|
HC HAND LIMITED 2 VIEWS
|
Facility
|
OP
|
$1,076.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
909001518
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$968.40 |
| Rate for Payer: Adventist Health Commercial |
$215.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.72
|
| Rate for Payer: Blue Shield of California Commercial |
$677.88
|
| Rate for Payer: Blue Shield of California EPN |
$427.17
|
| Rate for Payer: Cash Price |
$484.20
|
| Rate for Payer: Cash Price |
$484.20
|
| Rate for Payer: Central Health Plan Commercial |
$860.80
|
| Rate for Payer: Cigna of CA HMO |
$688.64
|
| Rate for Payer: Cigna of CA PPO |
$796.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$753.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$914.60
|
| Rate for Payer: Global Benefits Group Commercial |
$645.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$968.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$683.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$807.00
|
| Rate for Payer: Networks By Design Commercial |
$699.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$914.60
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$645.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$645.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC HAND MUSCLE TESTING MANUAL MCAL
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
900400010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$111.08 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$125.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$185.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$168.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$138.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Central Health Plan Commercial |
$244.80
|
| Rate for Payer: Cigna of CA HMO |
$195.84
|
| Rate for Payer: Cigna of CA PPO |
$226.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$260.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$214.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.40
|
| Rate for Payer: EPIC Health Plan Senior |
$122.40
|
| Rate for Payer: Galaxy Health WC |
$260.10
|
| Rate for Payer: Global Benefits Group Commercial |
$183.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$275.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$194.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$180.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.20
|
| Rate for Payer: Multiplan Commercial |
$229.50
|
| Rate for Payer: Networks By Design Commercial |
$198.90
|
| Rate for Payer: Prime Health Services Commercial |
$260.10
|
| Rate for Payer: Riverside University Health System MISP |
$122.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$183.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$183.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$260.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$260.10
|
| Rate for Payer: Vantage Medical Group Senior |
$260.10
|
|
|
HC HAND MUSCLE TESTING MANUAL MCAL
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
901300025
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Adventist Health Commercial |
$61.20
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Central Health Plan Commercial |
$244.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$214.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.40
|
| Rate for Payer: EPIC Health Plan Senior |
$122.40
|
| Rate for Payer: Galaxy Health WC |
$260.10
|
| Rate for Payer: Global Benefits Group Commercial |
$183.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$275.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$194.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$180.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$229.50
|
| Rate for Payer: Networks By Design Commercial |
$198.90
|
| Rate for Payer: Prime Health Services Commercial |
$260.10
|
|
|
HC HAND MUSCLE TESTING MANUAL MCAL
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
900400010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Adventist Health Commercial |
$61.20
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Central Health Plan Commercial |
$244.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$214.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.40
|
| Rate for Payer: EPIC Health Plan Senior |
$122.40
|
| Rate for Payer: Galaxy Health WC |
$260.10
|
| Rate for Payer: Global Benefits Group Commercial |
$183.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$275.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$194.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$180.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$229.50
|
| Rate for Payer: Networks By Design Commercial |
$198.90
|
| Rate for Payer: Prime Health Services Commercial |
$260.10
|
|
|
HC HAND MUSCLE TESTING MANUAL MCAL
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
901300025
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$111.08 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$125.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$185.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$168.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$138.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Central Health Plan Commercial |
$244.80
|
| Rate for Payer: Cigna of CA HMO |
$195.84
|
| Rate for Payer: Cigna of CA PPO |
$226.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$260.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$214.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.40
|
| Rate for Payer: EPIC Health Plan Senior |
$122.40
|
| Rate for Payer: Galaxy Health WC |
$260.10
|
| Rate for Payer: Global Benefits Group Commercial |
$183.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$275.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$194.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$180.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.20
|
| Rate for Payer: Multiplan Commercial |
$229.50
|
| Rate for Payer: Networks By Design Commercial |
$198.90
|
| Rate for Payer: Prime Health Services Commercial |
$260.10
|
| Rate for Payer: Riverside University Health System MISP |
$122.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$183.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$183.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$260.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$260.10
|
| Rate for Payer: Vantage Medical Group Senior |
$260.10
|
|
|
HC HAND MUSCLE TESTING MANUAL PT
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
905103403
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Adventist Health Commercial |
$61.20
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Central Health Plan Commercial |
