|
HC NGS PRE TX ENGRAFTMENT SCREEN
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT 81265
|
| Hospital Charge Code |
903902024
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Central Health Plan Commercial |
$596.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$521.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$473.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$439.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.00
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: Networks By Design Commercial |
$484.25
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
|
|
HC NICU BACK TRANSPORT PER HOUR
|
Facility
|
IP
|
$5,488.00
|
|
| Hospital Charge Code |
905200004
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$8,532.00 |
| Rate for Payer: Adventist Health Commercial |
$1,097.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,532.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,390.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,841.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,195.20
|
| Rate for Payer: Galaxy Health WC |
$4,664.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,292.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,939.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$334.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,484.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,237.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,097.60
|
| Rate for Payer: Multiplan Commercial |
$4,116.00
|
| Rate for Payer: Networks By Design Commercial |
$3,567.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,664.80
|
|
|
HC NICU TRANSPORT CASE RATE
|
Facility
|
IP
|
$2,094.00
|
|
| Hospital Charge Code |
905200005
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$8,532.00 |
| Rate for Payer: Adventist Health Commercial |
$418.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8,532.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$942.30
|
| Rate for Payer: Cash Price |
$942.30
|
| Rate for Payer: Cash Price |
$942.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,675.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,465.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$837.60
|
| Rate for Payer: EPIC Health Plan Senior |
$837.60
|
| Rate for Payer: Galaxy Health WC |
$1,779.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,256.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,884.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$334.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,329.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,235.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.80
|
| Rate for Payer: Multiplan Commercial |
$1,570.50
|
| Rate for Payer: Networks By Design Commercial |
$1,361.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,779.90
|
|
|
HC NICU TRANSPORT PER HOUR
|
Facility
|
IP
|
$4,134.00
|
|
| Hospital Charge Code |
905200001
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$8,532.00 |
| Rate for Payer: Adventist Health Commercial |
$826.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8,532.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$1,860.30
|
| Rate for Payer: Cash Price |
$1,860.30
|
| Rate for Payer: Cash Price |
$1,860.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,307.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,893.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,653.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,653.60
|
| Rate for Payer: Galaxy Health WC |
$3,513.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,480.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,720.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$334.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,625.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,439.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$826.80
|
| Rate for Payer: Multiplan Commercial |
$3,100.50
|
| Rate for Payer: Networks By Design Commercial |
$2,687.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,513.90
|
|
|
HC NID
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Central Health Plan Commercial |
$41.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Senior |
$20.80
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.40
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
|
|
HC NID
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.64
|
| Rate for Payer: Blue Shield of California Commercial |
$32.76
|
| Rate for Payer: Blue Shield of California EPN |
$20.64
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Central Health Plan Commercial |
$41.60
|
| Rate for Payer: Cigna of CA HMO |
$33.28
|
| Rate for Payer: Cigna of CA PPO |
$38.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.33
|
| Rate for Payer: EPIC Health Plan Senior |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.08
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
| Rate for Payer: Prime Health Services Medicare |
$8.56
|
| Rate for Payer: Riverside University Health System MISP |
$8.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC NIPT
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT 81507
|
| Hospital Charge Code |
910401507
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$406.80 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Central Health Plan Commercial |
$361.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$316.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.80
|
| Rate for Payer: EPIC Health Plan Senior |
$180.80
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$406.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$287.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$266.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.40
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
| Rate for Payer: Networks By Design Commercial |
$293.80
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
|
|
HC NIPT
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT 81507
|
| Hospital Charge Code |
910401507
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$3,543.37 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$795.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,543.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,192.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$874.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$795.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,046.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,844.60
|
| Rate for Payer: Blue Shield of California Commercial |
$284.76
|
| Rate for Payer: Blue Shield of California EPN |
$179.44
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Central Health Plan Commercial |
$361.60
|
| Rate for Payer: Cigna of CA HMO |
$289.28
|
| Rate for Payer: Cigna of CA PPO |
$334.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,192.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$874.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$795.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$316.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,311.75
|
| Rate for Payer: EPIC Health Plan Senior |
$874.50
