|
HC NEUROSTIM REMOVAL SENS LEAD
|
Facility
|
IP
|
$15,546.00
|
|
|
Service Code
|
CPT 0429T
|
| Hospital Charge Code |
906810429
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,109.20 |
| Max. Negotiated Rate |
$13,991.40 |
| Rate for Payer: Adventist Health Commercial |
$3,109.20
|
| Rate for Payer: Cash Price |
$6,995.70
|
| Rate for Payer: Central Health Plan Commercial |
$12,436.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,882.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,218.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,218.40
|
| Rate for Payer: Galaxy Health WC |
$13,214.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,327.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,991.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,871.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,172.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,109.20
|
| Rate for Payer: Multiplan Commercial |
$11,659.50
|
| Rate for Payer: Networks By Design Commercial |
$10,104.90
|
| Rate for Payer: Prime Health Services Commercial |
$13,214.10
|
|
|
HC NEUROSTIM REMOVAL SENS LEAD
|
Facility
|
OP
|
$15,546.00
|
|
|
Service Code
|
CPT 0429T
|
| Hospital Charge Code |
906810429
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,109.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,109.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,214.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,550.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,659.50
|
| 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 |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$6,995.70
|
| Rate for Payer: Cash Price |
$6,995.70
|
| Rate for Payer: Central Health Plan Commercial |
$12,436.80
|
| Rate for Payer: Cigna of CA HMO |
$9,949.44
|
| Rate for Payer: Cigna of CA PPO |
$11,504.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,214.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,214.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,214.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,882.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,218.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,218.40
|
| Rate for Payer: Galaxy Health WC |
$13,214.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,327.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,991.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,871.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,643.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,172.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,109.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,882.20
|
| Rate for Payer: Multiplan Commercial |
$11,659.50
|
| Rate for Payer: Networks By Design Commercial |
$10,104.90
|
| Rate for Payer: Prime Health Services Commercial |
$13,214.10
|
| Rate for Payer: Riverside University Health System MISP |
$6,218.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,327.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,773.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,214.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,214.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13,214.10
|
|
|
HC NEWBORN CAP LINER PADS
|
Facility
|
IP
|
$106.40
|
|
| Hospital Charge Code |
901608015
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$95.76 |
| Rate for Payer: Adventist Health Commercial |
$21.28
|
| Rate for Payer: Cash Price |
$47.88
|
| Rate for Payer: Central Health Plan Commercial |
$85.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.56
|
| Rate for Payer: EPIC Health Plan Senior |
$42.56
|
| Rate for Payer: Galaxy Health WC |
$90.44
|
| Rate for Payer: Global Benefits Group Commercial |
$63.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.28
|
| Rate for Payer: Multiplan Commercial |
$79.80
|
| Rate for Payer: Networks By Design Commercial |
$69.16
|
| Rate for Payer: Prime Health Services Commercial |
$90.44
|
|
|
HC NEWBORN CAP LINER PADS
|
Facility
|
OP
|
$106.40
|
|
| Hospital Charge Code |
901608015
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$95.76 |
| Rate for Payer: Adventist Health Commercial |
$21.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.89
|
| Rate for Payer: Blue Shield of California Commercial |
$67.46
|
| Rate for Payer: Blue Shield of California EPN |
$42.45
|
| Rate for Payer: Cash Price |
$47.88
|
| Rate for Payer: Central Health Plan Commercial |
$85.12
|
| Rate for Payer: Cigna of CA HMO |
$68.10
|
| Rate for Payer: Cigna of CA PPO |
$78.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.56
|
| Rate for Payer: EPIC Health Plan Senior |
$42.56
|
| Rate for Payer: Galaxy Health WC |
$90.44
|
| Rate for Payer: Global Benefits Group Commercial |
$63.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$74.48
|
| Rate for Payer: Multiplan Commercial |
$79.80
|
| Rate for Payer: Networks By Design Commercial |
$69.16
|
| Rate for Payer: Prime Health Services Commercial |
$90.44
|
| Rate for Payer: Riverside University Health System MISP |
$42.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.20
|
| Rate for Payer: United Healthcare All Other HMO |
$53.20
|
| Rate for Payer: United Healthcare HMO Rider |
$53.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.44
|
| Rate for Payer: Vantage Medical Group Senior |
$90.44
|
|
|
HC NEWBORN HEARING RESCREENING OP
|
Facility
|
OP
|
$236.00
|
|
| Hospital Charge Code |
903100102
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$47.20 |
| Max. Negotiated Rate |
$233.00 |
| Rate for Payer: Adventist Health Commercial |
$47.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$143.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$200.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$114.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.28
|
| Rate for Payer: Blue Shield of California Commercial |
$148.68
|
| Rate for Payer: Blue Shield of California EPN |
$93.69
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Central Health Plan Commercial |
$188.80
|
| Rate for Payer: Cigna of CA HMO |
$151.04
|
| Rate for Payer: Cigna of CA PPO |
$174.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$200.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$200.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$165.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.40
|