$244.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$214.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.40
|
| Rate for Payer: EPIC Health Plan Senior |
$122.40
|
| Rate for Payer: Galaxy Health WC |
$260.10
|
| Rate for Payer: Global Benefits Group Commercial |
$183.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$275.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$194.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$180.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$229.50
|
| Rate for Payer: Networks By Design Commercial |
$198.90
|
| Rate for Payer: Prime Health Services Commercial |
$260.10
|
|
|
HC HAND MUSCLE TESTING MANUAL PT
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
905103403
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$111.08 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$125.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$185.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$168.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$138.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Central Health Plan Commercial |
$244.80
|
| Rate for Payer: Cigna of CA HMO |
$195.84
|
| Rate for Payer: Cigna of CA PPO |
$226.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$260.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$214.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.40
|
| Rate for Payer: EPIC Health Plan Senior |
$122.40
|
| Rate for Payer: Galaxy Health WC |
$260.10
|
| Rate for Payer: Global Benefits Group Commercial |
$183.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$275.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$194.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$180.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.20
|
| Rate for Payer: Multiplan Commercial |
$229.50
|
| Rate for Payer: Networks By Design Commercial |
$198.90
|
| Rate for Payer: Prime Health Services Commercial |
$260.10
|
| Rate for Payer: Riverside University Health System MISP |
$122.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$183.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$183.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$260.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$260.10
|
| Rate for Payer: Vantage Medical Group Senior |
$260.10
|
|
|
HC HAND MUSCLE TESTING MANUAL PT
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
900419058
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$111.08 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$125.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$185.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$168.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$138.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Central Health Plan Commercial |
$244.80
|
| Rate for Payer: Cigna of CA HMO |
$195.84
|
| Rate for Payer: Cigna of CA PPO |
$226.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$260.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$214.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.40
|
| Rate for Payer: EPIC Health Plan Senior |
$122.40
|
| Rate for Payer: Galaxy Health WC |
$260.10
|
| Rate for Payer: Global Benefits Group Commercial |
$183.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$275.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$194.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$180.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.20
|
| Rate for Payer: Multiplan Commercial |
$229.50
|
| Rate for Payer: Networks By Design Commercial |
$198.90
|
| Rate for Payer: Prime Health Services Commercial |
$260.10
|
| Rate for Payer: Riverside University Health System MISP |
$122.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$183.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$183.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$260.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$260.10
|
| Rate for Payer: Vantage Medical Group Senior |
$260.10
|
|
|
HC HAND MUSCLE TESTING MANUAL PT
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
900419058
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Adventist Health Commercial |
$61.20
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Central Health Plan Commercial |
$244.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$214.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.40
|
| Rate for Payer: EPIC Health Plan Senior |
$122.40
|
| Rate for Payer: Galaxy Health WC |
$260.10
|
| Rate for Payer: Global Benefits Group Commercial |
$183.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$275.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$194.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$180.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$229.50
|
| Rate for Payer: Networks By Design Commercial |
$198.90
|
| Rate for Payer: Prime Health Services Commercial |
$260.10
|
|
|
HC HAND WRIST BOTH 1 VIEW
|
Facility
|
IP
|
$1,614.00
|
|
|
Service Code
|
CPT 73120 50
|
| Hospital Charge Code |
909073120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$322.80 |
| Max. Negotiated Rate |
$1,452.60 |
| Rate for Payer: Adventist Health Commercial |
$322.80
|
| Rate for Payer: Cash Price |
$726.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,291.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,129.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$645.60
|
| Rate for Payer: EPIC Health Plan Senior |
$645.60
|
| Rate for Payer: Galaxy Health WC |
$1,371.90
|
| Rate for Payer: Global Benefits Group Commercial |
$968.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,452.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,024.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$952.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.80
|
| Rate for Payer: Multiplan Commercial |
$1,210.50
|
| Rate for Payer: Networks By Design Commercial |
$1,049.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,371.90
|
|
|
HC HAND WRIST BOTH 1 VIEW
|
Facility
|
OP
|
$1,614.00
|
|
|
Service Code
|
CPT 73120 50
|
| Hospital Charge Code |
909073120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$1,452.60 |
| Rate for Payer: Adventist Health Commercial |
$322.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,371.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,210.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,016.82
|
| Rate for Payer: Blue Shield of California EPN |
$640.76
|
| Rate for Payer: Cash Price |
$726.30
|
| Rate for Payer: Cash Price |
$726.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,291.20
|
| Rate for Payer: Cigna of CA HMO |
$1,032.96
|
| Rate for Payer: Cigna of CA PPO |
