|
HC TCAT IMPL WRLS PUL ART PRS SNR
|
Facility
IP
|
$21,934.00
|
|
|
Service Code
|
CPT 33289
|
| Hospital Charge Code |
906811492
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$4,386.80 |
| Max. Negotiated Rate |
$19,740.60 |
| Rate for Payer: Cash Price |
$9,870.30
|
| Rate for Payer: Central Health Plan Commercial |
$17,547.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,773.60
|
| Rate for Payer: Galaxy Health WC |
$18,643.90
|
| Rate for Payer: Global Benefits Group Commercial |
$13,160.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,740.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,629.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,386.80
|
| Rate for Payer: Multiplan Commercial |
$16,450.50
|
| Rate for Payer: Networks By Design Commercial |
$14,257.10
|
| Rate for Payer: Prime Health Services Commercial |
$18,643.90
|
|
|
HC TCAT IMPL WRLS PUL ART PRS SNR
|
Facility
OP
|
$21,934.00
|
|
|
Service Code
|
CPT 33289
|
| Hospital Charge Code |
906811492
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$724.00 |
| Max. Negotiated Rate |
$59,918.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$36,314.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,989.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$54,471.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$39,945.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$36,314.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: BCBS Transplant Transplant |
$13,160.40
|
| Rate for Payer: Blue Shield of California Commercial |
$13,555.21
|
| Rate for Payer: Blue Shield of California EPN |
$10,659.92
|
| Rate for Payer: Caremore Medicare Advantage |
$36,314.24
|
| Rate for Payer: Cash Price |
$9,870.30
|
| Rate for Payer: Cash Price |
$9,870.30
|
| Rate for Payer: Cash Price |
$9,870.30
|
| Rate for Payer: Central Health Plan Commercial |
$17,547.20
|
| Rate for Payer: Cigna of CA HMO |
$14,037.76
|
| Rate for Payer: Cigna of CA PPO |
$16,231.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54,471.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$49,024.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$36,314.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$36,314.24
|
| Rate for Payer: Galaxy Health WC |
$18,643.90
|
| Rate for Payer: Global Benefits Group Commercial |
$13,160.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,740.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16,450.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$59,555.35
|
| Rate for Payer: IEHP medi-cal |
$59,918.50
|
| Rate for Payer: IEHP Medicare Advantage |
$36,314.24
|
| Rate for Payer: Innovage PACE Commercial |
$54,471.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,629.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36,314.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,386.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48,661.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48,661.08
|
| Rate for Payer: Multiplan Commercial |
$16,450.50
|
| Rate for Payer: Networks By Design Commercial |
$14,257.10
|
| Rate for Payer: Prime Health Services Commercial |
$18,643.90
|
| Rate for Payer: Prime Health Services Medicare |
$38,493.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13,160.40
|
| Rate for Payer: Riverside University Health MISP |
$39,945.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,160.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,160.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54,471.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39,945.66
|
| Rate for Payer: Vantage Medical Group Senior |
$36,314.24
|
|
|
HC TCAT INTRA COR INFUS SUPSAT OXY
|
Facility
OP
|
$2,595.00
|
|
|
Service Code
|
CPT 0659T
|
| Hospital Charge Code |
906810659
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$444.96 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$444.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,205.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,427.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,427.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,256.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,533.13
|
| Rate for Payer: BCBS Transplant Transplant |
$1,557.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$1,167.75
|
| Rate for Payer: Cash Price |
$1,167.75
|
| Rate for Payer: Cash Price |
$1,167.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,076.00
|
| Rate for Payer: Cigna of CA PPO |
$1,920.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,205.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,038.00
|
| Rate for Payer: Galaxy Health WC |
$2,205.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,557.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,335.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,946.25
|
| Rate for Payer: IEHP medi-cal |
$908.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,730.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$519.00
|
| Rate for Payer: Multiplan Commercial |
$1,946.25
|
| Rate for Payer: Networks By Design Commercial |
$1,686.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,205.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,557.00
|
| Rate for Payer: Riverside University Health MISP |
$1,038.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,557.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,557.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,205.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,205.75
|
|
|
HC TCAT INTRA COR INFUS SUPSAT OXY
|
Facility
IP
|
$2,595.00
|
|
|
Service Code
|
CPT 0659T
|
| Hospital Charge Code |
906810659
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$519.00 |
| Max. Negotiated Rate |
$2,335.50 |
| Rate for Payer: Cash Price |
$1,167.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,076.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Galaxy Health WC |