| Rate for Payer: EPIC Health Plan Senior |
$94.40
|
| Rate for Payer: Galaxy Health WC |
$200.60
|
| Rate for Payer: Global Benefits Group Commercial |
$141.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$212.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$139.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$165.20
|
| Rate for Payer: Multiplan Commercial |
$177.00
|
| Rate for Payer: Networks By Design Commercial |
$153.40
|
| Rate for Payer: Prime Health Services Commercial |
$200.60
|
| Rate for Payer: Riverside University Health System MISP |
$94.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$184.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$200.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$200.60
|
| Rate for Payer: Vantage Medical Group Senior |
$200.60
|
|
|
HC NEWBORN HEARING RESCREENING OP
|
Facility
|
IP
|
$236.00
|
|
| Hospital Charge Code |
903100102
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$47.20 |
| Max. Negotiated Rate |
$212.40 |
| Rate for Payer: Adventist Health Commercial |
$47.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Central Health Plan Commercial |
$188.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$165.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.40
|
| Rate for Payer: EPIC Health Plan Senior |
$94.40
|
| Rate for Payer: Galaxy Health WC |
$200.60
|
| Rate for Payer: Global Benefits Group Commercial |
$141.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$212.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$139.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.20
|
| Rate for Payer: Multiplan Commercial |
$177.00
|
| Rate for Payer: Networks By Design Commercial |
$153.40
|
| Rate for Payer: Prime Health Services Commercial |
$200.60
|
|
|
HC NEWBORN HEARING SCREENING IP
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100100
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$50.20 |
| Max. Negotiated Rate |
$225.90 |
| Rate for Payer: Adventist Health Commercial |
$50.20
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Central Health Plan Commercial |
$200.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$175.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.40
|
| Rate for Payer: EPIC Health Plan Senior |
$100.40
|
| Rate for Payer: Galaxy Health WC |
$213.35
|
| Rate for Payer: Global Benefits Group Commercial |
$150.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$159.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$148.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.20
|
| Rate for Payer: Multiplan Commercial |
$188.25
|
| Rate for Payer: Networks By Design Commercial |
$163.15
|
| Rate for Payer: Prime Health Services Commercial |
$213.35
|
|
|
HC NEWBORN HEARING SCREENING IP
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100100
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$19.06 |
| Max. Negotiated Rate |
$282.35 |
| Rate for Payer: Adventist Health Commercial |
$50.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$165.05
|
| 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 |
$121.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.01
|
| Rate for Payer: Blue Shield of California Commercial |
$158.13
|
| Rate for Payer: Blue Shield of California EPN |
$99.65
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Central Health Plan Commercial |
$200.80
|
| Rate for Payer: Cigna of CA HMO |
$160.64
|
| Rate for Payer: Cigna of CA PPO |
$185.74
|
| 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 |
$175.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$213.35
|
| Rate for Payer: Global Benefits Group Commercial |
$150.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$159.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$188.25
|
| Rate for Payer: Networks By Design Commercial |
$163.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Prime Health Services Commercial |
$213.35
|
| 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 |
$150.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$184.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| 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
|
|
|
HC NEWBORN HEARING SCREENING OP
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100101
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$50.20 |
| Max. Negotiated Rate |
$225.90 |
| Rate for Payer: Adventist Health Commercial |
$50.20
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Central Health Plan Commercial |
$200.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$175.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.40
|
| Rate for Payer: EPIC Health Plan Senior |
$100.40
|
| Rate for Payer: Galaxy Health WC |
$213.35
|
| Rate for Payer: Global Benefits Group Commercial |
$150.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$159.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$148.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.20
|
| Rate for Payer: Multiplan Commercial |
$188.25
|
| Rate for Payer: Networks By Design Commercial |
$163.15
|
| Rate for Payer: Prime Health Services Commercial |
$213.35
|
|
|
HC NEWBORN HEARING SCREENING OP
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100101
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$19.06 |
| Max. Negotiated Rate |
$282.35 |
| Rate for Payer: Adventist Health Commercial |
$50.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$165.05
|
| 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 |
$121.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.01
|
| Rate for Payer: Blue Shield of California Commercial |
$158.13
|
| Rate for Payer: Blue Shield of California EPN |
$99.65
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Central Health Plan Commercial |
$200.80
|
| Rate for Payer: Cigna of CA HMO |
$160.64
|
| Rate for Payer: Cigna of CA PPO |
$185.74
|
| 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 |
$175.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$213.35
|
| Rate for Payer: Global Benefits Group Commercial |
$150.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$159.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$188.25
|
| Rate for Payer: Networks By Design Commercial |
$163.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Prime Health Services Commercial |
$213.35
|
| 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 |
