|
HC COVID19 CONVALESCENT PLASMA
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
CPT C9507
|
| Hospital Charge Code |
900909507
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$172.40 |
| Max. Negotiated Rate |
$4,604.84 |
| Rate for Payer: Adventist Health Medi-Cal |
$642.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,604.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$964.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$707.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$642.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$417.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$509.27
|
| Rate for Payer: Blue Distinction Transplant |
$517.20
|
| Rate for Payer: Blue Shield of California Commercial |
$542.20
|
| Rate for Payer: Blue Shield of California EPN |
$421.52
|
| Rate for Payer: Caremore Medicare Advantage |
$642.73
|
| Rate for Payer: Cash Price |
$387.90
|
| Rate for Payer: Cash Price |
$387.90
|
| Rate for Payer: Cash Price |
$387.90
|
| Rate for Payer: Central Health Plan Commercial |
$689.60
|
| Rate for Payer: Cigna of CA HMO |
$551.68
|
| Rate for Payer: Cigna of CA PPO |
$637.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$964.10
|
| Rate for Payer: Dignity Health Media |
$642.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$707.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$867.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$642.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$642.73
|
| Rate for Payer: Galaxy Health WC |
$732.70
|
| Rate for Payer: Global Benefits Group Commercial |
$517.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$775.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$646.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,054.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,060.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$642.73
|
| Rate for Payer: InnovAge PACE Commercial |
$964.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$574.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,434.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$642.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$861.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$861.26
|
| Rate for Payer: Multiplan Commercial |
$646.50
|
| Rate for Payer: Networks By Design Commercial |
$560.30
|
| Rate for Payer: Prime Health Services Commercial |
$732.70
|
| Rate for Payer: Prime Health Services Medicare |
$681.29
|
| Rate for Payer: Riverside University Health System MISP |
$707.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$517.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$517.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$964.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$707.00
|
| Rate for Payer: Vantage Medical Group Senior |
$642.73
|
|
|
HC COVID19 CONVALESCENT PLASMA
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
CPT C9507
|
| Hospital Charge Code |
900909507
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$172.40 |
| Max. Negotiated Rate |
$775.80 |
| Rate for Payer: Cash Price |
$387.90
|
| Rate for Payer: Central Health Plan Commercial |
$689.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.80
|
| Rate for Payer: Galaxy Health WC |
$732.70
|
| Rate for Payer: Global Benefits Group Commercial |
$517.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$775.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$574.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$328.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.40
|
| Rate for Payer: Multiplan Commercial |
$646.50
|
| Rate for Payer: Networks By Design Commercial |
$560.30
|
| Rate for Payer: Prime Health Services Commercial |
$732.70
|
|
|
HC COVID 19 IGM IGG
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 86318
|
| Hospital Charge Code |
900912259
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$19.40 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Central Health Plan Commercial |
$77.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.80
|
| Rate for Payer: Galaxy Health WC |
$82.45
|
| Rate for Payer: Global Benefits Group Commercial |
$58.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.40
|
| Rate for Payer: Multiplan Commercial |
$72.75
|
| Rate for Payer: Networks By Design Commercial |
$63.05
|
| Rate for Payer: Prime Health Services Commercial |
$82.45
|
|
|
HC COVID 19 IGM IGG
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 86318
|
| Hospital Charge Code |
900912259
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$114.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.88
|
| Rate for Payer: Blue Distinction Transplant |
$40.20
|
| Rate for Payer: Blue Shield of California Commercial |
$41.41
|
| Rate for Payer: Blue Shield of California EPN |
$32.56
|
| Rate for Payer: Caremore Medicare Advantage |
$18.09
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Central Health Plan Commercial |
$53.60
|
| Rate for Payer: Cigna of CA HMO |
$42.88
|
| Rate for Payer: Cigna of CA PPO |
$49.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.14
|
| Rate for Payer: Dignity Health Media |
$18.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.09
|
| Rate for Payer: Galaxy Health WC |
$56.95
|
| Rate for Payer: Global Benefits Group Commercial |
$40.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$50.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.09
|
| Rate for Payer: InnovAge PACE Commercial |
$27.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.24
|
| Rate for Payer: Multiplan Commercial |
$50.25
|
| Rate for Payer: Networks By Design Commercial |
$43.55
|
| Rate for Payer: Prime Health Services Commercial |
$56.95
|
| Rate for Payer: Prime Health Services Medicare |
$19.18
|
| Rate for Payer: Riverside University Health System MISP |
$19.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.65
|
| Rate for Payer: United Healthcare All Other HMO |
$14.65
|
| Rate for Payer: United Healthcare HMO Rider |
$14.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.90
|
| Rate for Payer: Vantage Medical Group Senior |
$18.09
|
|
|
HC COVID19 RNA STAT
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913689
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Adventist Health Medi-Cal |
$51.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$262.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$320.15