$2,205.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,557.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,335.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,730.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$519.00
|
| Rate for Payer: Multiplan Commercial |
$1,946.25
|
| Rate for Payer: Networks By Design Commercial |
$1,686.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,205.75
|
|
|
HC TCAT PLMT AND OR RMVL CEREBRAL EMOLIC
|
Facility
OP
|
$69,981.00
|
|
|
Service Code
|
CPT 33370
|
| Hospital Charge Code |
906813370
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$62,982.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$59,483.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38,489.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$38,489.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: BCBS Transplant Transplant |
$41,988.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$31,491.45
|
| Rate for Payer: Cash Price |
$31,491.45
|
| Rate for Payer: Cash Price |
$31,491.45
|
| Rate for Payer: Central Health Plan Commercial |
$55,984.80
|
| Rate for Payer: Cigna of CA PPO |
$51,785.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59,483.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$27,992.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$27,992.40
|
| Rate for Payer: Galaxy Health WC |
$59,483.85
|
| Rate for Payer: Global Benefits Group Commercial |
$41,988.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$62,982.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$52,485.75
|
| Rate for Payer: IEHP medi-cal |
$24,493.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46,677.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,996.20
|
| Rate for Payer: Multiplan Commercial |
$52,485.75
|
| Rate for Payer: Networks By Design Commercial |
$45,487.65
|
| Rate for Payer: Prime Health Services Commercial |
$59,483.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$41,988.60
|
| Rate for Payer: Riverside University Health MISP |
$27,992.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41,988.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59,483.85
|
| Rate for Payer: Vantage Medical Group Senior |
$59,483.85
|
|
|
HC TCAT PLMT AND OR RMVL CEREBRAL EMOLIC
|
Facility
IP
|
$69,981.00
|
|
|
Service Code
|
CPT 33370
|
| Hospital Charge Code |
906813370
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$13,996.20 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$31,491.45
|
| Rate for Payer: Cash Price |
$31,491.45
|
| Rate for Payer: Central Health Plan Commercial |
$55,984.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$27,992.40
|
| Rate for Payer: Galaxy Health WC |
$59,483.85
|
| Rate for Payer: Global Benefits Group Commercial |
$41,988.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$62,982.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46,677.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,996.20
|
| Rate for Payer: Multiplan Commercial |
$52,485.75
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$59,483.85
|
|
|
HC TCAT RMVL PERM LDLS PM R VENTR
|
Facility
IP
|
$8,080.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
906833275
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,616.00 |
| Max. Negotiated Rate |
$7,272.00 |
| Rate for Payer: Cash Price |
$3,636.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,232.00
|
| Rate for Payer: Galaxy Health WC |
$6,868.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,848.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,272.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,389.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,616.00
|
| Rate for Payer: Multiplan Commercial |
$6,060.00
|
| Rate for Payer: Networks By Design Commercial |
$5,252.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,868.00
|
|
|
HC TCAT RMVL PERM LDLS PM R VENTR
|
Facility
OP
|
$8,080.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
906833275
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,616.00 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10,526.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,838.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,848.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$3,636.00
|
| Rate for Payer: Cash Price |
$3,636.00
|
| Rate for Payer: Cash Price |
$3,636.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,464.00
|
| Rate for Payer: Cigna of CA PPO |
$5,979.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$6,868.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,848.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,272.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,060.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: IEHP medi-cal |
$6,571.21
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Innovage PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,389.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,616.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$6,060.00
|
| Rate for Payer: Networks By Design Commercial |
$5,252.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,868.00
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,848.00
|
| Rate for Payer: Riverside University Health MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,848.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC TCAT RMVL PERM LDLS PM R VENTR
|
Facility
OP
|
$8,080.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
906820335
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,616.00 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10,526.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,838.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,848.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$3,636.00
|
| Rate for Payer: Cash Price |
$3,636.00
|
| Rate for Payer: Cash Price |
