|
HC TERM DEV, PASSIVE HAND MITT
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT L6703
|
| Hospital Charge Code |
915356703
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$544.50 |
| Rate for Payer: Adventist Health Commercial |
$121.00
|
| Rate for Payer: Blue Shield of California Commercial |
$485.21
|
| Rate for Payer: Blue Shield of California EPN |
$304.92
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Central Health Plan Commercial |
$484.00
|
| Rate for Payer: Cigna of CA HMO |
$423.50
|
| Rate for Payer: Cigna of CA PPO |
$423.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$423.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Senior |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$544.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$384.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$356.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.00
|
| Rate for Payer: Multiplan Commercial |
$453.75
|
| Rate for Payer: Networks By Design Commercial |
$393.25
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.06
|
| Rate for Payer: United Healthcare All Other HMO |
$221.01
|
| Rate for Payer: United Healthcare HMO Rider |
$216.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.14
|
|
|
HC TERM DEV, PASSIVE HAND MITT
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT L6703
|
| Hospital Charge Code |
905356703
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$544.50 |
| Rate for Payer: Adventist Health Commercial |
$121.00
|
| Rate for Payer: Blue Shield of California Commercial |
$485.21
|
| Rate for Payer: Blue Shield of California EPN |
$304.92
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Central Health Plan Commercial |
$484.00
|
| Rate for Payer: Cigna of CA HMO |
$423.50
|
| Rate for Payer: Cigna of CA PPO |
$423.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$423.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Senior |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$544.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$384.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$356.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.00
|
| Rate for Payer: Multiplan Commercial |
$453.75
|
| Rate for Payer: Networks By Design Commercial |
$393.25
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.06
|
| Rate for Payer: United Healthcare All Other HMO |
$221.01
|
| Rate for Payer: United Healthcare HMO Rider |
$216.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.14
|
|
|
HC TERM DEV, PASSIVE HAND MITT
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT L6703
|
| Hospital Charge Code |
905356703
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$198.14 |
| Max. Negotiated Rate |
$544.50 |
| Rate for Payer: Adventist Health Commercial |
$248.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$332.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$351.93
|
| Rate for Payer: Blue Shield of California Commercial |
$485.21
|
| Rate for Payer: Blue Shield of California EPN |
$304.92
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Central Health Plan Commercial |
$484.00
|
| Rate for Payer: Cigna of CA HMO |
$423.50
|
| Rate for Payer: Cigna of CA PPO |
$423.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$514.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$514.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$423.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Senior |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$544.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$413.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$384.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$456.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$356.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$423.50
|
| Rate for Payer: Multiplan Commercial |
$453.75
|
| Rate for Payer: Networks By Design Commercial |
$302.50
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
| Rate for Payer: Riverside University Health System MISP |
$242.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$363.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$363.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.06
|
| Rate for Payer: United Healthcare All Other HMO |
$221.01
|
| Rate for Payer: United Healthcare HMO Rider |
$216.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$514.25
|
| Rate for Payer: Vantage Medical Group Senior |
$514.25
|
|
|
HC TERM DEV, PASSIVE HAND MITT
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT L6703
|
| Hospital Charge Code |
915356703
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$198.14 |
| Max. Negotiated Rate |
$544.50 |
| Rate for Payer: Dignity Health Medi-Cal |
$514.25
|
| Rate for Payer: Adventist Health Commercial |
$248.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$332.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$351.93
|
| Rate for Payer: Blue Shield of California Commercial |
$485.21
|
| Rate for Payer: Blue Shield of California EPN |
$304.92
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Central Health Plan Commercial |
$484.00
|
| Rate for Payer: Cigna of CA HMO |
$423.50
|
| Rate for Payer: Cigna of CA PPO |
$423.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$514.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$423.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Senior |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$544.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$413.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$384.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$456.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$356.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$423.50
|
| Rate for Payer: Multiplan Commercial |
$453.75
|
| Rate for Payer: Networks By Design Commercial |
$302.50
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
| Rate for Payer: Riverside University Health System MISP |