|
| Rate for Payer: Blue Distinction Transplant |
$69.00
|
| Rate for Payer: Blue Shield of California Commercial |
$71.07
|
| Rate for Payer: Blue Shield of California EPN |
$55.89
|
| Rate for Payer: Caremore Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Central Health Plan Commercial |
$92.00
|
| Rate for Payer: Cigna of CA HMO |
$73.60
|
| Rate for Payer: Cigna of CA PPO |
$85.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.96
|
| Rate for Payer: Dignity Health Media |
$51.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$51.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.31
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$86.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$84.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$84.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: InnovAge PACE Commercial |
$76.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.76
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
| Rate for Payer: Prime Health Services Medicare |
$54.39
|
| Rate for Payer: Riverside University Health System MISP |
$56.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.56
|
| Rate for Payer: United Healthcare All Other HMO |
$41.56
|
| Rate for Payer: United Healthcare HMO Rider |
$41.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HC COVID19 RNA STAT
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913689
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Cash Price |
$72.45
|
| Rate for Payer: Central Health Plan Commercial |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.40
|
| Rate for Payer: Galaxy Health WC |
$136.85
|
| Rate for Payer: Global Benefits Group Commercial |
$96.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.20
|
| Rate for Payer: Multiplan Commercial |
$120.75
|
| Rate for Payer: Networks By Design Commercial |
$104.65
|
| Rate for Payer: Prime Health Services Commercial |
$136.85
|
|
|
HC CPAP/BIPAP/NIPPV - DAILY
|
Facility
|
IP
|
$5,030.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
900800110
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,006.00 |
| Max. Negotiated Rate |
$4,527.00 |
| Rate for Payer: Cash Price |
$2,263.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,024.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,012.00
|
| Rate for Payer: Galaxy Health WC |
$4,275.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,018.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,527.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,355.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,916.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,006.00
|
| Rate for Payer: Multiplan Commercial |
$3,772.50
|
| Rate for Payer: Networks By Design Commercial |
$3,269.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,275.50
|
|
|
HC CPAP/BIPAP/NIPPV - DAILY
|
Facility
|
OP
|
$5,030.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
900800110
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$77.52 |
| Max. Negotiated Rate |
$4,527.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$266.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$209.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$266.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$378.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,018.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$266.49
|
| Rate for Payer: Cash Price |
$2,263.50
|
| Rate for Payer: Cash Price |
$2,263.50
|
| Rate for Payer: Cash Price |
$2,263.50
|
| Rate for Payer: Cash Price |
$2,263.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,024.00
|
| Rate for Payer: Cigna of CA HMO |
$3,219.20
|
| Rate for Payer: Cigna of CA PPO |
$3,722.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.74
|
| Rate for Payer: Dignity Health Media |
$266.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$359.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$266.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$266.49
|
| Rate for Payer: Galaxy Health WC |
$4,275.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,018.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,527.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,772.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$437.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$439.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$266.49
|
| Rate for Payer: InnovAge PACE Commercial |
$399.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,355.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,006.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$357.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$357.10
|
| Rate for Payer: Multiplan Commercial |
$3,772.50
|
| Rate for Payer: Networks By Design Commercial |
$3,269.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,275.50
|
| Rate for Payer: Prime Health Services Medicare |
$282.48
|
| Rate for Payer: Riverside University Health System MISP |
$293.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,018.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,018.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Vantage Medical Group Senior |
$266.49
|
|
|
HC C PARAPSILOSIS NAT
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
900912493
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Central Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.60
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.80
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
| Rate for Payer: Networks By Design Commercial |
$70.85
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
|
|
HC C PARAPSILOSIS NAT
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
900912493
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$301.33 |
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.33
|
| Rate for Payer: Blue Distinction Transplant |
$46.80
|
| Rate for Payer: Blue Shield of California Commercial |
$48.20
|
| Rate for Payer: Blue Shield of California EPN |
$37.91
|
| Rate for Payer: Caremore Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Central Health Plan Commercial |
$62.40
|
| Rate for Payer: Cigna of CA HMO |
$49.92
|
| Rate for Payer: Cigna of CA PPO |
$57.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Media |
$35.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$58.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: InnovAge PACE Commercial |
