|
HC BATT CHRG 12 VOLT UTAH OR EQUL
|
Facility
|
OP
|
$1,961.00
|
|
|
Service Code
|
CPT L7366
|
| Hospital Charge Code |
905357366
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$532.00 |
| Max. Negotiated Rate |
$1,764.90 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,666.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,078.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,078.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$949.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,158.56
|
| Rate for Payer: Blue Distinction Transplant |
$1,176.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,470.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,066.78
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,568.80
|
| Rate for Payer: Cigna of CA HMO |
$1,372.70
|
| Rate for Payer: Cigna of CA PPO |
$1,372.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,666.85
|
| Rate for Payer: Dignity Health Media |
$1,666.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,666.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$784.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.40
|
| Rate for Payer: Galaxy Health WC |
$1,666.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,176.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,764.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,470.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$686.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,307.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$532.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$804.01
|
| Rate for Payer: Multiplan Commercial |
$1,470.75
|
| Rate for Payer: Networks By Design Commercial |
$980.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,666.85
|
| Rate for Payer: Riverside University Health System MISP |
$784.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,176.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,176.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$980.50
|
| Rate for Payer: United Healthcare All Other HMO |
$980.50
|
| Rate for Payer: United Healthcare HMO Rider |
$980.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$980.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,666.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,666.85
|
|
|
HC BATT CHRG 6 VOLT OTTO BOCK OR
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT L7362
|
| Hospital Charge Code |
905357362
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$155.75 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$244.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$244.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$215.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$262.91
|
| Rate for Payer: Blue Distinction Transplant |
$267.00
|
| Rate for Payer: Blue Shield of California Commercial |
$333.75
|
| Rate for Payer: Blue Shield of California EPN |
$242.08
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: Cigna of CA HMO |
$311.50
|
| Rate for Payer: Cigna of CA PPO |
$311.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.25
|
| Rate for Payer: Dignity Health Media |
$378.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$378.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$333.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$155.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.45
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$222.50
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: Riverside University Health System MISP |
$178.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$267.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$267.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$222.50
|
| Rate for Payer: United Healthcare All Other HMO |
$222.50
|
| Rate for Payer: United Healthcare HMO Rider |
$222.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$222.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$378.25
|
| Rate for Payer: Vantage Medical Group Senior |
$378.25
|
|
|
HC BATT CHRG 6 VOLT OTTO BOCK OR
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT L7362
|
| Hospital Charge Code |
905357362
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Blue Shield of California EPN |
$237.63
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: Cigna of CA HMO |
$311.50
|
| Rate for Payer: Cigna of CA PPO |
$311.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.00
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$222.50
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.03
|
| Rate for Payer: United Healthcare All Other HMO |
$164.12
|
| Rate for Payer: United Healthcare HMO Rider |
$160.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$146.85
|
|
|
HC BATTERY 12 VOLT UTAH OR EQUAL
|
Facility
|
OP
|
$1,517.00
|
|
|
Service Code
|
CPT L7364
|
| Hospital Charge Code |
905357364
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$406.66 |
| Max. Negotiated Rate |
$1,365.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,289.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$834.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$834.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$734.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$896.24
|
| Rate for Payer: Blue Distinction Transplant |
$910.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,137.75
|
| Rate for Payer: Blue Shield of California EPN |
$825.25
|
| Rate for Payer: Cash Price |
$682.65
|
| Rate for Payer: Cash Price |
$682.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,213.60
|
| Rate for Payer: Cigna of CA HMO |
$1,061.90
|
| Rate for Payer: Cigna of CA PPO |
$1,061.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,289.45
|
| Rate for Payer: Dignity Health Media |
$1,289.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,289.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$606.80
|
| Rate for Payer: Galaxy Health WC |
$1,289.45
|
| Rate for Payer: Global Benefits Group Commercial |
$910.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,365.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,137.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$530.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,011.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$621.97
|
| Rate for Payer: Multiplan Commercial |
$1,137.75
|
| Rate for Payer: Networks By Design Commercial |
$758.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,289.45
|