$242.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$363.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$363.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.06
|
| Rate for Payer: United Healthcare All Other HMO |
$221.01
|
| Rate for Payer: United Healthcare HMO Rider |
$216.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$514.25
|
| Rate for Payer: Vantage Medical Group Senior |
$514.25
|
|
|
HC TERM DEV, SPORT/REC/WORK ATT
|
Facility
|
OP
|
$1,310.00
|
|
|
Service Code
|
CPT L6704
|
| Hospital Charge Code |
905356704
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$429.02 |
| Max. Negotiated Rate |
$1,179.00 |
| Rate for Payer: Adventist Health Commercial |
$537.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,113.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$720.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$982.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$762.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1,050.62
|
| Rate for Payer: Blue Shield of California EPN |
$660.24
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,048.00
|
| Rate for Payer: Cigna of CA HMO |
$917.00
|
| Rate for Payer: Cigna of CA PPO |
$917.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,113.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,113.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,113.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$917.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$524.00
|
| Rate for Payer: EPIC Health Plan Senior |
$524.00
|
| Rate for Payer: Galaxy Health WC |
$1,113.50
|
| Rate for Payer: Global Benefits Group Commercial |
$786.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,179.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$898.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$831.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$992.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$772.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$917.00
|
| Rate for Payer: Multiplan Commercial |
$982.50
|
| Rate for Payer: Networks By Design Commercial |
$655.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,113.50
|
| Rate for Payer: Riverside University Health System MISP |
$524.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$786.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$786.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.64
|
| Rate for Payer: United Healthcare All Other HMO |
$478.54
|
| Rate for Payer: United Healthcare HMO Rider |
$468.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$429.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,113.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,113.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,113.50
|
|
|
HC TERM DEV, SPORT/REC/WORK ATT
|
Facility
|
IP
|
$1,310.00
|
|
|
Service Code
|
CPT L6704
|
| Hospital Charge Code |
905356704
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$262.00 |
| Max. Negotiated Rate |
$1,179.00 |
| Rate for Payer: Adventist Health Commercial |
$262.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,050.62
|
| Rate for Payer: Blue Shield of California EPN |
$660.24
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,048.00
|
| Rate for Payer: Cigna of CA HMO |
$917.00
|
| Rate for Payer: Cigna of CA PPO |
$917.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$917.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$524.00
|
| Rate for Payer: EPIC Health Plan Senior |
$524.00
|
| Rate for Payer: Galaxy Health WC |
$1,113.50
|
| Rate for Payer: Global Benefits Group Commercial |
$786.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,179.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$831.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$772.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.00
|
| Rate for Payer: Multiplan Commercial |
$982.50
|
| Rate for Payer: Networks By Design Commercial |
$851.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,113.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.64
|
| Rate for Payer: United Healthcare All Other HMO |
$478.54
|
| Rate for Payer: United Healthcare HMO Rider |
$468.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$429.02
|
|
|
HC TERM DEV, SPORT/REC/WORK ATT
|
Facility
|
IP
|
$1,310.00
|
|
|
Service Code
|
CPT L6704
|
| Hospital Charge Code |
915356704
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$262.00 |
| Max. Negotiated Rate |
$1,179.00 |
| Rate for Payer: Adventist Health Commercial |
$262.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,050.62
|
| Rate for Payer: Blue Shield of California EPN |
$660.24
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,048.00
|
| Rate for Payer: Cigna of CA HMO |
$917.00
|
| Rate for Payer: Cigna of CA PPO |
$917.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$917.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$524.00
|
| Rate for Payer: EPIC Health Plan Senior |
$524.00
|
| Rate for Payer: Galaxy Health WC |
$1,113.50
|
| Rate for Payer: Global Benefits Group Commercial |
$786.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,179.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$831.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$772.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.00
|
| Rate for Payer: Multiplan Commercial |
$982.50
|
| Rate for Payer: Networks By Design Commercial |
$851.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,113.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.64
|
| Rate for Payer: United Healthcare All Other HMO |
$478.54
|
| Rate for Payer: United Healthcare HMO Rider |
$468.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$429.02
|
|
|
HC TERM DEV, SPORT/REC/WORK ATT
|
Facility
|
OP
|
$1,310.00
|
|
|
Service Code
|
CPT L6704
|
| Hospital Charge Code |
915356704
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$429.02 |
| Max. Negotiated Rate |
$1,179.00 |
| Rate for Payer: Networks By Design Commercial |