$52.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: Networks By Design Commercial |
$50.70
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC CPM DORSAL SPLINT
|
Facility
|
OP
|
$217.00
|
|
| Hospital Charge Code |
901301036
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$75.95 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$131.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$119.35
|
| 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 |
$130.20
|
| 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 |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: Cigna of CA HMO |
$138.88
|
| Rate for Payer: Cigna of CA PPO |
$160.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$184.45
|
| Rate for Payer: Dignity Health Media |
$184.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$184.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$162.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$75.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.97
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: Riverside University Health System MISP |
$86.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.20
|
| 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 |
$184.45
|
| Rate for Payer: Vantage Medical Group Senior |
$184.45
|
|
|
HC CPM DORSAL SPLINT
|
Facility
|
IP
|
$217.00
|
|
| Hospital Charge Code |
901301036
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.40
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
|
|
HC CR51 SOD CHROMATE TO 250 UCI
|
Facility
|
IP
|
$2,771.00
|
|
|
Service Code
|
CPT A9553
|
| Hospital Charge Code |
909301525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$554.20 |
| Max. Negotiated Rate |
$2,493.90 |
| Rate for Payer: Blue Shield of California Commercial |
$2,078.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,479.71
|
| Rate for Payer: Cash Price |
$1,246.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,216.80
|
| Rate for Payer: Cigna of CA HMO |
$1,939.70
|
| Rate for Payer: Cigna of CA PPO |
$1,939.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,108.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,108.40
|
| Rate for Payer: Galaxy Health WC |
$2,355.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,662.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,493.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,848.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,055.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.20
|
| Rate for Payer: Multiplan Commercial |
$2,078.25
|
| Rate for Payer: Networks By Design Commercial |
$1,385.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,355.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,046.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1,021.94
|
| Rate for Payer: United Healthcare HMO Rider |
$999.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$914.43
|
|
|
HC CR51 SOD CHROMATE TO 250 UCI
|
Facility
|
OP
|
$2,771.00
|
|
|
Service Code
|
CPT A9553
|
| Hospital Charge Code |
909301525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$319.28 |
| Max. Negotiated Rate |
$2,493.90 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,355.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,524.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,524.05
|
| Rate for Payer: Blue Distinction Transplant |
$1,662.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,742.96
|
| Rate for Payer: Blue Shield of California EPN |
$1,355.02
|
| Rate for Payer: Cash Price |
$1,246.95
|
| Rate for Payer: Cash Price |
$1,246.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,216.80
|
| Rate for Payer: Cigna of CA HMO |
$1,939.70
|
| Rate for Payer: Cigna of CA PPO |
$1,939.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,355.35
|
| Rate for Payer: Dignity Health Media |
$2,355.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,355.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,108.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,108.40
|
| Rate for Payer: Galaxy Health WC |
$2,355.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,662.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,493.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,078.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$969.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,848.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.20
|
| Rate for Payer: Multiplan Commercial |
$2,078.25
|
| Rate for Payer: Networks By Design Commercial |
$1,385.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,355.35
|
| Rate for Payer: Riverside University Health System MISP |
$1,108.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,662.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,662.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,385.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,385.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,385.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,385.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,355.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,355.35
|
|
|
HC CRANIAL CERVICAL ORTHOSIS
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
CPT L0112
|
| Hospital Charge Code |
905350112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$770.00 |
| Max. Negotiated Rate |
$1,980.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,870.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,210.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,210.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,065.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,299.76
|
| Rate for Payer: Blue Distinction Transplant |
$1,320.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,650.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,196.80
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,760.00
|
| Rate for Payer: Cigna of CA HMO |
$1,540.00
|
| Rate for Payer: Cigna of CA PPO |
$1,540.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,870.00
|
| Rate for Payer: Dignity Health Media |
$1,870.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,870.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$880.00
|
| Rate for Payer: Galaxy Health WC |
$1,870.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,980.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,650.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$770.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,467.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$902.00
