|
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 |
$20.83 |
| Max. Negotiated Rate |
$1,452.60 |
| Rate for Payer: Adventist Health Commercial |
$322.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$980.18
|
| 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 |
$20.83
|
| Rate for Payer: Blue Shield of California Commercial |
$979.70
|
| 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: 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: InnovAge PACE Commercial |
$807.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,076.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$999.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,129.80
|
| Rate for Payer: Molina Healthcare of CA 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
|
OP
|
$105.26
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
900910844
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$94.73 |
| Rate for Payer: Adventist Health Commercial |
$21.05
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.92
|
| 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 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 HMO/PPO |
$18.57
|
| Rate for Payer: Blue Shield of California Commercial |
$63.89
|
| Rate for Payer: Blue Shield of California EPN |
$41.79
|
| Rate for Payer: Cash Price |
$47.37
|
| Rate for Payer: Cash Price |
$47.37
|
| Rate for Payer: Central Health Plan Commercial |
$84.21
|
| Rate for Payer: Cigna of CA HMO |
$67.37
|
| Rate for Payer: Cigna of CA PPO |
$77.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.98
|
| Rate for Payer: EPIC Health Plan Senior |
$12.58
|
| Rate for Payer: Galaxy Health WC |
$89.47
|
| Rate for Payer: Global Benefits Group Commercial |
$63.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.73
|
| 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) Medicare Advantage |
$12.58
|
| Rate for Payer: InnovAge PACE Commercial |
$18.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.86
|
| Rate for Payer: Multiplan Commercial |
$78.94
|
| Rate for Payer: Networks By Design Commercial |
$68.42
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.58
|
| Rate for Payer: Prime Health Services Commercial |
$89.47
|
| Rate for Payer: Prime Health Services Medicare |
$13.33
|
| Rate for Payer: Riverside University Health System MISP |
$13.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.16
|
| 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 HMO Rider |
$10.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.19
|
| 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 Medi-Cal |
$13.84
|
| Rate for Payer: Vantage Medical Group Senior |
$12.58
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$2,974.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,699.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,760.74
|
| 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 |
$2,708.56
|
| 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 |
$2,619.36
|
| Rate for Payer: Blue Shield of California Commercial |
$2,725.06
|
| Rate for Payer: Blue Shield of California EPN |
$1,779.54
|
| 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: 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: InnovAge PACE Commercial |
$2,230.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,974.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,760.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,122.00
|
| Rate for Payer: Molina Healthcare of CA 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: United Healthcare All Other Commercial |
$2,230.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,230.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,230.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,230.00
|
| 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 |
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: 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 Permanente of CA Commercial/Self Funded |
$2,974.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,699.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,760.74
|
| 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 |
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 |
$2,708.56
|
| 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 |
$2,619.36
|
| Rate for Payer: Blue Shield of California Commercial |
$2,725.06
|
| Rate for Payer: Blue Shield of California EPN |
$1,779.54
|
| 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: 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: InnovAge PACE Commercial |
$2,230.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,974.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,760.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,122.00
|
| Rate for Payer: Molina Healthcare of CA 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: United Healthcare All Other Commercial |
$2,230.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,230.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,230.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,230.00
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$444.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$412.25
|
| 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 |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$555.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$404.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$406.93
|
| 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: 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 |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| 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 |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: InnovAge PACE Commercial |
$833.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$444.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$744.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| 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 |
$555.48
|
| Rate for Payer: Prime Health Services Commercial |
$566.10
|
| Rate for Payer: Prime Health Services Medicare |
$588.81
|
| Rate for Payer: Riverside University Health System MISP |
$611.03
|
| 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 |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$444.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$412.25
|
| 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 |
900904699
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$555.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$404.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$404.26
|
| 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 |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| 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 |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: InnovAge PACE Commercial |
$833.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$444.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$744.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| 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 |
$555.48
|
| Rate for Payer: Prime Health Services Commercial |
$566.10
|
| Rate for Payer: Prime Health Services Medicare |
$588.81
|
| Rate for Payer: Riverside University Health System MISP |
$611.03
|
| 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 |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
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 |
$247.40 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$247.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$555.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$751.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$755.81