$655.00
|
| Rate for Payer: Adventist Health Commercial |
$537.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,113.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$720.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$982.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$762.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1,050.62
|
| Rate for Payer: Blue Shield of California EPN |
$660.24
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,048.00
|
| Rate for Payer: Cigna of CA HMO |
$917.00
|
| Rate for Payer: Cigna of CA PPO |
$917.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,113.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,113.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,113.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$917.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$524.00
|
| Rate for Payer: EPIC Health Plan Senior |
$524.00
|
| Rate for Payer: Galaxy Health WC |
$1,113.50
|
| Rate for Payer: Global Benefits Group Commercial |
$786.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,179.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$898.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$831.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$992.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$772.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$917.00
|
| Rate for Payer: Multiplan Commercial |
$982.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,113.50
|
| Rate for Payer: Riverside University Health System MISP |
$524.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$786.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$786.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.64
|
| Rate for Payer: United Healthcare All Other HMO |
$478.54
|
| Rate for Payer: United Healthcare HMO Rider |
$468.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$429.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,113.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,113.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,113.50
|
|
|
HC TESTICULAR SCAN
|
Facility
|
IP
|
$1,057.00
|
|
|
Service Code
|
CPT 78761
|
| Hospital Charge Code |
909301429
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.40 |
| Max. Negotiated Rate |
$951.30 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Central Health Plan Commercial |
$845.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.80
|
| Rate for Payer: EPIC Health Plan Senior |
$422.80
|
| Rate for Payer: Galaxy Health WC |
$898.45
|
| Rate for Payer: Global Benefits Group Commercial |
$634.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$951.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$671.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$623.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.40
|
| Rate for Payer: Multiplan Commercial |
$792.75
|
| Rate for Payer: Networks By Design Commercial |
$687.05
|
| Rate for Payer: Prime Health Services Commercial |
$898.45
|
|
|
HC TESTICULAR SCAN
|
Facility
|
OP
|
$1,057.00
|
|
|
Service Code
|
CPT 78761
|
| Hospital Charge Code |
909301429
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$148.81 |
| Max. Negotiated Rate |
$1,123.69 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$514.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,123.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$661.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$614.86
|
| Rate for Payer: Blue Shield of California Commercial |
$665.91
|
| Rate for Payer: Blue Shield of California EPN |
$419.63
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Central Health Plan Commercial |
$845.60
|
| Rate for Payer: Cigna of CA HMO |
$676.48
|
| Rate for Payer: Cigna of CA PPO |
$782.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$898.45
|
| Rate for Payer: Global Benefits Group Commercial |
$634.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$951.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$148.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$671.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$792.75
|
| Rate for Payer: Networks By Design Commercial |
$687.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$514.17
|
| Rate for Payer: Prime Health Services Commercial |
$898.45
|
| Rate for Payer: Prime Health Services Medicare |
$545.02
|
| Rate for Payer: Riverside University Health System MISP |
$565.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$634.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$634.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.78
|
| Rate for Payer: United Healthcare All Other HMO |
$815.78
|
| Rate for Payer: United Healthcare HMO Rider |
$815.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$815.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC TESTOSTERONE TOTAL
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900912134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Central Health Plan Commercial |
$192.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$168.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Senior |
$96.00
|
| Rate for Payer: Galaxy Health WC |
$204.00
|
| Rate for Payer: Global Benefits Group Commercial |
$144.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$216.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$152.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$141.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Networks By Design Commercial |
$156.00
|
| Rate for Payer: Prime Health Services Commercial |
$204.00
|
|
|
HC TESTOSTERONE TOTAL
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900912134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.91 |
| Max. Negotiated Rate |
$261.06 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$25.81
|
| Rate for Payer: Adventist Health Medi-Cal |