$1,194.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,371.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,371.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,371.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,129.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$645.60
|
| Rate for Payer: EPIC Health Plan Senior |
$645.60
|
| Rate for Payer: Galaxy Health WC |
$1,371.90
|
| Rate for Payer: Global Benefits Group Commercial |
$968.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,452.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,024.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$952.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,129.80
|
| Rate for Payer: Multiplan Commercial |
$1,210.50
|
| Rate for Payer: Networks By Design Commercial |
$1,049.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,371.90
|
| Rate for Payer: Riverside University Health System MISP |
$645.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$968.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$968.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,371.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,371.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,371.90
|
|
|
HC HAPTOGLOBIN
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
900910844
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
|
|
HC HAPTOGLOBIN
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
900910844
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$127.19 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.58
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$92.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$92.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.19
|
| Rate for Payer: Blue Shield of California Commercial |
$132.30
|
| Rate for Payer: Blue Shield of California Commercial |
$66.15
|
| Rate for Payer: Blue Shield of California EPN |
$83.37
|
| Rate for Payer: Blue Shield of California EPN |
$41.69
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Central Health Plan Commercial |
$84.00
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Cigna of CA PPO |
$77.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.76
|
| Rate for Payer: EPIC Health Plan Senior |
$13.84
|
| Rate for Payer: EPIC Health Plan Senior |
$13.84
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.63
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.86
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.58
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.58
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
| Rate for Payer: Prime Health Services Medicare |
$13.33
|
| Rate for Payer: Prime Health Services Medicare |
$13.33
|
| Rate for Payer: Riverside University Health System MISP |
$13.84
|
| Rate for Payer: Riverside University Health System MISP |
$13.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.19
|
| Rate for Payer: United Healthcare All Other HMO |
$10.19
|
| Rate for Payer: United Healthcare All Other HMO |
$10.19
|
| Rate for Payer: United Healthcare HMO Rider |
$10.19
|
| Rate for Payer: United Healthcare HMO Rider |
$10.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.84
|
| Rate for Payer: Vantage Medical Group Senior |
$12.58
|
| Rate for Payer: Vantage Medical Group Senior |
$12.58
|
|
|
HC HARD PROTECT HELMET CUSTOM
|
Facility
|
IP
|
$4,460.00
|
|
|
Service Code
|
CPT A8003
|
| Hospital Charge Code |
915350101
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$892.00 |
| Max. Negotiated Rate |
$4,014.00 |
| Rate for Payer: Adventist Health Commercial |
$892.00
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,568.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,122.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,784.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,784.00
|
| Rate for Payer: Galaxy Health WC |
$3,791.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,676.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,014.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,832.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,631.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.00
|
| Rate for Payer: Multiplan Commercial |
$3,345.00
|
| Rate for Payer: Networks By Design Commercial |
$2,899.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,791.00
|
|
|
HC HARD PROTECT HELMET CUSTOM
|
Facility
|
OP
|
$4,460.00
|
|
|
Service Code
|
CPT A8003
|
| Hospital Charge Code |
905350101
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$892.00 |
| Max. Negotiated Rate |
$4,014.00 |
| Rate for Payer: Adventist Health Commercial |
$892.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,472.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,791.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,453.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,345.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,159.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,594.38
|
| Rate for Payer: Blue Shield of California Commercial |
$2,827.64
|
| Rate for Payer: Blue Shield of California EPN |
$1,779.54
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,568.00
|
| Rate for Payer: Cigna of CA HMO |
$2,854.40
|
| Rate for Payer: Cigna of CA PPO |
$3,300.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,791.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,791.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,791.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,122.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,784.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,784.00
|
| Rate for Payer: Galaxy Health WC |
$3,791.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,676.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,014.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,832.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,631.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,122.00
|
| Rate for Payer: Multiplan Commercial |
$3,345.00
|
| Rate for Payer: Networks By Design Commercial |
$2,899.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,791.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,784.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,676.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,791.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,791.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,791.00
|
|
|
HC HARD PROTECT HELMET CUSTOM
|
Facility
|
OP
|
$4,460.00
|
|
|
Service Code
|
CPT A8003
|
| Hospital Charge Code |
915350101
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$892.00 |
| Max. Negotiated Rate |
$4,014.00 |
| Rate for Payer: Adventist Health Commercial |