|
| 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: 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 |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| 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 |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: InnovAge PACE Commercial |
$833.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$825.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$744.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| 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 |
$555.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,051.45
|
| Rate for Payer: Prime Health Services Medicare |
$588.81
|
| Rate for Payer: Riverside University Health System MISP |
$611.03
|
| 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 |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$825.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$471.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$765.70
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$905.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$517.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$839.98
|
| 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 |
$163.78 |
| Max. Negotiated Rate |
$1,221.30 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$824.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$254.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$796.97
|
| Rate for Payer: Blue Shield of California Commercial |
$823.70
|
| 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 |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| 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 |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$905.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$517.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| 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 |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$1,153.45
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| 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 |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC HAST W/02 TITRATE
|
Facility
|
IP
|
$1,275.00
|
|
|
Service Code
|
CPT 94453
|
| Hospital Charge Code |
900801035
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$1,147.50 |
| Rate for Payer: Adventist Health Commercial |
$255.00
|
| Rate for Payer: Cash Price |
$573.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,020.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$510.00
|
| Rate for Payer: EPIC Health Plan Senior |
$510.00
|
| Rate for Payer: Galaxy Health WC |
$1,083.75
|
| Rate for Payer: Global Benefits Group Commercial |
$765.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,147.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$850.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$485.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$789.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.00
|
| Rate for Payer: Multiplan Commercial |
$956.25
|
| Rate for Payer: Networks By Design Commercial |
$828.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,083.75
|
|
|
HC HAST W/02 TITRATE
|
Facility
|
OP
|
$1,275.00
|
|
|
Service Code
|
CPT 94453
|
| Hospital Charge Code |
900801035
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$163.78 |
| Max. Negotiated Rate |
$1,147.50 |
| Rate for Payer: Adventist Health Commercial |
$255.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$774.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$382.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$748.81
|
| Rate for Payer: Blue Shield of California Commercial |
$773.92
|
| Rate for Payer: Blue Shield of California EPN |
$506.18
|
| Rate for Payer: Cash Price |
$573.75
|
| Rate for Payer: Cash Price |
$573.75
|
| Rate for Payer: Cash Price |
$573.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,020.00
|
| Rate for Payer: Cigna of CA HMO |
$816.00
|
| Rate for Payer: Cigna of CA PPO |
$943.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$1,083.75
|
| Rate for Payer: Global Benefits Group Commercial |
$765.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,147.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$850.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$485.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$956.25
|
| Rate for Payer: Networks By Design Commercial |
$828.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$1,083.75
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$765.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$765.00
|
| 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 |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC HCV RNA QUANT
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
900913610
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$128.60 |
| Max. Negotiated Rate |
$578.70 |
| Rate for Payer: Adventist Health Commercial |
$128.60
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Central Health Plan Commercial |
$514.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.20
|
| Rate for Payer: EPIC Health Plan Senior |
$257.20
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$578.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$428.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$398.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.60
|
| Rate for Payer: Multiplan Commercial |
$482.25
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
|
|
HC HCV RNA QUANT
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
900913610
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$137.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.20
|
| Rate for Payer: Blue Shield of California Commercial |
$137.18
|
| Rate for Payer: Blue Shield of California EPN |
$89.72
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Central Health Plan Commercial |
$180.80
|
| Rate for Payer: Cigna of CA HMO |
$144.64
|
| Rate for Payer: Cigna of CA PPO |
$167.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.83
|
| Rate for Payer: EPIC Health Plan Senior |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$192.10
|
| Rate for Payer: Global Benefits Group Commercial |
$135.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$203.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$54.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: InnovAge PACE Commercial |
$64.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$169.50
|
| Rate for Payer: Networks By Design Commercial |
$146.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$192.10
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Riverside University Health System MISP |
$47.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC HCV RNA QUANT PCR TEST
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
900913694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$188.22 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.20
|
| Rate for Payer: Blue Shield of California Commercial |
$84.98
|
| Rate for Payer: Blue Shield of California EPN |
$55.58
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Central Health Plan Commercial |
$112.00
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$103.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.83
|
| Rate for Payer: EPIC Health Plan Senior |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$54.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: InnovAge PACE Commercial |
$64.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Riverside University Health System MISP |
$47.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC HCV RNA QUANT PCR TEST