$150.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$184.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| 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
|
|
|
HC NEWBORN SCREENING PANEL
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT S3620
|
| Hospital Charge Code |
903100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$208.80 |
| Rate for Payer: Adventist Health Commercial |
$46.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Central Health Plan Commercial |
$185.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.80
|
| Rate for Payer: EPIC Health Plan Senior |
$92.80
|
| Rate for Payer: Galaxy Health WC |
$197.20
|
| Rate for Payer: Global Benefits Group Commercial |
$139.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$208.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$136.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.40
|
| Rate for Payer: Multiplan Commercial |
$174.00
|
| Rate for Payer: Networks By Design Commercial |
$150.80
|
| Rate for Payer: Prime Health Services Commercial |
$197.20
|
|
|
HC NEWBORN SCREENING PANEL
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT S3620
|
| Hospital Charge Code |
903100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$400.90 |
| Rate for Payer: Adventist Health Commercial |
$46.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.95
|
| Rate for Payer: Blue Shield of California Commercial |
$146.16
|
| Rate for Payer: Blue Shield of California EPN |
$92.10
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Central Health Plan Commercial |
$185.60
|
| Rate for Payer: Cigna of CA HMO |
$148.48
|
| Rate for Payer: Cigna of CA PPO |
$171.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.80
|
| Rate for Payer: EPIC Health Plan Senior |
$92.80
|
| Rate for Payer: Galaxy Health WC |
$197.20
|
| Rate for Payer: Global Benefits Group Commercial |
$139.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$208.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$362.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$400.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$136.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$162.40
|
| Rate for Payer: Multiplan Commercial |
$174.00
|
| Rate for Payer: Networks By Design Commercial |
$150.80
|
| Rate for Payer: Prime Health Services Commercial |
$197.20
|
| Rate for Payer: Riverside University Health System MISP |
$92.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.00
|
| Rate for Payer: United Healthcare All Other HMO |
$116.00
|
| Rate for Payer: United Healthcare HMO Rider |
$116.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.20
|
| Rate for Payer: Vantage Medical Group Senior |
$197.20
|
|
|
HC NF/AH RN CASE MGMT
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT T1016
|
| Hospital Charge Code |
903400607
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$235.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.72
|
| Rate for Payer: Blue Shield of California Commercial |
$44.38
|
| Rate for Payer: Blue Shield of California EPN |
$27.93
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Riverside University Health System MISP |
$28.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.50
|
| Rate for Payer: Vantage Medical Group Senior |
$59.50
|
|
|
HC NF/AH RN CASE MGMT
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT T1016
|
| Hospital Charge Code |
903400607
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
|
|
HC NF/AH WAIVER
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT S9124
|
| Hospital Charge Code |
903400010
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.90
|
| Rate for Payer: Blue Shield of California Commercial |
$38.04
|
| Rate for Payer: Blue Shield of California EPN |
$23.94
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$63.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Riverside University Health System MISP |
$24.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.00
|
| Rate for Payer: Vantage Medical Group Senior |
$51.00
|
|
|
HC NF/AH WAIVER
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT S9124
|
| Hospital Charge Code |
903400010
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
|
|
HC N GONNORHOEAE AMPLIFICATION
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912305
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Central Health Plan Commercial |
$376.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$329.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$188.00
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$423.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.00
|
| Rate for Payer: Multiplan Commercial |
$352.50
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
|
|
HC N GONNORHOEAE AMPLIFICATION
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912305
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$343.45 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.45
|
| Rate for Payer: Blue Shield of California Commercial |
$296.10
|
| Rate for Payer: Blue Shield of California Commercial |
$85.68
|
| Rate for Payer: Blue Shield of California EPN |
$186.59
|
| Rate for Payer: Blue Shield of California EPN |
$53.99
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Central Health Plan Commercial |
$376.00
|
| Rate for Payer: Cigna of CA HMO |
$300.80
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$347.80
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$329.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$423.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$352.50
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$282.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$282.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC NGS POST TX CD3 ENGRAFTMENT
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
CPT 81268
|
| Hospital Charge Code |
903902026
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$2,603.90 |
| Rate for Payer: Adventist Health Commercial |
$158.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$260.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,113.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$391.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,872.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,603.90
|
| Rate for Payer: Blue Shield of California Commercial |