| Rate for Payer: Riverside University Health System MISP |
$606.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$910.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$910.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$758.50
|
| Rate for Payer: United Healthcare All Other HMO |
$758.50
|
| Rate for Payer: United Healthcare HMO Rider |
$758.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$758.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,289.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,289.45
|
|
|
HC BATTERY 12 VOLT UTAH OR EQUAL
|
Facility
|
IP
|
$1,517.00
|
|
|
Service Code
|
CPT L7364
|
| Hospital Charge Code |
905357364
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$303.40 |
| Max. Negotiated Rate |
$1,365.30 |
| Rate for Payer: Blue Shield of California EPN |
$810.08
|
| Rate for Payer: Cash Price |
$682.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,213.60
|
| Rate for Payer: Cigna of CA HMO |
$1,061.90
|
| Rate for Payer: Cigna of CA PPO |
$1,061.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$606.80
|
| Rate for Payer: Galaxy Health WC |
$1,289.45
|
| Rate for Payer: Global Benefits Group Commercial |
$910.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,365.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,011.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.40
|
| Rate for Payer: Multiplan Commercial |
$1,137.75
|
| Rate for Payer: Networks By Design Commercial |
$758.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,289.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$572.82
|
| Rate for Payer: United Healthcare All Other HMO |
$559.47
|
| Rate for Payer: United Healthcare HMO Rider |
$547.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$500.61
|
|
|
HC BCEDP CASE MANAGEMENT FEE
|
Facility
|
OP
|
$39.00
|
|
| Hospital Charge Code |
909099998
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.04
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.15
|
| Rate for Payer: Dignity Health Media |
$33.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Riverside University Health System MISP |
$15.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.50
|
| Rate for Payer: United Healthcare All Other HMO |
$19.50
|
| Rate for Payer: United Healthcare HMO Rider |
$19.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.15
|
| Rate for Payer: Vantage Medical Group Senior |
$33.15
|
|
|
HC BCEDP CASE MANAGEMENT FEE
|
Facility
|
IP
|
$39.00
|
|
| Hospital Charge Code |
909099998
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
|
|
HC B-CELL LYMPH FISH DNA PROBE SO
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914114
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$1,505.45 |
| Rate for Payer: Adventist Health Medi-Cal |
$21.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,234.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,505.45
|
| Rate for Payer: Blue Distinction Transplant |
$51.60
|
| Rate for Payer: Blue Shield of California Commercial |
$53.15
|
| Rate for Payer: Blue Shield of California EPN |
$41.80
|
| Rate for Payer: Caremore Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Central Health Plan Commercial |
$68.80
|
| Rate for Payer: Cigna of CA HMO |
$55.04
|
| Rate for Payer: Cigna of CA PPO |
$63.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Media |
$21.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.42
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$64.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: InnovAge PACE Commercial |
$32.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
| Rate for Payer: Prime Health Services Medicare |
$22.71
|
| Rate for Payer: Riverside University Health System MISP |
$23.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.35
|
| Rate for Payer: United Healthcare All Other HMO |
$17.35
|
| Rate for Payer: United Healthcare HMO Rider |
$17.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC B-CELL LYMPH FISH DNA PROBE SO
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914114
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Central Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.40
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.20
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
|
|
HC B-CELL LYMPH FISH INTRPHAS IN
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914115
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$2,322.69 |
| Rate for Payer: Adventist Health Medi-Cal |
$51.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$294.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,904.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,322.69
|
| Rate for Payer: Blue Distinction Transplant |
$97.20
|
| Rate for Payer: Blue Shield of California Commercial |
$100.12
|
| Rate for Payer: Blue Shield of California EPN |
$78.73
|
| Rate for Payer: Caremore Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: Cigna of CA HMO |
$103.68
|
| Rate for Payer: Cigna of CA PPO |
$119.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: Dignity Health Media |
$51.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$51.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.19
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$121.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$83.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$84.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: InnovAge PACE Commercial |
$76.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.59
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: Prime Health Services Medicare |
$54.26
|
| Rate for Payer: Riverside University Health System MISP |
$56.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.46
|
| Rate for Payer: United Healthcare All Other HMO |
$41.46
|
| Rate for Payer: United Healthcare HMO Rider |
$41.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC B-CELL LYMPH FISH INTRPHAS IN
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914115
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
|
|
HC BC-GN NUCLEIC ACID ID CULTURE
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912467
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$177.79 |
| Rate for Payer: Adventist Health Medi-Cal |
$20.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$147.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$145.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.79
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$20.05
