HC RETROBULBAR INJECTION
|
Facility
|
OP
|
$719.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
900567500
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$172.56 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$294.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$446.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$323.55
|
| Rate for Payer: Cash Price |
$323.55
|
| Rate for Payer: Cash Price |
$323.55
|
| Rate for Payer: Cigna of CA HMO |
$460.16
|
| Rate for Payer: Cigna of CA PPO |
$532.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$503.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$673.60
|
| Rate for Payer: EPIC Health Plan Senior |
$449.06
|
| Rate for Payer: Galaxy Health WC |
$611.15
|
| Rate for Payer: Global Benefits Group Commercial |
$431.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$669.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$408.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$456.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$283.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$438.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$514.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$547.04
|
| Rate for Payer: Multiplan Commercial |
$575.20
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$467.35
|
| Rate for Payer: Prime Health Services Commercial |
$611.15
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$431.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$431.40
|
| 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 |
$408.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Vantage Medical Group Senior |
$408.24
|
|
|
HC RETROBULBAR INJECTION
|
Facility
|
IP
|
$719.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
900567500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$143.80 |
| Max. Negotiated Rate |
$611.15 |
| Rate for Payer: Adventist Health Commercial |
$143.80
|
| Rate for Payer: Cash Price |
$323.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$503.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$287.60
|
| Rate for Payer: EPIC Health Plan Senior |
$287.60
|
| Rate for Payer: Galaxy Health WC |
$611.15
|
| Rate for Payer: Global Benefits Group Commercial |
$431.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$456.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.56
|
| Rate for Payer: Multiplan Commercial |
$575.20
|
| Rate for Payer: Networks By Design Commercial |
$467.35
|
| Rate for Payer: Prime Health Services Commercial |
$611.15
|
|
|
HC RETROGRADE DBL BLLN ENTSCPY
|
Facility
|
IP
|
$4,668.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745435
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$933.60 |
| Max. Negotiated Rate |
$3,967.80 |
| Rate for Payer: Adventist Health Commercial |
$933.60
|
| Rate for Payer: Cash Price |
$2,100.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,267.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,867.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,867.20
|
| Rate for Payer: Galaxy Health WC |
$3,967.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,800.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,964.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,754.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,120.32
|
| Rate for Payer: Multiplan Commercial |
$3,734.40
|
| Rate for Payer: Networks By Design Commercial |
$3,034.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,967.80
|
|
|
HC RETROGRADE DBL BLLN ENTSCPY
|
Facility
|
OP
|
$4,668.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745435
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$933.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$933.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,995.46
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$2,100.60
|
| Rate for Payer: Cash Price |
$2,100.60
|
| Rate for Payer: Cash Price |
$2,100.60
|
| Rate for Payer: Cigna of CA HMO |
$2,987.52
|
| Rate for Payer: Cigna of CA PPO |
$3,454.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,267.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$3,967.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,800.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,964.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,120.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$3,734.40
|
| Rate for Payer: Networks By Design Commercial |
$3,034.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,967.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,800.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,334.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC RETROGRADE SNGL BLLN ENTSCPY
|
Facility
|
OP
|
$4,668.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745434
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$933.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$933.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,995.46
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$2,100.60
|
| Rate for Payer: Cash Price |
$2,100.60
|
| Rate for Payer: Cash Price |
$2,100.60
|
| Rate for Payer: Cigna of CA HMO |
$2,987.52
|
| Rate for Payer: Cigna of CA PPO |
$3,454.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,267.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$3,967.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,800.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,964.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,120.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$3,734.40
|
| Rate for Payer: Networks By Design Commercial |
$3,034.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,967.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,800.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,334.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC RETROGRADE SNGL BLLN ENTSCPY
|
Facility
|
IP
|
$4,668.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745434
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$933.60 |
| Max. Negotiated Rate |
$3,967.80 |
| Rate for Payer: Adventist Health Commercial |
$933.60
|
| Rate for Payer: Cash Price |
$2,100.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,267.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,867.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,867.20
|
| Rate for Payer: Galaxy Health WC |
$3,967.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,800.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,964.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,754.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,120.32
|
| Rate for Payer: Multiplan Commercial |
$3,734.40
|
| Rate for Payer: Networks By Design Commercial |
$3,034.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,967.80
|
|
|
HC RETROGRAD URETHROGRAM
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
909001903
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.75 |
| Max. Negotiated Rate |
$1,267.87 |
| Rate for Payer: Adventist Health Commercial |
$240.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,267.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$429.09
|
| Rate for Payer: Blue Shield of California Commercial |
$506.88
|
| Rate for Payer: Blue Shield of California Commercial |
$768.15
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cigna of CA HMO |
$770.56
|
| Rate for Payer: Cigna of CA PPO |
$890.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$842.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$1,023.40
|
| Rate for Payer: Global Benefits Group Commercial |
$722.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$69.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$764.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$963.20
|
| Rate for Payer: Networks By Design Commercial |
$782.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,023.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$722.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$722.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC RETROGRAD URETHROGRAM
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
909001903
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$240.80 |
| Max. Negotiated Rate |
$1,023.40 |
| Rate for Payer: Adventist Health Commercial |
$240.80
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$842.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$481.60
|
| Rate for Payer: EPIC Health Plan Senior |
$481.60
|
| Rate for Payer: Galaxy Health WC |
$1,023.40
|
| Rate for Payer: Global Benefits Group Commercial |
$722.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$764.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$710.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.96
|
| Rate for Payer: Multiplan Commercial |
$963.20
|
| Rate for Payer: Networks By Design Commercial |
$782.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,023.40
|
|
|
HC RETRO PYELOGRAM
|
Facility
|
IP
|
$1,017.00
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
909001912
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$203.40 |
| Max. Negotiated Rate |
$864.45 |
| Rate for Payer: Adventist Health Commercial |
$203.40
|
| Rate for Payer: Cash Price |
$457.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$711.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.80
|
| Rate for Payer: EPIC Health Plan Senior |
$406.80
|
| Rate for Payer: Galaxy Health WC |
$864.45
|
| Rate for Payer: Global Benefits Group Commercial |
$610.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$645.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$600.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.08
|
| Rate for Payer: Multiplan Commercial |
$813.60
|
| Rate for Payer: Networks By Design Commercial |
$661.05
|
| Rate for Payer: Prime Health Services Commercial |
$864.45
|
|
|
HC RETRO PYELOGRAM
|
Facility
|
OP
|
$1,017.00
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
909001912
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$1,267.87 |
| Rate for Payer: Adventist Health Commercial |
$203.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,267.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$679.53
|
| Rate for Payer: Blue Shield of California Commercial |
$428.16
|
| Rate for Payer: Blue Shield of California Commercial |
$648.85
|
| Rate for Payer: Cash Price |
$457.65
|
| Rate for Payer: Cash Price |
$457.65
|
| Rate for Payer: Cigna of CA HMO |
$650.88
|
| Rate for Payer: Cigna of CA PPO |
$752.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$711.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: Galaxy Health WC |
$864.45
|
| Rate for Payer: Global Benefits Group Commercial |
$610.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$645.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$813.60
|
| Rate for Payer: Networks By Design Commercial |
$661.05
|
| Rate for Payer: Prime Health Services Commercial |
$864.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$610.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$610.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