$3,636.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,464.00
|
| Rate for Payer: Cigna of CA PPO |
$5,979.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$6,868.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,848.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,272.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,060.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: IEHP medi-cal |
$6,571.21
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Innovage PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,389.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,616.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$6,060.00
|
| Rate for Payer: Networks By Design Commercial |
$5,252.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,868.00
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,848.00
|
| Rate for Payer: Riverside University Health MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,848.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC TCAT RMVL PERM LDLS PM R VENTR
|
Facility
IP
|
$8,080.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
906820335
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,616.00 |
| Max. Negotiated Rate |
$7,272.00 |
| Rate for Payer: Cash Price |
$3,636.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,232.00
|
| Rate for Payer: Galaxy Health WC |
$6,868.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,848.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,272.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,389.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,616.00
|
| Rate for Payer: Multiplan Commercial |
$6,060.00
|
| Rate for Payer: Networks By Design Commercial |
$5,252.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,868.00
|
|
|
HC TCELL ABSOLUTE CD4
|
Facility
IP
|
$339.00
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
903900104
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.80
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$220.35
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
|
|
HC TCELL ABSOLUTE CD4
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
903900104
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$238.96 |
| Rate for Payer: Adventist Health Medi-Cal |
$26.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$196.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$26.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$195.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$238.96
|
| Rate for Payer: BCBS Transplant Transplant |
$42.60
|
| Rate for Payer: Blue Shield of California Commercial |
$43.88
|
| Rate for Payer: Blue Shield of California EPN |
$34.51
|
| Rate for Payer: Caremore Medicare Advantage |
$26.78
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Central Health Plan Commercial |
$56.80
|
| Rate for Payer: Cigna of CA HMO |
$45.44
|
| Rate for Payer: Cigna of CA PPO |
$52.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.15
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$26.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.78
|
| Rate for Payer: Galaxy Health WC |
$60.35
|
| Rate for Payer: Global Benefits Group Commercial |
$42.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$53.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$43.92
|
| Rate for Payer: IEHP medi-cal |
$44.19
|
| Rate for Payer: IEHP Medicare Advantage |
$26.78
|
| Rate for Payer: Innovage PACE Commercial |
$40.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.89
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: Networks By Design Commercial |
$46.15
|
| Rate for Payer: Prime Health Services Commercial |
$60.35
|
| Rate for Payer: Prime Health Services Medicare |
$28.39
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$42.60
|
| Rate for Payer: Riverside University Health MISP |
$29.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.69
|
| Rate for Payer: United Healthcare All Other HMO |
$21.69
|
| Rate for Payer: United Healthcare HMO Rider |
$21.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Vantage Medical Group Senior |
$26.78
|
|
|
HC TCELL ABSOLUTE CD8
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
903900105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$350.14 |
| Rate for Payer: Adventist Health Medi-Cal |
$46.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$344.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$70.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$51.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$46.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$287.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.14
|
| Rate for Payer: BCBS Transplant Transplant |
$42.60
|
| Rate for Payer: Blue Shield of California Commercial |
$43.88
|
| Rate for Payer: Blue Shield of California EPN |
$34.51
|
| Rate for Payer: Caremore Medicare Advantage |
$46.98
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Central Health Plan Commercial |
$56.80
|
| Rate for Payer: Cigna of CA HMO |
$45.44
|
| Rate for Payer: Cigna of CA PPO |
$52.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$46.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$46.98
|
| Rate for Payer: Galaxy Health WC |
$60.35
|
| Rate for Payer: Global Benefits Group Commercial |
$42.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$53.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$77.05
|
| Rate for Payer: IEHP medi-cal |
$77.52
|
| Rate for Payer: IEHP Medicare Advantage |
$46.98
|
| Rate for Payer: Innovage PACE Commercial |
$70.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.95
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: Networks By Design Commercial |
$46.15
|
| Rate for Payer: Prime Health Services Commercial |
$60.35
|
| Rate for Payer: Prime Health Services Medicare |
$49.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$42.60
|