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$406.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,303.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,093.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$795.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$287.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,208.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,113.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,065.30
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
| Rate for Payer: Networks By Design Commercial |
$293.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$795.00
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
| Rate for Payer: Prime Health Services Medicare |
$842.70
|
| Rate for Payer: Riverside University Health System MISP |
$874.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$271.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$271.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$643.95
|
| Rate for Payer: United Healthcare All Other HMO |
$643.95
|
| Rate for Payer: United Healthcare HMO Rider |
$643.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$795.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,192.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$874.50
|
| Rate for Payer: Vantage Medical Group Senior |
$795.00
|
|
|
HC NITINAL WIRES/SHORT
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$207.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$183.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$118.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.93
|
| Rate for Payer: Blue Shield of California Commercial |
$154.70
|
| Rate for Payer: Blue Shield of California EPN |
$97.36
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Central Health Plan Commercial |
$195.20
|
| Rate for Payer: Cigna of CA HMO |
$156.16
|
| Rate for Payer: Cigna of CA PPO |
$180.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$207.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$207.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$170.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: EPIC Health Plan Senior |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$154.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$143.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$170.80
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Networks By Design Commercial |
$158.60
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
| Rate for Payer: Riverside University Health System MISP |
$97.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$146.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$146.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.00
|
| Rate for Payer: United Healthcare All Other HMO |
$122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$122.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$207.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.40
|
| Rate for Payer: Vantage Medical Group Senior |
$207.40
|
|
|
HC NITINAL WIRES/SHORT
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Central Health Plan Commercial |
$195.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$170.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: EPIC Health Plan Senior |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$154.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$143.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.80
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Networks By Design Commercial |
$158.60
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
|
|
HC NITRIC OXIDE EXPIRED GAS
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 95012
|
| Hospital Charge Code |
900801050
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.60
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
|
|
HC NITRIC OXIDE EXPIRED GAS
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 95012
|
| Hospital Charge Code |
900801050
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$32.25 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$116.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.81
|
| Rate for Payer: Blue Shield of California Commercial |
$137.34
|
| Rate for Payer: Blue Shield of California EPN |
$86.55
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: Cigna of CA HMO |
$139.52
|
| Rate for Payer: Cigna of CA PPO |
$161.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.27
|
| Rate for Payer: EPIC Health Plan Senior |
$52.84
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.37
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.04
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
| Rate for Payer: Prime Health Services Medicare |
$50.92
|
| Rate for Payer: Riverside University Health System MISP |
$52.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.80
|
| 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 |
$48.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Vantage Medical Group Senior |
$48.04
|
|
|
HC NITRIC OXIDE/HELIOX THRPY PER DAY
|
Facility
|
IP
|
$3,537.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800400
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$707.40 |
| Max. Negotiated Rate |
$3,183.30 |
| Rate for Payer: Adventist Health Commercial |
$707.40
|
| Rate for Payer: Cash Price |
$1,591.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,829.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,475.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,414.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,414.80
|
| Rate for Payer: Galaxy Health WC |
$3,006.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,122.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,183.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,245.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,086.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.40
|
| Rate for Payer: Multiplan Commercial |
$2,652.75
|
| Rate for Payer: Networks By Design Commercial |
$2,299.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,006.45
|
|
|
HC NITRIC OXIDE/HELIOX THRPY PER DAY
|
Facility
|
OP
|
$3,537.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800400
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$165.49 |
| Max. Negotiated Rate |
$3,183.30 |
| Rate for Payer: Adventist Health Commercial |
$707.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$165.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,148.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,712.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,057.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,228.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,404.19
|
| Rate for Payer: Cash Price |
$1,591.65
|
| Rate for Payer: Cash Price |
$1,591.65
|
| Rate for Payer: Cash Price |
$1,591.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,829.60
|
| Rate for Payer: Cigna of CA HMO |
$2,263.68
|
| Rate for Payer: Cigna of CA PPO |
$2,617.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,475.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$3,006.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,122.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,183.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,245.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$2,652.75
|
| Rate for Payer: Networks By Design Commercial |