$892.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,472.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,791.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,453.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,345.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,159.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,594.38
|
| Rate for Payer: Blue Shield of California Commercial |
$2,827.64
|
| Rate for Payer: Blue Shield of California EPN |
$1,779.54
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,568.00
|
| Rate for Payer: Cigna of CA HMO |
$2,854.40
|
| Rate for Payer: Cigna of CA PPO |
$3,300.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,791.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,791.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,791.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,122.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,784.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,784.00
|
| Rate for Payer: Galaxy Health WC |
$3,791.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,676.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,014.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,832.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,631.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,122.00
|
| Rate for Payer: Multiplan Commercial |
$3,345.00
|
| Rate for Payer: Networks By Design Commercial |
$2,899.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,791.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,784.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,676.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,791.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,791.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,791.00
|
|
|
HC HARD PROTECT HELMET CUSTOM
|
Facility
|
IP
|
$4,460.00
|
|
|
Service Code
|
CPT A8003
|
| Hospital Charge Code |
905350101
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$892.00 |
| Max. Negotiated Rate |
$4,014.00 |
| Rate for Payer: Adventist Health Commercial |
$892.00
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,568.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,122.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,784.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,784.00
|
| Rate for Payer: Galaxy Health WC |
$3,791.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,676.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,014.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,832.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,631.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.00
|
| Rate for Payer: Multiplan Commercial |
$3,345.00
|
| Rate for Payer: Networks By Design Commercial |
$2,899.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,791.00
|
|
|
HC HARVEST THAW WO WASHING
|
Facility
|
OP
|
$666.00
|
|
|
Service Code
|
CPT 38208
|
| Hospital Charge Code |
900904699
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$567.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$172.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$419.58
|
| Rate for Payer: Blue Shield of California EPN |
$264.40
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Central Health Plan Commercial |
$532.80
|
| Rate for Payer: Cigna of CA HMO |
$426.24
|
| Rate for Payer: Cigna of CA PPO |
$492.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$466.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.24
|
| Rate for Payer: EPIC Health Plan Senior |
$624.16
|
| Rate for Payer: Galaxy Health WC |
$566.10
|
| Rate for Payer: Global Benefits Group Commercial |
$399.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$599.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$930.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$422.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$760.34
|
| Rate for Payer: Multiplan Commercial |
$499.50
|
| Rate for Payer: Networks By Design Commercial |
$432.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$567.42
|
| Rate for Payer: Prime Health Services Commercial |
$566.10
|
| Rate for Payer: Prime Health Services Medicare |
$601.47
|
| Rate for Payer: Riverside University Health System MISP |
$624.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$399.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$399.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$333.00
|
| Rate for Payer: United Healthcare All Other HMO |
$333.00
|
| Rate for Payer: United Healthcare HMO Rider |
$333.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$333.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$567.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC HARVEST THAW WO WASHING
|
Facility
|
IP
|
$666.00
|
|
|
Service Code
|
CPT 38208
|
| Hospital Charge Code |
900904699
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$599.40 |
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Central Health Plan Commercial |
$532.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$466.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.40
|
| Rate for Payer: EPIC Health Plan Senior |
$266.40
|
| Rate for Payer: Galaxy Health WC |
$566.10
|
| Rate for Payer: Global Benefits Group Commercial |
$399.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$599.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$422.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$392.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.20
|
| Rate for Payer: Multiplan Commercial |
$499.50
|
| Rate for Payer: Networks By Design Commercial |
$432.90
|
| Rate for Payer: Prime Health Services Commercial |
$566.10
|
|
|
HC HARVEST THAW WO WASHING
|
Facility
|
IP
|
$666.00
|
|
|
Service Code
|
CPT 38208
|
| Hospital Charge Code |
911800304
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$599.40 |
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Central Health Plan Commercial |
$532.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$466.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.40
|
| Rate for Payer: EPIC Health Plan Senior |
$266.40
|
| Rate for Payer: Galaxy Health WC |
$566.10
|
| Rate for Payer: Global Benefits Group Commercial |
$399.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$599.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$422.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$392.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.20
|
| Rate for Payer: Multiplan Commercial |
$499.50
|
| Rate for Payer: Networks By Design Commercial |
$432.90
|
| Rate for Payer: Prime Health Services Commercial |
$566.10
|
|
|
HC HARVEST THAW WO WASHING
|
Facility
|
OP
|
$666.00
|
|
|
Service Code
|
CPT 38208
|
| Hospital Charge Code |
911800304