| Rate for Payer: Riverside University Health MISP |
$51.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.05
|
| Rate for Payer: United Healthcare All Other HMO |
$38.05
|
| Rate for Payer: United Healthcare HMO Rider |
$38.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.68
|
| Rate for Payer: Vantage Medical Group Senior |
$46.98
|
|
|
HC TCELL ABSOLUTE CD8
|
Facility
IP
|
$423.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
903900105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$84.60 |
| Max. Negotiated Rate |
$380.70 |
| Rate for Payer: Cash Price |
$190.35
|
| Rate for Payer: Central Health Plan Commercial |
$338.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.20
|
| Rate for Payer: Galaxy Health WC |
$359.55
|
| Rate for Payer: Global Benefits Group Commercial |
$253.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$380.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.60
|
| Rate for Payer: Multiplan Commercial |
$317.25
|
| Rate for Payer: Networks By Design Commercial |
$274.95
|
| Rate for Payer: Prime Health Services Commercial |
$359.55
|
|
|
HC TCELL TOTAL COUNT CD2/CD3
|
Facility
IP
|
$423.00
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
903900101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$84.60 |
| Max. Negotiated Rate |
$380.70 |
| Rate for Payer: Cash Price |
$190.35
|
| Rate for Payer: Central Health Plan Commercial |
$338.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.20
|
| Rate for Payer: Galaxy Health WC |
$359.55
|
| Rate for Payer: Global Benefits Group Commercial |
$253.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$380.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.60
|
| Rate for Payer: Multiplan Commercial |
$317.25
|
| Rate for Payer: Networks By Design Commercial |
$274.95
|
| Rate for Payer: Prime Health Services Commercial |
$359.55
|
|
|
HC TCELL TOTAL COUNT CD2/CD3
|
Facility
OP
|
$144.00
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
903900101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$335.32 |
| Rate for Payer: Adventist Health Medi-Cal |
$37.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$56.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$274.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.32
|
| Rate for Payer: BCBS Transplant Transplant |
$86.40
|
| Rate for Payer: Blue Shield of California Commercial |
$88.99
|
| Rate for Payer: Blue Shield of California EPN |
$69.98
|
| Rate for Payer: Caremore Medicare Advantage |
$37.73
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Central Health Plan Commercial |
$115.20
|
| Rate for Payer: Cigna of CA HMO |
$92.16
|
| Rate for Payer: Cigna of CA PPO |
$106.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.73
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.88
|
| Rate for Payer: IEHP medi-cal |
$62.25
|
| Rate for Payer: IEHP Medicare Advantage |
$37.73
|
| Rate for Payer: Innovage PACE Commercial |
$56.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
| Rate for Payer: Prime Health Services Medicare |
$39.99
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$86.40
|
| Rate for Payer: Riverside University Health MISP |
$41.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.56
|
| Rate for Payer: United Healthcare All Other HMO |
$30.56
|
| Rate for Payer: United Healthcare HMO Rider |
$30.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC TD ELECT HOOD SWITCH CONTROL
|
Facility
IP
|
$3,454.00
|
|
|
Service Code
|
CPT L7045
|
| Hospital Charge Code |
905357045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$690.80 |
| Max. Negotiated Rate |
$3,108.60 |
| Rate for Payer: Blue Shield of California EPN |
$1,844.44
|
| Rate for Payer: Cash Price |
$1,554.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,763.20
|
| Rate for Payer: Cigna of CA HMO |
$2,417.80
|
| Rate for Payer: Cigna of CA PPO |
$2,417.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,381.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,381.60
|
| Rate for Payer: Galaxy Health WC |
$2,935.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,072.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,108.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,303.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$690.80
|
| Rate for Payer: Multiplan Commercial |
$2,590.50
|
| Rate for Payer: Networks By Design Commercial |
$1,727.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,935.90
|
|
|
HC TD ELECT HOOD SWITCH CONTROL
|
Facility
OP
|
$3,454.00
|
|
|
Service Code
|
CPT L7045
|
| Hospital Charge Code |
905357045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,208.90 |
| Max. Negotiated Rate |
$7,149.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,149.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,935.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,899.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,899.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,672.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,040.62
|
| Rate for Payer: BCBS Transplant Transplant |
$2,072.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,590.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,878.98
|
| Rate for Payer: Cash Price |
$1,554.30
|
| Rate for Payer: Cash Price |
$1,554.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,763.20
|
| Rate for Payer: Cigna of CA HMO |
$2,417.80
|
| Rate for Payer: Cigna of CA PPO |
$2,417.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,935.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,381.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,381.60
|
| Rate for Payer: Galaxy Health WC |
$2,935.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,072.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,108.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,590.50
|
| Rate for Payer: IEHP medi-cal |
