|
HC TCAT PLMT AND OR RMVL CEREBRAL EMOLIC
|
Facility
|
OP
|
$56,510.00
|
|
|
Service Code
|
CPT 33370
|
| Hospital Charge Code |
906813370
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$189.54 |
| Max. Negotiated Rate |
$50,859.00 |
| Rate for Payer: Adventist Health Commercial |
$11,302.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48,033.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31,080.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42,382.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27,362.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33,188.32
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$25,429.50
|
| Rate for Payer: Cash Price |
$25,429.50
|
| Rate for Payer: Cash Price |
$25,429.50
|
| Rate for Payer: Central Health Plan Commercial |
$45,208.00
|
| Rate for Payer: Cigna of CA HMO |
$36,166.40
|
| Rate for Payer: Cigna of CA PPO |
$41,817.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48,033.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$48,033.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48,033.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,604.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22,604.00
|
| Rate for Payer: Galaxy Health WC |
$48,033.50
|
| Rate for Payer: Global Benefits Group Commercial |
$33,906.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$50,859.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$189.54
|
| Rate for Payer: InnovAge PACE Commercial |
$28,255.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37,692.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,979.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,302.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,557.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39,557.00
|
| Rate for Payer: Multiplan Commercial |
$42,382.50
|
| Rate for Payer: Networks By Design Commercial |
$36,731.50
|
| Rate for Payer: Prime Health Services Commercial |
$48,033.50
|
| Rate for Payer: Riverside University Health System MISP |
$22,604.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33,906.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48,033.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48,033.50
|
| Rate for Payer: Vantage Medical Group Senior |
$48,033.50
|
|
|
HC TCAT PLMT AND OR RMVL CEREBRAL EMOLIC
|
Facility
|
IP
|
$56,510.00
|
|
|
Service Code
|
CPT 33370
|
| Hospital Charge Code |
906813370
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,302.00 |
| Max. Negotiated Rate |
$50,859.00 |
| Rate for Payer: Adventist Health Commercial |
$11,302.00
|
| Rate for Payer: Cash Price |
$25,429.50
|
| Rate for Payer: Central Health Plan Commercial |
$45,208.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,604.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22,604.00
|
| Rate for Payer: Galaxy Health WC |
$48,033.50
|
| Rate for Payer: Global Benefits Group Commercial |
$33,906.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$50,859.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37,692.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21,530.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,979.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,302.00
|
| Rate for Payer: Multiplan Commercial |
$42,382.50
|
| Rate for Payer: Networks By Design Commercial |
$36,731.50
|
| Rate for Payer: Prime Health Services Commercial |
$48,033.50
|
|
|
HC TCAT RMVL PERM LDLS PM R VENTR
|
Facility
|
OP
|
$7,676.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
906820335
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$758.83 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,535.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10,526.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,070.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$5,999.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$3,454.20
|
| Rate for Payer: Cash Price |
$3,454.20
|
| Rate for Payer: Cash Price |
$3,454.20
|
| Rate for Payer: Central Health Plan Commercial |
$6,140.80
|
| Rate for Payer: Cigna of CA HMO |
$4,912.64
|
| Rate for Payer: Cigna of CA PPO |
$5,680.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$6,524.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,605.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,908.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$758.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,119.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,535.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$5,757.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$4,989.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$6,524.60
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,605.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC TCAT RMVL PERM LDLS PM R VENTR
|
Facility
|
IP
|
$7,676.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
906820335
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,535.20 |
| Max. Negotiated Rate |
$6,908.40 |
| Rate for Payer: Adventist Health Commercial |
$1,535.20
|
| Rate for Payer: Cash Price |
$3,454.20
|
| Rate for Payer: Central Health Plan Commercial |
$6,140.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,070.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,070.40
|
| Rate for Payer: Galaxy Health WC |
$6,524.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,605.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,908.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,119.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,924.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,751.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,535.20
|
| Rate for Payer: Multiplan Commercial |
$5,757.00
|
| Rate for Payer: Networks By Design Commercial |
$4,989.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,524.60
|
|
|
HC TCAT RMVL PERM LDLS PM R VENTR
|
Facility
|
IP
|
$6,525.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
906833275
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,305.00 |
| Max. Negotiated Rate |
$5,872.50 |
| Rate for Payer: Adventist Health Commercial |
$1,305.00
|
| Rate for Payer: Cash Price |
$2,936.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,220.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,610.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,610.00
|
| Rate for Payer: Galaxy Health WC |
$5,546.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,915.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,872.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,352.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,486.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,038.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,305.00
|
| Rate for Payer: Multiplan Commercial |
$4,893.75
|
| Rate for Payer: Networks By Design Commercial |
$4,241.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,546.25
|
|
|
HC TCAT RMVL PERM LDLS PM R VENTR
|
Facility
|
OP
|
$6,525.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
906833275
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$758.83 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,305.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10,526.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,070.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$5,999.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$2,936.25
|
| Rate for Payer: Cash Price |
$2,936.25
|
| Rate for Payer: Cash Price |
$2,936.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,220.00
|
| Rate for Payer: Cigna of CA HMO |
$4,176.00
|