$500.22
|
| Rate for Payer: Blue Shield of California EPN |
$315.22
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Central Health Plan Commercial |
$635.20
|
| Rate for Payer: Cigna of CA HMO |
$508.16
|
| Rate for Payer: Cigna of CA PPO |
$587.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$391.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$555.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$430.30
|
| Rate for Payer: EPIC Health Plan Senior |
$286.87
|
| Rate for Payer: Galaxy Health WC |
$674.90
|
| Rate for Payer: Global Benefits Group Commercial |
$476.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$714.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$427.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$206.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$260.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$504.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$227.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$365.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$349.46
|
| Rate for Payer: Multiplan Commercial |
$595.50
|
| Rate for Payer: Networks By Design Commercial |
$516.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$260.79
|
| Rate for Payer: Prime Health Services Commercial |
$674.90
|
| Rate for Payer: Prime Health Services Medicare |
$276.44
|
| Rate for Payer: Riverside University Health System MISP |
$286.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$476.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$476.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$211.24
|
| Rate for Payer: United Healthcare All Other HMO |
$211.24
|
| Rate for Payer: United Healthcare HMO Rider |
$211.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$260.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$391.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.87
|
| Rate for Payer: Vantage Medical Group Senior |
$260.79
|
|
|
HC NGS POST TX CD3 ENGRAFTMENT
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
CPT 81268
|
| Hospital Charge Code |
903902026
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$714.60 |
| Rate for Payer: Adventist Health Commercial |
$158.80
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Central Health Plan Commercial |
$635.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$555.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.60
|
| Rate for Payer: EPIC Health Plan Senior |
$317.60
|
| Rate for Payer: Galaxy Health WC |
$674.90
|
| Rate for Payer: Global Benefits Group Commercial |
$476.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$714.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$504.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$468.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.80
|
| Rate for Payer: Multiplan Commercial |
$595.50
|
| Rate for Payer: Networks By Design Commercial |
$516.10
|
| Rate for Payer: Prime Health Services Commercial |
$674.90
|
|
|
HC NGS POST TX ENGRAFTMENT
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
CPT 81267
|
| Hospital Charge Code |
903902025
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$168.04 |
| Max. Negotiated Rate |
$5,542.12 |
| Rate for Payer: Adventist Health Commercial |
$250.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$207.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,890.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$311.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,986.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,542.12
|
| Rate for Payer: Blue Shield of California Commercial |
$787.50
|
| Rate for Payer: Blue Shield of California EPN |
$496.25
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,000.00
|
| Rate for Payer: Cigna of CA HMO |
$800.00
|
| Rate for Payer: Cigna of CA PPO |
$925.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$311.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$228.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$207.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$875.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.31
|
| Rate for Payer: EPIC Health Plan Senior |
$228.21
|
| Rate for Payer: Galaxy Health WC |
$1,062.50
|
| Rate for Payer: Global Benefits Group Commercial |
$750.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,125.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$340.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$206.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$207.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$793.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$227.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$290.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$278.00
|
| Rate for Payer: Multiplan Commercial |
$937.50
|
| Rate for Payer: Networks By Design Commercial |
$812.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$207.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,062.50
|
| Rate for Payer: Prime Health Services Medicare |
$219.91
|
| Rate for Payer: Riverside University Health System MISP |
$228.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$750.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$750.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.04
|
| Rate for Payer: United Healthcare All Other HMO |
$168.04
|
| Rate for Payer: United Healthcare HMO Rider |
$168.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$207.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$311.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$228.21
|
| Rate for Payer: Vantage Medical Group Senior |
$207.46
|
|
|
HC NGS POST TX ENGRAFTMENT
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
CPT 81267
|
| Hospital Charge Code |
903902025
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Adventist Health Commercial |
$250.00
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,000.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$875.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$500.00
|
| Rate for Payer: Galaxy Health WC |
$1,062.50
|
| Rate for Payer: Global Benefits Group Commercial |
$750.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,125.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$793.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$737.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.00