$1,208.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,303.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,416.14
|
| Rate for Payer: Multiplan Commercial |
$2,590.50
|
| Rate for Payer: Networks By Design Commercial |
$1,727.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,935.90
|
| Rate for Payer: Riverside University Health MISP |
$1,381.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,072.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,072.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,727.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,727.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,727.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,727.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,935.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,935.90
|
|
|
HC TD GLOVE ABOVE HANDS PROD GLVE
|
Facility
OP
|
$712.00
|
|
|
Service Code
|
CPT L6890
|
| Hospital Charge Code |
905356890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$249.20 |
| Max. Negotiated Rate |
$752.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$752.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$605.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$391.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$391.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$344.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$420.65
|
| Rate for Payer: BCBS Transplant Transplant |
$427.20
|
| Rate for Payer: Blue Shield of California Commercial |
$534.00
|
| Rate for Payer: Blue Shield of California EPN |
$387.33
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Central Health Plan Commercial |
$569.60
|
| Rate for Payer: Cigna of CA HMO |
$498.40
|
| Rate for Payer: Cigna of CA PPO |
$498.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$605.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$284.80
|
| Rate for Payer: Galaxy Health WC |
$605.20
|
| Rate for Payer: Global Benefits Group Commercial |
$427.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$640.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$534.00
|
| Rate for Payer: IEHP medi-cal |
$249.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$474.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.92
|
| Rate for Payer: Multiplan Commercial |
$534.00
|
| Rate for Payer: Networks By Design Commercial |
$356.00
|
| Rate for Payer: Prime Health Services Commercial |
$605.20
|
| Rate for Payer: Riverside University Health MISP |
$284.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$427.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$427.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$356.00
|
| Rate for Payer: United Healthcare All Other HMO |
$356.00
|
| Rate for Payer: United Healthcare HMO Rider |
$356.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$356.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$605.20
|
| Rate for Payer: Vantage Medical Group Senior |
$605.20
|
|
|
HC TD GLOVE ABOVE HANDS PROD GLVE
|
Facility
IP
|
$712.00
|
|
|
Service Code
|
CPT L6890
|
| Hospital Charge Code |
905356890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.40 |
| Max. Negotiated Rate |
$640.80 |
| Rate for Payer: Blue Shield of California EPN |
$380.21
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Central Health Plan Commercial |
$569.60
|
| Rate for Payer: Cigna of CA HMO |
$498.40
|
| Rate for Payer: Cigna of CA PPO |
$498.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$284.80
|
| Rate for Payer: Galaxy Health WC |
$605.20
|
| Rate for Payer: Global Benefits Group Commercial |
$427.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$640.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$474.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.40
|
| Rate for Payer: Multiplan Commercial |
$534.00
|
| Rate for Payer: Networks By Design Commercial |
$356.00
|
| Rate for Payer: Prime Health Services Commercial |
$605.20
|
|
|
HC TD GLOVE CUSTOM
|
Facility
IP
|
$1,040.00
|
|
|
Service Code
|
CPT L6895
|
| Hospital Charge Code |
905356895
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Blue Shield of California EPN |
$555.36
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Central Health Plan Commercial |
$832.00
|
| Rate for Payer: Cigna of CA HMO |
$728.00
|
| Rate for Payer: Cigna of CA PPO |
$728.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$416.00
|
| Rate for Payer: Galaxy Health WC |
$884.00
|
| Rate for Payer: Global Benefits Group Commercial |
$624.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$693.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.00
|
| Rate for Payer: Multiplan Commercial |
$780.00
|
| Rate for Payer: Networks By Design Commercial |
$520.00
|
| Rate for Payer: Prime Health Services Commercial |
$884.00
|
|
|
HC TD GLOVE CUSTOM
|
Facility
OP
|
$1,040.00
|
|
|
Service Code
|
CPT L6895
|
| Hospital Charge Code |
905356895
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$2,469.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,469.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$884.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$572.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$572.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$503.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$614.43
|
| Rate for Payer: BCBS Transplant Transplant |
$624.00
|
| Rate for Payer: Blue Shield of California Commercial |
$780.00
|
| Rate for Payer: Blue Shield of California EPN |
$565.76
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Central Health Plan Commercial |
$832.00
|
| Rate for Payer: Cigna of CA HMO |
$728.00
|
| Rate for Payer: Cigna of CA PPO |
$728.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$884.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$416.00
|
| Rate for Payer: Galaxy Health WC |
$884.00
|
| Rate for Payer: Global Benefits Group Commercial |