|
| Rate for Payer: Multiplan Commercial |
$1,650.00
|
| Rate for Payer: Networks By Design Commercial |
$1,100.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.00
|
| Rate for Payer: Riverside University Health System MISP |
$880.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,320.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,320.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,100.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,100.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,100.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,100.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,870.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,870.00
|
|
|
HC CRANIAL CERVICAL ORTHOSIS
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
CPT L0112
|
| Hospital Charge Code |
905350112
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$1,980.00 |
| Rate for Payer: Blue Shield of California EPN |
$1,174.80
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,760.00
|
| Rate for Payer: Cigna of CA HMO |
$1,540.00
|
| Rate for Payer: Cigna of CA PPO |
$1,540.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$880.00
|
| Rate for Payer: Galaxy Health WC |
$1,870.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,980.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,467.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.00
|
| Rate for Payer: Multiplan Commercial |
$1,650.00
|
| Rate for Payer: Networks By Design Commercial |
$1,100.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$830.72
|
| Rate for Payer: United Healthcare All Other HMO |
$811.36
|
| Rate for Payer: United Healthcare HMO Rider |
$793.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$726.00
|
|
|
HC CRANIAL CERVICAL TORTICOLLIS ORTHOSIS PREFAB
|
Facility
|
OP
|
$794.73
|
|
|
Service Code
|
CPT L0113
|
| Hospital Charge Code |
905350113
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$278.16 |
| Max. Negotiated Rate |
$715.26 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$675.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$437.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$437.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$384.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$469.53
|
| Rate for Payer: Blue Distinction Transplant |
$476.84
|
| Rate for Payer: Blue Shield of California Commercial |
$596.05
|
| Rate for Payer: Blue Shield of California EPN |
$432.33
|
| Rate for Payer: Cash Price |
$357.63
|
| Rate for Payer: Cash Price |
$357.63
|
| Rate for Payer: Central Health Plan Commercial |
$635.78
|
| Rate for Payer: Cigna of CA HMO |
$556.31
|
| Rate for Payer: Cigna of CA PPO |
$556.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$675.52
|
| Rate for Payer: Dignity Health Media |
$675.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$675.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$317.89
|
| Rate for Payer: Galaxy Health WC |
$675.52
|
| Rate for Payer: Global Benefits Group Commercial |
$476.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.26
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$596.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$278.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$383.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.84
|
| Rate for Payer: Multiplan Commercial |
$596.05
|
| Rate for Payer: Networks By Design Commercial |
$397.36
|
| Rate for Payer: Prime Health Services Commercial |
$675.52
|
| Rate for Payer: Riverside University Health System MISP |
$317.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$476.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$476.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$397.36
|
| Rate for Payer: United Healthcare All Other HMO |
$397.36
|
| Rate for Payer: United Healthcare HMO Rider |
$397.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$397.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$675.52
|
| Rate for Payer: Vantage Medical Group Senior |
$675.52
|
|
|
HC CRANIAL CERVICAL TORTICOLLIS ORTHOSIS PREFAB
|
Facility
|
IP
|
$794.73
|
|
|
Service Code
|
CPT L0113
|
| Hospital Charge Code |
905350113
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$158.95 |
| Max. Negotiated Rate |
$715.26 |
| Rate for Payer: Blue Shield of California EPN |
$424.39
|
| Rate for Payer: Cash Price |
$357.63
|
| Rate for Payer: Central Health Plan Commercial |
$635.78
|
| Rate for Payer: Cigna of CA HMO |
$556.31
|
| Rate for Payer: Cigna of CA PPO |
$556.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$317.89
|
| Rate for Payer: Galaxy Health WC |
$675.52
|
| Rate for Payer: Global Benefits Group Commercial |
$476.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.95
|
| Rate for Payer: Multiplan Commercial |
$596.05
|
| Rate for Payer: Networks By Design Commercial |
$397.36
|
| Rate for Payer: Prime Health Services Commercial |
$675.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$300.09
|
| Rate for Payer: United Healthcare All Other HMO |
$293.10
|
| Rate for Payer: United Healthcare HMO Rider |
$286.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.26
|
|
|
HC CRANIAL REMOLDING ORTHOSIS
|
Facility
|
IP
|
$5,184.00
|
|
|
Service Code
|
CPT S1040
|
| Hospital Charge Code |
905368475
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,036.80 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Blue Shield of California EPN |
$2,768.26
|
| Rate for Payer: Cash Price |
$2,332.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,147.20
|
| Rate for Payer: Cigna of CA HMO |
$3,628.80
|
| Rate for Payer: Cigna of CA PPO |
$3,628.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,073.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,073.60
|
| Rate for Payer: Galaxy Health WC |
$4,406.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,665.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,457.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,975.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,036.80
|
| Rate for Payer: Multiplan Commercial |
$3,888.00
|
| Rate for Payer: Networks By Design Commercial |
$2,592.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,406.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,957.48
|