| Rate for Payer: Cigna of CA PPO |
$4,828.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$5,546.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,915.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,872.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$758.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,352.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,305.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$4,893.75
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$4,241.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$5,546.25
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,915.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC TCELL ABSOLUTE CD4
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
903900104
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$351.00 |
| Rate for Payer: Adventist Health Commercial |
$78.00
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Central Health Plan Commercial |
$312.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.00
|
| Rate for Payer: EPIC Health Plan Senior |
$156.00
|
| Rate for Payer: Galaxy Health WC |
$331.50
|
| Rate for Payer: Global Benefits Group Commercial |
$234.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$351.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$241.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$292.50
|
| Rate for Payer: Networks By Design Commercial |
$253.50
|
| Rate for Payer: Prime Health Services Commercial |
$331.50
|
|
|
HC TCELL ABSOLUTE CD4
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
903900104
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.69 |
| Max. Negotiated Rate |
$195.91 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$26.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$86.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Alpha Care 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 |
$39.76
|
| Rate for Payer: Blue Shield of California Commercial |
$86.19
|
| Rate for Payer: Blue Shield of California EPN |
$56.37
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Central Health Plan Commercial |
$113.60
|
| Rate for Payer: Cigna of CA HMO |
$90.88
|
| Rate for Payer: Cigna of CA PPO |
$105.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.15
|
| Rate for Payer: EPIC Health Plan Senior |
$26.78
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$43.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$40.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.78
|
| Rate for Payer: InnovAge PACE Commercial |
$40.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.40
|
| 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 |
$106.50
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$26.78
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Prime Health Services Medicare |
$28.39
|
| Rate for Payer: Riverside University Health System MISP |
$29.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| 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: Upland Medical Group Pediatric |
$26.78
|
| 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
|
$142.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
903900105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$287.05 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$46.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$86.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.68
|
| Rate for Payer: Alpha Care 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 |
$58.26
|
| Rate for Payer: Blue Shield of California Commercial |
$86.19
|
| Rate for Payer: Blue Shield of California EPN |
$56.37
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Central Health Plan Commercial |
$113.60
|
| Rate for Payer: Cigna of CA HMO |
$90.88
|
| Rate for Payer: Cigna of CA PPO |
$105.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.42
|
| Rate for Payer: EPIC Health Plan Senior |
$46.98
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$77.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$71.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$46.98
|
| Rate for Payer: InnovAge PACE Commercial |
$70.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.40
|
| 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 |
$106.50
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$46.98
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Prime Health Services Medicare |
$49.80
|
| Rate for Payer: Riverside University Health System MISP |
$51.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| 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: Upland Medical Group Pediatric |
$46.98
|
| 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: Adventist Health Commercial |
$84.60
|
| 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: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$161.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$261.84
|
| 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
|
$182.16
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
903900101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.56 |
| Max. Negotiated Rate |
$274.91 |
| Rate for Payer: Adventist Health Commercial |
$36.43
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care 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 |
$55.79
|
| Rate for Payer: Blue Shield of California Commercial |
$110.57
|
| Rate for Payer: Blue Shield of California EPN |
$72.32
|
| Rate for Payer: Cash Price |
$81.97
|
| Rate for Payer: Cash Price |
$81.97
|
| Rate for Payer: Central Health Plan Commercial |
$145.73
|
| Rate for Payer: Cigna of CA HMO |
$116.58
|
| Rate for Payer: Cigna of CA PPO |
$134.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.94
|
| Rate for Payer: EPIC Health Plan Senior |
$37.73
|
| Rate for Payer: Galaxy Health WC |
$154.84
|
| Rate for Payer: Global Benefits Group Commercial |
$109.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$163.94
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: InnovAge PACE Commercial |
$56.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.43
|
| 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 |
$136.62
|
| Rate for Payer: Networks By Design Commercial |
$118.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.73
|
| Rate for Payer: Prime Health Services Commercial |
$154.84
|
| Rate for Payer: Prime Health Services Medicare |
$39.99
|
| Rate for Payer: Riverside University Health System MISP |
$41.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.30
|
| 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: Upland Medical Group Pediatric |
$37.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
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: Adventist Health Commercial |
$84.60
|
| 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: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$161.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$261.84
|
| 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 TD ELECT HOOD SWITCH CONTROL
|
Facility
|
IP
|
$3,454.00
|
|
|
Service Code
|
CPT L7045
|
| Hospital Charge Code |
915357045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$690.80 |
| Max. Negotiated Rate |
$3,108.60 |
| Rate for Payer: Adventist Health Commercial |
$690.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,669.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,740.82
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$1,315.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,138.03
|
| 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 |