$624.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$936.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$780.00
|
| Rate for Payer: IEHP medi-cal |
$364.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$693.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$426.40
|
| Rate for Payer: Multiplan Commercial |
$780.00
|
| Rate for Payer: Networks By Design Commercial |
$520.00
|
| Rate for Payer: Prime Health Services Commercial |
$884.00
|
| Rate for Payer: Riverside University Health MISP |
$416.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$624.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$624.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$520.00
|
| Rate for Payer: United Healthcare All Other HMO |
$520.00
|
| Rate for Payer: United Healthcare HMO Rider |
$520.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$520.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$884.00
|
| Rate for Payer: Vantage Medical Group Senior |
$884.00
|
|
|
HC TD MODIFIER WRIST FLEX UNIT
|
Facility
IP
|
$1,001.00
|
|
|
Service Code
|
CPT L6805
|
| Hospital Charge Code |
905356805
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$200.20 |
| Max. Negotiated Rate |
$900.90 |
| Rate for Payer: Blue Shield of California EPN |
$534.53
|
| Rate for Payer: Cash Price |
$450.45
|
| Rate for Payer: Central Health Plan Commercial |
$800.80
|
| Rate for Payer: Cigna of CA HMO |
$700.70
|
| Rate for Payer: Cigna of CA PPO |
$700.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.40
|
| Rate for Payer: Galaxy Health WC |
$850.85
|
| Rate for Payer: Global Benefits Group Commercial |
$600.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$900.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$667.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.20
|
| Rate for Payer: Multiplan Commercial |
$750.75
|
| Rate for Payer: Networks By Design Commercial |
$500.50
|
| Rate for Payer: Prime Health Services Commercial |
$850.85
|
|
|
HC TD MODIFIER WRIST FLEX UNIT
|
Facility
OP
|
$1,001.00
|
|
|
Service Code
|
CPT L6805
|
| Hospital Charge Code |
905356805
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$350.35 |
| Max. Negotiated Rate |
$1,504.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,504.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$850.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$550.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$550.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$484.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$591.39
|
| Rate for Payer: BCBS Transplant Transplant |
$600.60
|
| Rate for Payer: Blue Shield of California Commercial |
$750.75
|
| Rate for Payer: Blue Shield of California EPN |
$544.54
|
| Rate for Payer: Cash Price |
$450.45
|
| Rate for Payer: Cash Price |
$450.45
|
| Rate for Payer: Central Health Plan Commercial |
$800.80
|
| Rate for Payer: Cigna of CA HMO |
$700.70
|
| Rate for Payer: Cigna of CA PPO |
$700.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$850.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.40
|
| Rate for Payer: Galaxy Health WC |
$850.85
|
| Rate for Payer: Global Benefits Group Commercial |
$600.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$900.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$750.75
|
| Rate for Payer: IEHP medi-cal |
$350.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$667.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$410.41
|
| Rate for Payer: Multiplan Commercial |
$750.75
|
| Rate for Payer: Networks By Design Commercial |
$500.50
|
| Rate for Payer: Prime Health Services Commercial |
$850.85
|
| Rate for Payer: Riverside University Health MISP |
$400.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$600.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$600.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$500.50
|
| Rate for Payer: United Healthcare All Other HMO |
$500.50
|
| Rate for Payer: United Healthcare HMO Rider |
$500.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$500.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$850.85
|
| Rate for Payer: Vantage Medical Group Senior |
$850.85
|
|
|
HC TD PNCHR TOOL OTTO BOCK OR EQL
|
Facility
OP
|
$201.00
|
|
|
Service Code
|
CPT L6810
|
| Hospital Charge Code |
905356810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.35 |
| Max. Negotiated Rate |
$825.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$825.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$110.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$110.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$97.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.75
|
| Rate for Payer: BCBS Transplant Transplant |
$120.60
|
| Rate for Payer: Blue Shield of California Commercial |
$150.75
|
| Rate for Payer: Blue Shield of California EPN |
$109.34
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Central Health Plan Commercial |
$160.80
|
| Rate for Payer: Cigna of CA HMO |
$140.70
|
| Rate for Payer: Cigna of CA PPO |
$140.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.40
|
| Rate for Payer: Galaxy Health WC |
$170.85
|
| Rate for Payer: Global Benefits Group Commercial |
$120.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$150.75
|
| Rate for Payer: IEHP medi-cal |
$70.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.41
|
| Rate for Payer: Multiplan Commercial |
$150.75
|
| Rate for Payer: Networks By Design Commercial |
$100.50
|
| Rate for Payer: Prime Health Services Commercial |
$170.85
|
| Rate for Payer: Riverside University Health MISP |
$80.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.50
|
| Rate for Payer: United Healthcare All Other HMO |
$100.50
|
| Rate for Payer: United Healthcare HMO Rider |
$100.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.85
|
| Rate for Payer: Vantage Medical Group Senior |
$170.85
|
|