$2,299.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$165.49
|
| Rate for Payer: Prime Health Services Commercial |
$3,006.45
|
| Rate for Payer: Prime Health Services Medicare |
$175.42
|
| Rate for Payer: Riverside University Health System MISP |
$182.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,122.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,122.20
|
| 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 |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC NK CELLS TOTAL COUNTCD16+56
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
903900106
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$373.20 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Adventist Health Commercial |
$95.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.73
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$268.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$268.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$373.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$373.20
|
| Rate for Payer: Blue Shield of California Commercial |
$299.88
|
| Rate for Payer: Blue Shield of California Commercial |
$89.46
|
| Rate for Payer: Blue Shield of California EPN |
$188.97
|
| Rate for Payer: Blue Shield of California EPN |
$56.37
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Central Health Plan Commercial |
$113.60
|
| Rate for Payer: Central Health Plan Commercial |
$380.80
|
| Rate for Payer: Cigna of CA HMO |
$304.64
|
| Rate for Payer: Cigna of CA HMO |
$90.88
|
| Rate for Payer: Cigna of CA PPO |
$352.24
|
| Rate for Payer: Cigna of CA PPO |
$105.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$333.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.25
|
| Rate for Payer: EPIC Health Plan Senior |
$41.50
|
| Rate for Payer: EPIC Health Plan Senior |
$41.50
|
| Rate for Payer: Galaxy Health WC |
$404.60
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$428.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$302.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$357.00
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Networks By Design Commercial |
$309.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.73
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.73
|
| Rate for Payer: Prime Health Services Commercial |
$404.60
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Prime Health Services Medicare |
$39.99
|
| Rate for Payer: Prime Health Services Medicare |
$39.99
|
| Rate for Payer: Riverside University Health System MISP |
$41.50
|
| Rate for Payer: Riverside University Health System MISP |
$41.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$285.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$285.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.56
|
| Rate for Payer: United Healthcare All Other HMO |
$30.56
|
| Rate for Payer: United Healthcare All Other HMO |
$30.56
|
| Rate for Payer: United Healthcare HMO Rider |
$30.56
|
| Rate for Payer: United Healthcare HMO Rider |
$30.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC NK CELLS TOTAL COUNTCD16+56
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
903900106
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$95.20 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Adventist Health Commercial |
$95.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Central Health Plan Commercial |
$380.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$333.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.40
|
| Rate for Payer: EPIC Health Plan Senior |
$190.40
|
| Rate for Payer: Galaxy Health WC |
$404.60
|
| Rate for Payer: Global Benefits Group Commercial |
$285.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$428.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$302.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$280.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.20
|
| Rate for Payer: Multiplan Commercial |
$357.00
|
| Rate for Payer: Networks By Design Commercial |
$309.40
|
| Rate for Payer: Prime Health Services Commercial |
$404.60
|
|
|
HC NMIC306
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC NMIC306
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.64
|
| Rate for Payer: Blue Shield of California Commercial |
$31.50
|
| Rate for Payer: Blue Shield of California EPN |
$19.85
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.33
|
| Rate for Payer: EPIC Health Plan Senior |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.08
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$8.56
|
| Rate for Payer: Riverside University Health System MISP |
$8.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC NMIC312
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913013
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC NMIC312
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913013
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.08
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.64
|
| Rate for Payer: Blue Shield of California Commercial |
$12.60
|
| Rate for Payer: Blue Shield of California Commercial |
$15.75
|
| Rate for Payer: Blue Shield of California EPN |
$9.93
|
| Rate for Payer: Blue Shield of California EPN |
$7.94
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.33
|
| Rate for Payer: EPIC Health Plan Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Senior |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.08
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.08
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$8.56
|
| Rate for Payer: Prime Health Services Medicare |
$8.56
|
| Rate for Payer: Riverside University Health System MISP |
$8.89
|
| Rate for Payer: Riverside University Health System MISP |
$8.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC NM MYCRD IMG PET RST & STRS CT
|
Facility
|
OP
|
$4,751.00
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
909308431
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$137.72 |
| Max. Negotiated Rate |
$9,203.55 |
| Rate for Payer: Adventist Health Commercial |
$950.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,833.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,203.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,249.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,116.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,833.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$475.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,763.66
|
| Rate for Payer: Blue Shield of California Commercial |
$2,993.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,886.15
|
| Rate for Payer: Cash Price |
$2,137.95
|
| Rate for Payer: Cash Price |
$2,137.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,800.80
|
| Rate for Payer: Cigna of CA HMO |
$3,040.64
|
| Rate for Payer: Cigna of CA PPO |
$3,515.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,249.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,116.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,833.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,325.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,674.70
|
| Rate for Payer: EPIC Health Plan Senior |
$3,116.47
|
| Rate for Payer: Galaxy Health WC |