$25.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$189.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$189.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$187.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$187.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.06
|
| Rate for Payer: Blue Shield of California Commercial |
$151.20
|
| Rate for Payer: Blue Shield of California Commercial |
$75.60
|
| Rate for Payer: Blue Shield of California EPN |
$95.28
|
| Rate for Payer: Blue Shield of California EPN |
$47.64
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Central Health Plan Commercial |
$192.00
|
| Rate for Payer: Cigna of CA HMO |
$153.60
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$177.60
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$168.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.59
|
| Rate for Payer: EPIC Health Plan Senior |
$28.39
|
| Rate for Payer: EPIC Health Plan Senior |
$28.39
|
| Rate for Payer: Galaxy Health WC |
$204.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$144.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$216.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$42.33
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$42.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$152.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.59
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Networks By Design Commercial |
$156.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25.81
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25.81
|
| Rate for Payer: Prime Health Services Commercial |
$204.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Medicare |
$27.36
|
| Rate for Payer: Prime Health Services Medicare |
$27.36
|
| Rate for Payer: Riverside University Health System MISP |
$28.39
|
| Rate for Payer: Riverside University Health System MISP |
$28.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$144.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$144.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.91
|
| Rate for Payer: United Healthcare All Other HMO |
$20.91
|
| Rate for Payer: United Healthcare All Other HMO |
$20.91
|
| Rate for Payer: United Healthcare HMO Rider |
$20.91
|
| Rate for Payer: United Healthcare HMO Rider |
$20.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Vantage Medical Group Senior |
$25.81
|
| Rate for Payer: Vantage Medical Group Senior |
$25.81
|
|
|
HC TEST URINE VOLUME
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
900910797
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Adventist Health Commercial |
$20.40
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Central Health Plan Commercial |
$81.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$71.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.80
|
| Rate for Payer: EPIC Health Plan Senior |
$40.80
|
| Rate for Payer: Galaxy Health WC |
$86.70
|
| Rate for Payer: Global Benefits Group Commercial |
$61.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$91.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$64.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: Multiplan Commercial |
$76.50
|
| Rate for Payer: Networks By Design Commercial |
$66.30
|
| Rate for Payer: Prime Health Services Commercial |
$86.70
|
|
|
HC TEST URINE VOLUME
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
900910797
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Adventist Health Commercial |
$20.40
|
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.64
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.74
|
| Rate for Payer: Blue Shield of California Commercial |
$16.38
|
| Rate for Payer: Blue Shield of California Commercial |
$64.26
|
| Rate for Payer: Blue Shield of California EPN |
$10.32
|
| Rate for Payer: Blue Shield of California EPN |
$40.49
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Central Health Plan Commercial |
$81.60
|
| Rate for Payer: Central Health Plan Commercial |
$20.80
|
| Rate for Payer: Cigna of CA HMO |
$16.64
|
| Rate for Payer: Cigna of CA HMO |
$65.28
|
| Rate for Payer: Cigna of CA PPO |
$19.24
|
| Rate for Payer: Cigna of CA PPO |
$75.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$71.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.01
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Galaxy Health WC |
$86.70
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Global Benefits Group Commercial |
$61.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$91.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$64.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.88
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$76.50
|
| Rate for Payer: Networks By Design Commercial |
$66.30
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.64
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.64
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$86.70
|
| Rate for Payer: Prime Health Services Medicare |
$3.86
|
| Rate for Payer: Prime Health Services Medicare |
$3.86
|
| Rate for Payer: Riverside University Health System MISP |
$4.00
|
| Rate for Payer: Riverside University Health System MISP |
$4.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.95
|
| Rate for Payer: United Healthcare All Other HMO |
$2.95
|
| Rate for Payer: United Healthcare All Other HMO |
$2.95
|
| Rate for Payer: United Healthcare HMO Rider |
$2.95
|
| Rate for Payer: United Healthcare HMO Rider |
$2.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.64
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3.64
|
| Rate for Payer: Vantage Medical Group Senior |
$3.64
|
|
|
HC TETRACYCLINE E TEST
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912444
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Central Health Plan Commercial |
$84.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.00
|
| Rate for Payer: EPIC Health Plan Senior |
$42.00
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
|
|
HC TETRACYCLINE E TEST
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912444
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.75