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
900913694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Central Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
|
|
HC HD ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
IP
|
$3,193.00
|
|
|
Service Code
|
CPT L5960
|
| Hospital Charge Code |
905355960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$638.60 |
| Max. Negotiated Rate |
$2,873.70 |
| Rate for Payer: Adventist Health Commercial |
$638.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,468.19
|
| Rate for Payer: Blue Shield of California EPN |
$1,609.27
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,554.40
|
| Rate for Payer: Cigna of CA HMO |
$2,235.10
|
| Rate for Payer: Cigna of CA PPO |
$2,235.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,277.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,277.20
|
| Rate for Payer: Galaxy Health WC |
$2,714.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,873.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,129.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,216.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,976.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$638.60
|
| Rate for Payer: Multiplan Commercial |
$2,394.75
|
| Rate for Payer: Networks By Design Commercial |
$2,075.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,714.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,198.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1,166.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1,141.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,045.71
|
|
|
HC HD ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
OP
|
$3,193.00
|
|
|
Service Code
|
CPT L5960
|
| Hospital Charge Code |
905355960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$966.98 |
| Max. Negotiated Rate |
$2,873.70 |
| Rate for Payer: Adventist Health Commercial |
$1,309.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,714.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,756.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,394.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,875.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,468.19
|
| Rate for Payer: Blue Shield of California EPN |
$1,609.27
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,554.40
|
| Rate for Payer: Cigna of CA HMO |
$2,235.10
|
| Rate for Payer: Cigna of CA PPO |
$2,235.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,714.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,714.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,277.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,277.20
|
| Rate for Payer: Galaxy Health WC |
$2,714.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,873.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$966.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,596.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,129.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,068.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,976.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,309.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,235.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,235.10
|
| Rate for Payer: Multiplan Commercial |
$2,394.75
|
| Rate for Payer: Networks By Design Commercial |
$1,596.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,714.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,277.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,915.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,915.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,198.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1,166.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1,141.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,045.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,714.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,714.05
|
|
|
HC HD ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
IP
|
$3,193.00
|
|
|
Service Code
|
CPT L5960
|
| Hospital Charge Code |
915355960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$638.60 |
| Max. Negotiated Rate |
$2,873.70 |
| Rate for Payer: Adventist Health Commercial |
$638.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,468.19
|
| Rate for Payer: Blue Shield of California EPN |
$1,609.27
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,554.40
|
| Rate for Payer: Cigna of CA HMO |
$2,235.10
|
| Rate for Payer: Cigna of CA PPO |
$2,235.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,277.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,277.20
|
| Rate for Payer: Galaxy Health WC |
$2,714.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,873.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,129.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,216.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,976.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$638.60
|
| Rate for Payer: Multiplan Commercial |
$2,394.75
|
| Rate for Payer: Networks By Design Commercial |
$2,075.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,714.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,198.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1,166.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1,141.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,045.71
|
|
|
HC HD ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
OP
|
$3,193.00
|
|
|
Service Code
|
CPT L5960
|
| Hospital Charge Code |
915355960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$966.98 |
| Max. Negotiated Rate |
$2,873.70 |
| Rate for Payer: Adventist Health Commercial |
$1,309.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,714.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,756.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,394.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,875.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,468.19
|
| Rate for Payer: Blue Shield of California EPN |
$1,609.27
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,554.40
|
| Rate for Payer: Cigna of CA HMO |
$2,235.10
|
| Rate for Payer: Cigna of CA PPO |
$2,235.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,714.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,714.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,277.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,277.20
|
| Rate for Payer: Galaxy Health WC |
$2,714.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,873.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$966.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,596.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,129.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,068.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,976.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,309.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,235.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,235.10
|
| Rate for Payer: Multiplan Commercial |
$2,394.75
|
| Rate for Payer: Networks By Design Commercial |
$1,596.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,714.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,277.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,915.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,915.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,198.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1,166.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1,141.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,045.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,714.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,714.05
|
|