|
| Rate for Payer: Multiplan Commercial |
$937.50
|
| Rate for Payer: Networks By Design Commercial |
$812.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,062.50
|
|
|
HC NGS POST TX MYELOID ENGRAFTMENT
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
CPT 81268
|
| Hospital Charge Code |
903902027
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$714.60 |
| Rate for Payer: Adventist Health Commercial |
$158.80
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Central Health Plan Commercial |
$635.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$555.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.60
|
| Rate for Payer: EPIC Health Plan Senior |
$317.60
|
| Rate for Payer: Galaxy Health WC |
$674.90
|
| Rate for Payer: Global Benefits Group Commercial |
$476.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$714.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$504.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$468.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.80
|
| Rate for Payer: Multiplan Commercial |
$595.50
|
| Rate for Payer: Networks By Design Commercial |
$516.10
|
| Rate for Payer: Prime Health Services Commercial |
$674.90
|
|
|
HC NGS POST TX MYELOID ENGRAFTMENT
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
CPT 81268
|
| Hospital Charge Code |
903902027
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$2,603.90 |
| Rate for Payer: Adventist Health Commercial |
$158.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$260.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,113.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$391.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,872.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,603.90
|
| Rate for Payer: Blue Shield of California Commercial |
$500.22
|
| Rate for Payer: Blue Shield of California EPN |
$315.22
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Central Health Plan Commercial |
$635.20
|
| Rate for Payer: Cigna of CA HMO |
$508.16
|
| Rate for Payer: Cigna of CA PPO |
$587.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$391.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$555.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$430.30
|
| Rate for Payer: EPIC Health Plan Senior |
$286.87
|
| Rate for Payer: Galaxy Health WC |
$674.90
|
| Rate for Payer: Global Benefits Group Commercial |
$476.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$714.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$427.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$206.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$260.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$504.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$227.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$365.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$349.46
|
| Rate for Payer: Multiplan Commercial |
$595.50
|
| Rate for Payer: Networks By Design Commercial |
$516.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$260.79
|
| Rate for Payer: Prime Health Services Commercial |
$674.90
|
| Rate for Payer: Prime Health Services Medicare |
$276.44
|
| Rate for Payer: Riverside University Health System MISP |
$286.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$476.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$476.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$211.24
|
| Rate for Payer: United Healthcare All Other HMO |
$211.24
|
| Rate for Payer: United Healthcare HMO Rider |
$211.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$260.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$391.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.87
|
| Rate for Payer: Vantage Medical Group Senior |
$260.79
|
|
|
HC NGS PRE TX ENGRAFTMENT SCREEN
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT 81265
|
| Hospital Charge Code |
903902024
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$2,412.43 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$233.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,656.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$349.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$256.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$233.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,735.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,412.43
|
| Rate for Payer: Blue Shield of California Commercial |
$469.35
|
| Rate for Payer: Blue Shield of California EPN |
$295.76
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Central Health Plan Commercial |
$596.00
|
| Rate for Payer: Cigna of CA HMO |
$476.80
|
| Rate for Payer: Cigna of CA PPO |
$551.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$349.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$256.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$233.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$521.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.57
|
| Rate for Payer: EPIC Health Plan Senior |
$256.38
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$670.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$382.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$328.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$233.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$473.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$363.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$326.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$312.31
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: Networks By Design Commercial |
$484.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$233.07
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: Prime Health Services Medicare |
$247.05
|
| Rate for Payer: Riverside University Health System MISP |
$256.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$447.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$447.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.78
|
| Rate for Payer: United Healthcare All Other HMO |
$188.78
|
| Rate for Payer: United Healthcare HMO Rider |
$188.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$233.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$349.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$256.38
|
| Rate for Payer: Vantage Medical Group Senior |
$233.07
|
|