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.81
|
| Rate for Payer: Blue Shield of California Commercial |
$11.34
|
| Rate for Payer: Blue Shield of California Commercial |
$66.15
|
| Rate for Payer: Blue Shield of California EPN |
$7.15
|
| Rate for Payer: Blue Shield of California EPN |
$41.69
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Central Health Plan Commercial |
$84.00
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Cigna of CA PPO |
$77.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.84
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.75
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
| Rate for Payer: Prime Health Services Medicare |
$5.04
|
| Rate for Payer: Prime Health Services Medicare |
$5.04
|
| Rate for Payer: Riverside University Health System MISP |
$5.22
|
| Rate for Payer: Riverside University Health System MISP |
$5.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC THAL-QUICK 18FR CHEST TUBE
|
Facility
|
OP
|
$889.13
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901698529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.83 |
| Max. Negotiated Rate |
$800.22 |
| Rate for Payer: Adventist Health Commercial |
$177.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$755.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$489.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$666.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$405.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$487.60
|
| Rate for Payer: Blue Shield of California Commercial |
$713.08
|
| Rate for Payer: Blue Shield of California EPN |
$448.12
|
| Rate for Payer: Cash Price |
$400.11
|
| Rate for Payer: Central Health Plan Commercial |
$711.30
|
| Rate for Payer: Cigna of CA HMO |
$622.39
|
| Rate for Payer: Cigna of CA PPO |
$622.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$755.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$755.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$755.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$622.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$355.65
|
| Rate for Payer: EPIC Health Plan Senior |
$355.65
|
| Rate for Payer: Galaxy Health WC |
$755.76
|
| Rate for Payer: Global Benefits Group Commercial |
$533.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$800.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$564.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$322.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$524.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$622.39
|
| Rate for Payer: Multiplan Commercial |
$666.85
|
| Rate for Payer: Networks By Design Commercial |
$444.56
|
| Rate for Payer: Prime Health Services Commercial |
$755.76
|
| Rate for Payer: Riverside University Health System MISP |
$355.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$533.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$533.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$333.69
|
| Rate for Payer: United Healthcare All Other HMO |
$324.80
|
| Rate for Payer: United Healthcare HMO Rider |
$317.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$755.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$755.76
|
| Rate for Payer: Vantage Medical Group Senior |
$755.76
|
|
|
HC THAL-QUICK 18FR CHEST TUBE
|
Facility
|
IP
|
$889.13
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901698529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.83 |
| Max. Negotiated Rate |
$800.22 |
| Rate for Payer: Adventist Health Commercial |
$177.83
|
| Rate for Payer: Blue Shield of California Commercial |
$713.08
|
| Rate for Payer: Blue Shield of California EPN |
$448.12
|
| Rate for Payer: Cash Price |
$400.11
|
| Rate for Payer: Central Health Plan Commercial |
$711.30
|
| Rate for Payer: Cigna of CA HMO |
$622.39
|
| Rate for Payer: Cigna of CA PPO |
$622.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$622.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$355.65
|
| Rate for Payer: EPIC Health Plan Senior |
$355.65
|
| Rate for Payer: Galaxy Health WC |
$755.76
|
| Rate for Payer: Global Benefits Group Commercial |
$533.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$800.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$564.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$524.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.83
|
| Rate for Payer: Multiplan Commercial |
$666.85
|
| Rate for Payer: Networks By Design Commercial |
$444.56
|
| Rate for Payer: Prime Health Services Commercial |
$755.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$333.69
|
| Rate for Payer: United Healthcare All Other HMO |
$324.80
|
| Rate for Payer: United Healthcare HMO Rider |
$317.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.19
|
|
|
HC THAWING COMPONENT
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT 86927
|
| Hospital Charge Code |
900904700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$270.90 |
| Rate for Payer: Adventist Health Commercial |
$60.20
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Central Health Plan Commercial |
$240.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.40
|
| Rate for Payer: EPIC Health Plan Senior |
$120.40
|
| Rate for Payer: Galaxy Health WC |
$255.85
|
| Rate for Payer: Global Benefits Group Commercial |
$180.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$191.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.20
|
| Rate for Payer: Multiplan Commercial |
$225.75
|
| Rate for Payer: Networks By Design Commercial |
$195.65
|
| Rate for Payer: Prime Health Services Commercial |
$255.85
|
|
|
HC THAWING COMPONENT
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT 86927
|
| Hospital Charge Code |
900904700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$361.55 |
| Rate for Payer: Adventist Health Commercial |
$60.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$219.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.04