| Rate for Payer: United Healthcare All Other HMO |
$1,911.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1,870.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,710.72
|
|
|
HC CRANIAL REMOLDING ORTHOSIS
|
Facility
|
OP
|
$5,184.00
|
|
|
Service Code
|
CPT S1040
|
| Hospital Charge Code |
905368475
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,814.40 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,406.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,851.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,851.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,510.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,062.71
|
| Rate for Payer: Blue Distinction Transplant |
$3,110.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,888.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,820.10
|
| Rate for Payer: Cash Price |
$2,332.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,147.20
|
| Rate for Payer: Cigna of CA HMO |
$3,628.80
|
| Rate for Payer: Cigna of CA PPO |
$3,628.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,406.40
|
| Rate for Payer: Dignity Health Media |
$4,406.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,406.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,073.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,073.60
|
| Rate for Payer: Galaxy Health WC |
$4,406.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,665.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,888.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,814.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,457.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,125.44
|
| Rate for Payer: Multiplan Commercial |
$3,888.00
|
| Rate for Payer: Networks By Design Commercial |
$2,592.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,406.40
|
| Rate for Payer: Riverside University Health System MISP |
$2,073.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,592.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,592.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,592.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,406.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4,406.40
|
|
|
HC C-REACTIVE PROTEIN
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
900910887
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.88
|
| Rate for Payer: Blue Distinction Transplant |
$10.80
|
| Rate for Payer: Blue Shield of California Commercial |
$11.12
|
| Rate for Payer: Blue Shield of California EPN |
$8.75
|
| Rate for Payer: Caremore Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Media |
$5.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: InnovAge PACE Commercial |
$7.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Medicare |
$5.49
|
| Rate for Payer: Riverside University Health System MISP |
$5.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC C-REACTIVE PROTEIN
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
900910887
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Central Health Plan Commercial |
$152.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.00
|
| Rate for Payer: Galaxy Health WC |
$161.50
|
| Rate for Payer: Global Benefits Group Commercial |
$114.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Multiplan Commercial |
$142.50
|
| Rate for Payer: Networks By Design Commercial |
$123.50
|
| Rate for Payer: Prime Health Services Commercial |
$161.50
|
|
|
HC C-REACTIVE PROTEIN HI SENSITIVITY
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
900912102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Central Health Plan Commercial |
$214.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.60
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
|
|
HC C-REACTIVE PROTEIN HI SENSITIVITY
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
900912102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$114.82 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.82
|
| Rate for Payer: Blue Distinction Transplant |
$21.60
|
| Rate for Payer: Blue Shield of California Commercial |
$22.25
|
| Rate for Payer: Blue Shield of California EPN |
$17.50
|
| Rate for Payer: Caremore Medicare Advantage |
$12.95
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.42
|
| Rate for Payer: Dignity Health Media |
$12.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.95
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.95
|
| Rate for Payer: InnovAge PACE Commercial |
$19.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.35
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Medicare |
$13.73
|
| Rate for Payer: Riverside University Health System MISP |
$14.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.49
|
| Rate for Payer: United Healthcare All Other HMO |
$10.49
|
| Rate for Payer: United Healthcare HMO Rider |
$10.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Vantage Medical Group Senior |
$12.95
|
|
|
HC CREAM WOUND CARE ATRACTAIN 2OZ
|
Facility
|
OP
|
$27.55
|
|
| Hospital Charge Code |
901606201
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$24.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.28
|
| Rate for Payer: Blue Distinction Transplant |
$16.53
|
| Rate for Payer: Blue Shield of California Commercial |
$17.33
|
| Rate for Payer: Blue Shield of California EPN |
$13.47
|
| Rate for Payer: Cash Price |
$12.40
|
| Rate for Payer: Central Health Plan Commercial |
$22.04
|
| Rate for Payer: Cigna of CA HMO |
$17.63
|
| Rate for Payer: Cigna of CA PPO |
$20.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.42
|
| Rate for Payer: Dignity Health Media |
$23.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.02
|
| Rate for Payer: Galaxy Health WC |
$23.42
|
| Rate for Payer: Global Benefits Group Commercial |
$16.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$20.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.51
|
| Rate for Payer: Multiplan Commercial |
$20.66
|
| Rate for Payer: Networks By Design Commercial |
$17.91
|
| Rate for Payer: Prime Health Services Commercial |
$23.42
|
| Rate for Payer: Riverside University Health System MISP |
$11.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.78
|
| Rate for Payer: United Healthcare All Other HMO |
$13.78
|
| Rate for Payer: United Healthcare HMO Rider |
$13.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.42
|
| Rate for Payer: Vantage Medical Group Senior |
$23.42
|
|