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.08
|
| Rate for Payer: Dignity Health Media |
$20.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.05
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: InnovAge PACE Commercial |
$30.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.87
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$21.25
|
| Rate for Payer: Riverside University Health System MISP |
$22.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.24
|
| Rate for Payer: United Healthcare All Other HMO |
$16.24
|
| Rate for Payer: United Healthcare HMO Rider |
$16.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.06
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
HC BC-GN NUCLEIC ACID ID CULTURE
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912467
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Central Health Plan Commercial |
$140.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.40
|
| Rate for Payer: Galaxy Health WC |
$149.60
|
| Rate for Payer: Global Benefits Group Commercial |
$105.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$158.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.20
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$114.40
|
| Rate for Payer: Prime Health Services Commercial |
$149.60
|
|
|
HC BC-GP NUCLEIC ACID ID CULTURE
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$177.79 |
| Rate for Payer: Adventist Health Medi-Cal |
$20.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$147.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$145.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.79
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$20.05
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.08
|
| Rate for Payer: Dignity Health Media |
$20.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.05
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: InnovAge PACE Commercial |
$30.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.87
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$21.25
|
| Rate for Payer: Riverside University Health System MISP |
$22.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.24
|
| Rate for Payer: United Healthcare All Other HMO |
$16.24
|
| Rate for Payer: United Healthcare HMO Rider |
$16.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.06
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
HC BC-GP NUCLEIC ACID ID CULTURE
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Central Health Plan Commercial |
$140.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.40
|
| Rate for Payer: Galaxy Health WC |
$149.60
|
| Rate for Payer: Global Benefits Group Commercial |
$105.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$158.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.20
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$114.40
|
| Rate for Payer: Prime Health Services Commercial |
$149.60
|
|
|
HC BCT LIMITED STUDY
|
Facility
|
OP
|
$1,045.00
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
909201971
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$113.54 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$663.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$617.39
|
| Rate for Payer: Blue Distinction Transplant |
$627.00
|
| Rate for Payer: Blue Shield of California Commercial |
$645.81
|
| Rate for Payer: Blue Shield of California EPN |
$507.87
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Central Health Plan Commercial |
$836.00
|
| Rate for Payer: Cigna of CA HMO |
$668.80
|
| Rate for Payer: Cigna of CA PPO |
$773.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$888.25
|
| Rate for Payer: Global Benefits Group Commercial |
$627.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$940.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$783.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$697.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$783.75
|
| Rate for Payer: Networks By Design Commercial |
$679.25
|
| Rate for Payer: Prime Health Services Commercial |
$888.25
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$627.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$627.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$522.50
|
| Rate for Payer: United Healthcare All Other HMO |
$522.50
|
| Rate for Payer: United Healthcare HMO Rider |
$522.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$522.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC BCT LIMITED STUDY
|
Facility
|
IP
|
$1,489.00
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
909201971
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$297.80 |
| Max. Negotiated Rate |
$1,340.10 |
| Rate for Payer: Cash Price |
$670.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,191.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$595.60
|
| Rate for Payer: Galaxy Health WC |
$1,265.65
|
| Rate for Payer: Global Benefits Group Commercial |
$893.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,340.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$993.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$567.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.80
|
| Rate for Payer: Multiplan Commercial |
$1,116.75
|
| Rate for Payer: Networks By Design Commercial |
$967.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,265.65
|
|
|
HC BE ENDOSK INCLUD TISSUE SHAPNG
|
Facility
|
OP
|
$4,043.00
|
|
|
Service Code
|
CPT L6400
|
| Hospital Charge Code |
905356400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,415.05 |
| Max. Negotiated Rate |
$3,638.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,436.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,223.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,223.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,957.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,388.60
|
| Rate for Payer: Blue Distinction Transplant |
$2,425.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,032.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,199.39
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,234.40
|
| Rate for Payer: Cigna of CA HMO |
$2,830.10
|
| Rate for Payer: Cigna of CA PPO |
$2,830.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,436.55
|
| Rate for Payer: Dignity Health Media |
$3,436.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,436.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,617.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,617.20
|