|
| Rate for Payer: Blue Shield of California Commercial |
$189.63
|
| Rate for Payer: Blue Shield of California EPN |
$119.50
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Central Health Plan Commercial |
$240.80
|
| Rate for Payer: Cigna of CA HMO |
$192.64
|
| Rate for Payer: Cigna of CA PPO |
$222.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.55
|
| Rate for Payer: EPIC Health Plan Senior |
$241.03
|
| Rate for Payer: Galaxy Health WC |
$255.85
|
| Rate for Payer: Global Benefits Group Commercial |
$180.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$359.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$191.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$225.75
|
| Rate for Payer: Networks By Design Commercial |
$195.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$219.12
|
| Rate for Payer: Prime Health Services Commercial |
$255.85
|
| Rate for Payer: Prime Health Services Medicare |
$232.27
|
| Rate for Payer: Riverside University Health System MISP |
$241.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$219.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC THAWING COMPONENT CRYO
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904698
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$270.90 |
| Rate for Payer: Adventist Health Commercial |
$60.20
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Central Health Plan Commercial |
$240.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.40
|
| Rate for Payer: EPIC Health Plan Senior |
$120.40
|
| Rate for Payer: Galaxy Health WC |
$255.85
|
| Rate for Payer: Global Benefits Group Commercial |
$180.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$191.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.20
|
| Rate for Payer: Multiplan Commercial |
$225.75
|
| Rate for Payer: Networks By Design Commercial |
$195.65
|
| Rate for Payer: Prime Health Services Commercial |
$255.85
|
|
|
HC THAWING COMPONENT CRYO
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904698
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$270.90 |
| Rate for Payer: Adventist Health Commercial |
$60.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$182.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$145.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.09
|
| Rate for Payer: Blue Shield of California Commercial |
$189.63
|
| Rate for Payer: Blue Shield of California EPN |
$119.50
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Central Health Plan Commercial |
$240.80
|
| Rate for Payer: Cigna of CA HMO |
$192.64
|
| Rate for Payer: Cigna of CA PPO |
$222.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.38
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$255.85
|
| Rate for Payer: Global Benefits Group Commercial |
$180.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$191.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$225.75
|
| Rate for Payer: Networks By Design Commercial |
$195.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.20
|
| Rate for Payer: Prime Health Services Commercial |
$255.85
|
| Rate for Payer: Prime Health Services Medicare |
$39.43
|
| Rate for Payer: Riverside University Health System MISP |
$40.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC THEOPHYLLINE
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
900910457
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC THEOPHYLLINE
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
900910457
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.46 |
| Max. Negotiated Rate |
$143.13 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.14
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.13
|
| Rate for Payer: Blue Shield of California Commercial |
$126.00
|
| Rate for Payer: Blue Shield of California Commercial |
$75.60
|
| Rate for Payer: Blue Shield of California EPN |
$79.40
|
| Rate for Payer: Blue Shield of California EPN |
$47.64
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.33
|
| Rate for Payer: EPIC Health Plan Senior |
$15.55
|
| Rate for Payer: EPIC Health Plan Senior |
$15.55
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.19
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.95
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.14
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Medicare |
$14.99
|
| Rate for Payer: Prime Health Services Medicare |
$14.99
|
| Rate for Payer: Riverside University Health System MISP |
$15.55
|
| Rate for Payer: Riverside University Health System MISP |
$15.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.46
|
| Rate for Payer: United Healthcare All Other HMO |
$11.46
|
| Rate for Payer: United Healthcare All Other HMO |
$11.46
|
| Rate for Payer: United Healthcare HMO Rider |
$11.46
|
| Rate for Payer: United Healthcare HMO Rider |
$11.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.55
|
| Rate for Payer: Vantage Medical Group Senior |
$14.14
|
| Rate for Payer: Vantage Medical Group Senior |
$14.14
|
|
|
HC THERAPEUTIC ACTIVITY 15 MIN MCAL
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
901300061
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$47.20 |
| Max. Negotiated Rate |
$212.40 |
| Rate for Payer: Adventist Health Commercial |
$47.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Central Health Plan Commercial |
$188.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$165.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.40
|
| Rate for Payer: EPIC Health Plan Senior |
$94.40
|
| Rate for Payer: Galaxy Health WC |
$200.60
|
| Rate for Payer: Global Benefits Group Commercial |
$141.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$212.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$139.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.20
|
| Rate for Payer: Multiplan Commercial |
$177.00
|
| Rate for Payer: Networks By Design Commercial |
$153.40
|
| Rate for Payer: Prime Health Services Commercial |
$200.60
|
|