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$567.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$172.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$422.24
|
| Rate for Payer: Blue Shield of California EPN |
$265.73
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Central Health Plan Commercial |
$532.80
|
| Rate for Payer: Cigna of CA HMO |
$426.24
|
| Rate for Payer: Cigna of CA PPO |
$492.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$466.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.24
|
| Rate for Payer: EPIC Health Plan Senior |
$624.16
|
| Rate for Payer: Galaxy Health WC |
$566.10
|
| Rate for Payer: Global Benefits Group Commercial |
$399.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$599.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$930.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$422.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$760.34
|
| Rate for Payer: Multiplan Commercial |
$499.50
|
| Rate for Payer: Networks By Design Commercial |
$432.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$567.42
|
| Rate for Payer: Prime Health Services Commercial |
$566.10
|
| Rate for Payer: Prime Health Services Medicare |
$601.47
|
| Rate for Payer: Riverside University Health System MISP |
$624.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$399.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$399.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$567.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC HARVEST THAW W/WASHING
|
Facility
|
OP
|
$1,237.00
|
|
|
Service Code
|
CPT 38209
|
| Hospital Charge Code |
911800305
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$74.43 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$247.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$567.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$784.26
|
| Rate for Payer: Blue Shield of California EPN |
$493.56
|
| Rate for Payer: Cash Price |
$556.65
|
| Rate for Payer: Cash Price |
$556.65
|
| Rate for Payer: Cash Price |
$556.65
|
| Rate for Payer: Cash Price |
$556.65
|
| Rate for Payer: Central Health Plan Commercial |
$989.60
|
| Rate for Payer: Cigna of CA HMO |
$791.68
|
| Rate for Payer: Cigna of CA PPO |
$915.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$865.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.24
|
| Rate for Payer: EPIC Health Plan Senior |
$624.16
|
| Rate for Payer: Galaxy Health WC |
$1,051.45
|
| Rate for Payer: Global Benefits Group Commercial |
$742.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,113.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$930.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$785.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$760.34
|
| Rate for Payer: Multiplan Commercial |
$927.75
|
| Rate for Payer: Networks By Design Commercial |
$804.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$567.42
|
| Rate for Payer: Prime Health Services Commercial |
$1,051.45
|
| Rate for Payer: Prime Health Services Medicare |
$601.47
|
| Rate for Payer: Riverside University Health System MISP |
$624.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$742.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$742.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$567.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC HARVEST THAW W/WASHING
|
Facility
|
IP
|
$1,237.00
|
|
|
Service Code
|
CPT 38209
|
| Hospital Charge Code |
911800305
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$247.40 |
| Max. Negotiated Rate |
$1,113.30 |
| Rate for Payer: Adventist Health Commercial |
$247.40
|
| Rate for Payer: Cash Price |
$556.65
|
| Rate for Payer: Central Health Plan Commercial |
$989.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$865.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$494.80
|
| Rate for Payer: EPIC Health Plan Senior |
$494.80
|
| Rate for Payer: Galaxy Health WC |
$1,051.45
|
| Rate for Payer: Global Benefits Group Commercial |
$742.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,113.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$785.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$729.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.40
|
| Rate for Payer: Multiplan Commercial |
$927.75
|
| Rate for Payer: Networks By Design Commercial |
$804.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,051.45
|
|
|
HC HAST
|
Facility
|
IP
|
$1,357.00
|
|
|
Service Code
|
CPT 94452
|
| Hospital Charge Code |
900801034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$271.40 |
| Max. Negotiated Rate |
$1,221.30 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,085.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$949.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$542.80
|
| Rate for Payer: EPIC Health Plan Senior |
$542.80
|
| Rate for Payer: Galaxy Health WC |
$1,153.45
|
| Rate for Payer: Global Benefits Group Commercial |
$814.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,221.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$861.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$800.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.40
|
| Rate for Payer: Multiplan Commercial |
$1,017.75
|
| Rate for Payer: Networks By Design Commercial |
$882.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,153.45
|
|
|
HC HAST
|
Facility
|
OP
|
$1,357.00
|
|
|
Service Code
|
CPT 94452
|
| Hospital Charge Code |
900801034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$171.12 |
| Max. Negotiated Rate |
$1,221.30 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$280.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$254.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$789.37
|
| Rate for Payer: Blue Shield of California Commercial |
$854.91
|
| Rate for Payer: Blue Shield of California EPN |
$538.73
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,085.60
|
| Rate for Payer: Cigna of CA HMO |
$868.48
|
| Rate for Payer: Cigna of CA PPO |
$1,004.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$949.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$1,153.45
|
| Rate for Payer: Global Benefits Group Commercial |
$814.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,221.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$861.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$492.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$1,017.75
|
| Rate for Payer: Networks By Design Commercial |
$882.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,153.45
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$814.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$814.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