| Rate for Payer: Galaxy Health WC |
$3,436.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,425.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,638.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,032.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,415.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,696.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,741.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,657.63
|
| Rate for Payer: Multiplan Commercial |
$3,032.25
|
| Rate for Payer: Networks By Design Commercial |
$2,021.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,436.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,617.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,425.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,425.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,021.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,021.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,021.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,021.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,436.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,436.55
|
|
|
HC BE ENDOSK INCLUD TISSUE SHAPNG
|
Facility
|
IP
|
$4,043.00
|
|
|
Service Code
|
CPT L6400
|
| Hospital Charge Code |
905356400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$808.60 |
| Max. Negotiated Rate |
$3,638.70 |
| Rate for Payer: Blue Shield of California EPN |
$2,158.96
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,234.40
|
| Rate for Payer: Cigna of CA HMO |
$2,830.10
|
| Rate for Payer: Cigna of CA PPO |
$2,830.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,617.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,617.20
|
| Rate for Payer: Galaxy Health WC |
$3,436.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,425.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,638.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,696.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,540.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$808.60
|
| Rate for Payer: Multiplan Commercial |
$3,032.25
|
| Rate for Payer: Networks By Design Commercial |
$2,021.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,436.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,526.64
|
| Rate for Payer: United Healthcare All Other HMO |
$1,491.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1,458.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,334.19
|
|
|
HC BE EXTERN POWER SWITCH CONTROL
|
Facility
|
OP
|
$15,332.00
|
|
|
Service Code
|
CPT L6930
|
| Hospital Charge Code |
905356930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,366.20 |
| Max. Negotiated Rate |
$13,798.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,032.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,432.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,432.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,423.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,058.15
|
| Rate for Payer: Blue Distinction Transplant |
$9,199.20
|
| Rate for Payer: Blue Shield of California Commercial |
$11,499.00
|
| Rate for Payer: Blue Shield of California EPN |
$8,340.61
|
| Rate for Payer: Cash Price |
$6,899.40
|
| Rate for Payer: Cash Price |
$6,899.40
|
| Rate for Payer: Central Health Plan Commercial |
$12,265.60
|
| Rate for Payer: Cigna of CA HMO |
$10,732.40
|
| Rate for Payer: Cigna of CA PPO |
$10,732.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,032.20
|
| Rate for Payer: Dignity Health Media |
$13,032.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,032.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,132.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,132.80
|
| Rate for Payer: Galaxy Health WC |
$13,032.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,199.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,798.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,499.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,366.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,226.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,982.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,286.12
|
| Rate for Payer: Multiplan Commercial |
$11,499.00
|
| Rate for Payer: Networks By Design Commercial |
$7,666.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,032.20
|
| Rate for Payer: Riverside University Health System MISP |
$6,132.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,199.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,199.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,666.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,666.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,666.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,666.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,032.20
|
| Rate for Payer: Vantage Medical Group Senior |
$13,032.20
|
|
|
HC BE EXTERN POWER SWITCH CONTROL
|
Facility
|
IP
|
$15,332.00
|
|
|
Service Code
|
CPT L6930
|
| Hospital Charge Code |
905356930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,066.40 |
| Max. Negotiated Rate |
$13,798.80 |
| Rate for Payer: Blue Shield of California EPN |
$8,187.29
|
| Rate for Payer: Cash Price |
$6,899.40
|
| Rate for Payer: Central Health Plan Commercial |
$12,265.60
|
| Rate for Payer: Cigna of CA HMO |
$10,732.40
|
| Rate for Payer: Cigna of CA PPO |
$10,732.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,132.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,132.80
|
| Rate for Payer: Galaxy Health WC |
$13,032.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,199.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,798.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,226.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,841.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,066.40
|
| Rate for Payer: Multiplan Commercial |
$11,499.00
|
| Rate for Payer: Networks By Design Commercial |
$7,666.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,032.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,789.36
|
| Rate for Payer: United Healthcare All Other HMO |
$5,654.44
|
| Rate for Payer: United Healthcare HMO Rider |
$5,531.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,059.56
|
|
|
HC BE EXT POWER MYOLELECTRIC CONT
|
Facility
|
IP
|
$19,984.00
|
|
|
Service Code
|
CPT L6935
|
| Hospital Charge Code |
905356935
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,996.80 |
| Max. Negotiated Rate |
$17,985.60 |