$4,038.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,850.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,275.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,646.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$137.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,833.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,016.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$152.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,966.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$950.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,796.42
|
| Rate for Payer: Multiplan Commercial |
$3,563.25
|
| Rate for Payer: Networks By Design Commercial |
$3,088.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,833.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,038.35
|
| Rate for Payer: Prime Health Services Medicare |
$3,003.14
|
| Rate for Payer: Riverside University Health System MISP |
$3,116.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,850.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,850.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,761.28
|
| Rate for Payer: United Healthcare All Other HMO |
$5,761.28
|
| Rate for Payer: United Healthcare HMO Rider |
$5,761.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,761.28
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,833.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,249.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,116.47
|
| Rate for Payer: Vantage Medical Group Senior |
$2,833.15
|
|
|
HC NM MYCRD IMG PET RST & STRS CT
|
Facility
|
IP
|
$4,751.00
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
909308431
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$950.20 |
| Max. Negotiated Rate |
$4,275.90 |
| Rate for Payer: Adventist Health Commercial |
$950.20
|
| Rate for Payer: Cash Price |
$2,137.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,800.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,325.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,900.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,900.40
|
| Rate for Payer: Galaxy Health WC |
$4,038.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,850.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,275.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,016.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,803.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$950.20
|
| Rate for Payer: Multiplan Commercial |
$3,563.25
|
| Rate for Payer: Networks By Design Commercial |
$3,088.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,038.35
|
|
|
HC NM MYCRD IMG PET RST/STRS W/CT
|
Facility
|
IP
|
$3,046.00
|
|
|
Service Code
|
CPT 78430
|
| Hospital Charge Code |
909308430
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$609.20 |
| Max. Negotiated Rate |
$2,741.40 |
| Rate for Payer: Adventist Health Commercial |
$609.20
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,436.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,132.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,218.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,218.40
|
| Rate for Payer: Galaxy Health WC |
$2,589.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,827.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,741.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,934.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,797.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$609.20
|
| Rate for Payer: Multiplan Commercial |
$2,284.50
|
| Rate for Payer: Networks By Design Commercial |
$1,979.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,589.10
|
|
|
HC NM MYCRD IMG PET RST/STRS W/CT
|
Facility
|
OP
|
$3,046.00
|
|
|
Service Code
|
CPT 78430
|
| Hospital Charge Code |
909308430
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$118.27 |
| Max. Negotiated Rate |
$9,203.55 |
| Rate for Payer: Adventist Health Commercial |
$609.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,839.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,203.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,023.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,839.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$408.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,771.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1,918.98
|
| Rate for Payer: Blue Shield of California EPN |
$1,209.26
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,436.80
|
| Rate for Payer: Cigna of CA HMO |
$1,949.44
|
| Rate for Payer: Cigna of CA PPO |
$2,254.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,023.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,839.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,132.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,034.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,023.07
|
| Rate for Payer: Galaxy Health WC |
$2,589.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,827.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,741.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,016.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$118.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,839.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,934.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,574.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$609.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,464.46
|
| Rate for Payer: Multiplan Commercial |
$2,284.50
|
| Rate for Payer: Networks By Design Commercial |
$1,979.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,589.10
|
| Rate for Payer: Prime Health Services Medicare |
$1,949.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,023.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,827.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,827.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,694.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3,694.08
|
| Rate for Payer: United Healthcare HMO Rider |
$3,694.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,694.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,839.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,758.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,023.07
|
| Rate for Payer: Vantage Medical Group Senior |
$1,839.15
|
|
|
HC NM MYOCRD IMG PET 1 STUDY W/CT
|
Facility
|
IP
|
$3,046.00
|
|
|
Service Code
|
CPT 78429
|
| Hospital Charge Code |
909308429
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$609.20 |
| Max. Negotiated Rate |
$2,741.40 |
| Rate for Payer: Adventist Health Commercial |
$609.20
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,436.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,132.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,218.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,218.40
|
| Rate for Payer: Galaxy Health WC |
$2,589.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,827.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,741.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,934.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,797.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$609.20
|
| Rate for Payer: Multiplan Commercial |
$2,284.50
|
| Rate for Payer: Networks By Design Commercial |
$1,979.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,589.10
|
|