$2,245.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,935.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,296.29
|
| Rate for Payer: United Healthcare All Other HMO |
$1,261.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1,234.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,131.18
|
|
|
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 |
$1,131.18 |
| Max. Negotiated Rate |
$3,108.60 |
| Rate for Payer: Adventist Health Commercial |
$1,416.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,935.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,899.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,590.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,028.53
|
| Rate for Payer: Blue Shield of California Commercial |
$2,669.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,740.82
|
| 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: Dignity Health Medi-Cal |
$2,935.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,935.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,381.60
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$1,162.07
|
| Rate for Payer: InnovAge PACE Commercial |
$1,727.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,303.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,283.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,138.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,416.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,417.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,417.80
|
| 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
|
| Rate for Payer: Riverside University Health System 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 |
$1,296.29
|
| Rate for Payer: United Healthcare All Other HMO |
$1,261.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1,234.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,131.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,935.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,935.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,935.90
|
|
|
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: Adventist Health Commercial |
$690.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,669.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,740.82
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$1,315.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,138.03
|
| 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 |
$2,245.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,935.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,296.29
|
| Rate for Payer: United Healthcare All Other HMO |
$1,261.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1,234.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,131.18
|
|
|
HC TD ELECT HOOD SWITCH CONTROL
|
Facility
|
OP
|
$3,454.00
|
|
|
Service Code
|
CPT L7045
|
| Hospital Charge Code |
915357045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,131.18 |
| Max. Negotiated Rate |
$3,108.60 |
| Rate for Payer: Adventist Health Commercial |
$1,416.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,935.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,899.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,590.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,028.53
|
| Rate for Payer: Blue Shield of California Commercial |
$2,669.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,740.82
|
| 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: Dignity Health Medi-Cal |
$2,935.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,935.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,381.60
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$1,162.07
|
| Rate for Payer: InnovAge PACE Commercial |
$1,727.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,303.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,283.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,138.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,416.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,417.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,417.80
|
| 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
|
| Rate for Payer: Riverside University Health System 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 |
$1,296.29
|
| Rate for Payer: United Healthcare All Other HMO |
$1,261.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1,234.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,131.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,935.90
|
| 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 |
915356890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$158.91 |
| Max. Negotiated Rate |
$640.80 |
| Rate for Payer: Adventist Health Commercial |
$291.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$605.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$391.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$534.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$418.16
|
| Rate for Payer: Blue Shield of California Commercial |
$550.38
|
| Rate for Payer: Blue Shield of California EPN |
$358.85
|
| 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: Dignity Health Medi-Cal |
$605.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$605.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.80
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$158.91
|
| Rate for Payer: InnovAge PACE Commercial |
$356.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$474.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$440.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$498.40
|
| 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
|
| Rate for Payer: Riverside University Health System 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 |
$267.21
|
| Rate for Payer: United Healthcare All Other HMO |
$260.09
|
| Rate for Payer: United Healthcare HMO Rider |
$254.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$233.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$605.20
|
| 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
|
OP
|
$712.00
|
|
|
Service Code
|
CPT L6890
|
| Hospital Charge Code |
905356890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$158.91 |
| Max. Negotiated Rate |
$640.80 |
| Rate for Payer: Adventist Health Commercial |
$291.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$605.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$391.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$534.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$418.16
|
| Rate for Payer: Blue Shield of California Commercial |
$550.38
|
| Rate for Payer: Blue Shield of California EPN |
$358.85
|
| 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: Dignity Health Medi-Cal |
$605.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$605.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.80
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$158.91
|
| Rate for Payer: InnovAge PACE Commercial |
$356.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$474.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$440.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$498.40
|
| 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
|
| Rate for Payer: Riverside University Health System 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 |
$267.21
|
| Rate for Payer: United Healthcare All Other HMO |
$260.09
|
| Rate for Payer: United Healthcare HMO Rider |
$254.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$233.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$605.20
|
| 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 |
915356890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.40 |
| Max. Negotiated Rate |