| Rate for Payer: Blue Shield of California EPN |
$10,671.46
|
| Rate for Payer: Cash Price |
$8,992.80
|
| Rate for Payer: Central Health Plan Commercial |
$15,987.20
|
| Rate for Payer: Cigna of CA HMO |
$13,988.80
|
| Rate for Payer: Cigna of CA PPO |
$13,988.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,993.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,993.60
|
| Rate for Payer: Galaxy Health WC |
$16,986.40
|
| Rate for Payer: Global Benefits Group Commercial |
$11,990.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,985.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,329.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,613.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,996.80
|
| Rate for Payer: Multiplan Commercial |
$14,988.00
|
| Rate for Payer: Networks By Design Commercial |
$9,992.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,986.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,545.96
|
| Rate for Payer: United Healthcare All Other HMO |
$7,370.10
|
| Rate for Payer: United Healthcare HMO Rider |
$7,210.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,594.72
|
|
|
HC BE EXT POWER MYOLELECTRIC CONT
|
Facility
|
OP
|
$19,984.00
|
|
|
Service Code
|
CPT L6935
|
| Hospital Charge Code |
905356935
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6,994.40 |
| Max. Negotiated Rate |
$17,985.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,986.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,991.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,991.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9,676.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,806.55
|
| Rate for Payer: Blue Distinction Transplant |
$11,990.40
|
| Rate for Payer: Blue Shield of California Commercial |
$14,988.00
|
| Rate for Payer: Blue Shield of California EPN |
$10,871.30
|
| Rate for Payer: Cash Price |
$8,992.80
|
| Rate for Payer: Cash Price |
$8,992.80
|
| Rate for Payer: Central Health Plan Commercial |
$15,987.20
|
| Rate for Payer: Cigna of CA HMO |
$13,988.80
|
| Rate for Payer: Cigna of CA PPO |
$13,988.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,986.40
|
| Rate for Payer: Dignity Health Media |
$16,986.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,986.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,993.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,993.60
|
| Rate for Payer: Galaxy Health WC |
$16,986.40
|
| Rate for Payer: Global Benefits Group Commercial |
$11,990.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,985.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$14,988.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,994.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,329.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,957.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,193.44
|
| Rate for Payer: Multiplan Commercial |
$14,988.00
|
| Rate for Payer: Networks By Design Commercial |
$9,992.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,986.40
|
| Rate for Payer: Riverside University Health System MISP |
$7,993.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,990.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,990.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,992.00
|
| Rate for Payer: United Healthcare All Other HMO |
$9,992.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,992.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,992.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,986.40
|
| Rate for Payer: Vantage Medical Group Senior |
$16,986.40
|
|
|
HC BEHAVIORAL & QUALITATIVE ANALYSIS VOICE & RESONANCE
|
Facility
|
IP
|
$1,075.00
|
|
|
Service Code
|
CPT 92524
|
| Hospital Charge Code |
900100021
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$215.00 |
| Max. Negotiated Rate |
$967.50 |
| Rate for Payer: Cash Price |
$483.75
|
| Rate for Payer: Central Health Plan Commercial |
$860.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$430.00
|
| Rate for Payer: Galaxy Health WC |
$913.75
|
| Rate for Payer: Global Benefits Group Commercial |
$645.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$967.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$717.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.00
|
| Rate for Payer: Multiplan Commercial |
$806.25
|
| Rate for Payer: Networks By Design Commercial |
$698.75
|
| Rate for Payer: Prime Health Services Commercial |
$913.75
|
|
|
HC BEHAVIORAL & QUALITATIVE ANALYSIS VOICE & RESONANCE
|
Facility
|
OP
|
$1,075.00
|
|
|
Service Code
|
CPT 92524
|
| Hospital Charge Code |
900100021
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$102.30 |
| Max. Negotiated Rate |
$967.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$566.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$913.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$591.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$591.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$645.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$483.75
|
| Rate for Payer: Cash Price |
$483.75
|
| Rate for Payer: Cash Price |
$483.75
|
| Rate for Payer: Cash Price |
$483.75
|
| Rate for Payer: Central Health Plan Commercial |
$860.00
|
| Rate for Payer: Cigna of CA HMO |
$688.00
|
| Rate for Payer: Cigna of CA PPO |
$795.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$913.75
|
| Rate for Payer: Dignity Health Media |
$913.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$913.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$430.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$430.00
|
| Rate for Payer: Galaxy Health WC |
$913.75
|
| Rate for Payer: Global Benefits Group Commercial |
$645.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$967.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$806.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$376.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$717.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.75
|
| Rate for Payer: Multiplan Commercial |
$806.25
|
| Rate for Payer: Networks By Design Commercial |
$698.75
|
| Rate for Payer: Prime Health Services Commercial |
$913.75
|
| Rate for Payer: Riverside University Health System MISP |
$430.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$645.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$645.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$913.75
|
| Rate for Payer: Vantage Medical Group Senior |
$913.75
|
|