$640.80 |
| Rate for Payer: Adventist Health Commercial |
$142.40
|
| Rate for Payer: Blue Shield of California Commercial |
$550.38
|
| Rate for Payer: Blue Shield of California EPN |
$358.85
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$271.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$440.73
|
| 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 |
$462.80
|
| Rate for Payer: Prime Health Services Commercial |
$605.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.21
|
| Rate for Payer: United Healthcare All Other HMO |
$260.09
|
| Rate for Payer: United Healthcare HMO Rider |
$254.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$233.18
|
|
|
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: Adventist Health Commercial |
$142.40
|
| Rate for Payer: Blue Shield of California Commercial |
$550.38
|
| Rate for Payer: Blue Shield of California EPN |
$358.85
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$271.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$440.73
|
| 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 |
$462.80
|
| Rate for Payer: Prime Health Services Commercial |
$605.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.21
|
| Rate for Payer: United Healthcare All Other HMO |
$260.09
|
| Rate for Payer: United Healthcare HMO Rider |
$254.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$233.18
|
|
|
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: Adventist Health Commercial |
$208.00
|
| Rate for Payer: Blue Shield of California Commercial |
$803.92
|
| Rate for Payer: Blue Shield of California EPN |
$524.16
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$396.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$643.76
|
| 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 |
$676.00
|
| Rate for Payer: Prime Health Services Commercial |
$884.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$390.31
|
| Rate for Payer: United Healthcare All Other HMO |
$379.91
|
| Rate for Payer: United Healthcare HMO Rider |
$371.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.60
|
|
|
HC TD GLOVE CUSTOM
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
CPT L6895
|
| Hospital Charge Code |
915356895
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Adventist Health Commercial |
$208.00
|
| Rate for Payer: Blue Shield of California Commercial |
$803.92
|
| Rate for Payer: Blue Shield of California EPN |
$524.16
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$396.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$643.76
|
| 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 |
$676.00
|
| Rate for Payer: Prime Health Services Commercial |
$884.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$390.31
|
| Rate for Payer: United Healthcare All Other HMO |
$379.91
|
| Rate for Payer: United Healthcare HMO Rider |
$371.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.60
|
|
|
HC TD GLOVE CUSTOM
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
CPT L6895
|
| Hospital Charge Code |
915356895
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$340.60 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Adventist Health Commercial |
$426.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$884.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$572.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$610.79
|
| Rate for Payer: Blue Shield of California Commercial |
$803.92
|
| Rate for Payer: Blue Shield of California EPN |
$524.16
|
| 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: Dignity Health Medi-Cal |
$884.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$884.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$369.94
|
| Rate for Payer: InnovAge PACE Commercial |
$520.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$693.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$643.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$426.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$728.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$728.00
|
| 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
|
| Rate for Payer: Riverside University Health System 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 |
$390.31
|
| Rate for Payer: United Healthcare All Other HMO |
$379.91
|
| Rate for Payer: United Healthcare HMO Rider |
$371.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$884.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$884.00
|
| Rate for Payer: Vantage Medical Group Senior |
$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 |
$340.60 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Adventist Health Commercial |
$426.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$884.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$572.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$610.79
|
| Rate for Payer: Blue Shield of California Commercial |
$803.92
|
| Rate for Payer: Blue Shield of California EPN |
$524.16
|
| 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: Dignity Health Medi-Cal |
$884.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$884.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$369.94
|
| Rate for Payer: InnovAge PACE Commercial |
$520.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$693.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$643.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$426.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$728.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$728.00
|
| 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
|
| Rate for Payer: Riverside University Health System 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 |
$390.31
|
| Rate for Payer: United Healthcare All Other HMO |
$379.91
|
| Rate for Payer: United Healthcare HMO Rider |
$371.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$884.00
|
| 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
|
OP
|
$1,001.00
|
|
|
Service Code
|
CPT L6805
|
| Hospital Charge Code |
905356805
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$270.61 |
| Max. Negotiated Rate |
$900.90 |
| Rate for Payer: Adventist Health Commercial |
$410.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$850.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$550.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$750.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$587.89
|
| Rate for Payer: Blue Shield of California Commercial |
$773.77
|
| Rate for Payer: Blue Shield of California EPN |
$504.50
|
| 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: Dignity Health Medi-Cal |
$850.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$850.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.40
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$270.61
|
| Rate for Payer: InnovAge PACE Commercial |
$500.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$667.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$619.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$410.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$700.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.70
|
| 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 System 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 |
$375.68
|
| Rate for Payer: United Healthcare All Other HMO |
$365.67
|
| Rate for Payer: United Healthcare HMO Rider |
$357.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$327.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$850.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$850.85
|
| Rate for Payer: Vantage Medical Group Senior |
$850.85
|
|
