|
HC PREPARE FACE/ORAL PROSTHESIS
|
Facility
|
IP
|
$7,319.00
|
|
|
Service Code
|
CPT 21085
|
| Hospital Charge Code |
900501350
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,463.80 |
| Max. Negotiated Rate |
$6,587.10 |
| Rate for Payer: Adventist Health Commercial |
$1,463.80
|
| Rate for Payer: Cash Price |
$3,293.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,855.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,123.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,927.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,927.60
|
| Rate for Payer: Galaxy Health WC |
$6,221.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,391.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,587.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,647.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,318.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,463.80
|
| Rate for Payer: Multiplan Commercial |
$5,489.25
|
| Rate for Payer: Networks By Design Commercial |
$4,757.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,221.15
|
|
|
HC PREPARE FACE/ORAL PROSTHESIS
|
Facility
|
OP
|
$7,319.00
|
|
|
Service Code
|
CPT 21085
|
| Hospital Charge Code |
900501350
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.63 |
| Max. Negotiated Rate |
$6,587.10 |
| Rate for Payer: Adventist Health Commercial |
$1,463.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$470.13
|
| Rate for Payer: Cash Price |
$3,293.55
|
| Rate for Payer: Cash Price |
$3,293.55
|
| Rate for Payer: Cash Price |
$3,293.55
|
| Rate for Payer: Cash Price |
$3,293.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,855.20
|
| Rate for Payer: Cigna of CA HMO |
$4,684.16
|
| Rate for Payer: Cigna of CA PPO |
$5,416.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,123.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.64
|
| Rate for Payer: EPIC Health Plan Senior |
$335.09
|
| Rate for Payer: Galaxy Health WC |
$6,221.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,391.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,587.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,647.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,656.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,463.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$5,489.25
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$4,757.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$304.63
|
| Rate for Payer: Preferred Health Network WC |
$479.72
|
| Rate for Payer: Prime Health Services Commercial |
$6,221.15
|
| Rate for Payer: Prime Health Services Medicare |
$322.91
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Riverside University Health System MISP |
$335.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,391.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,659.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,659.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,659.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,659.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC PREP/HARVEST CELL CON/MONO/BUF
|
Facility
|
IP
|
$2,078.00
|
|
|
Service Code
|
CPT 38215
|
| Hospital Charge Code |
911800311
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$415.60 |
| Max. Negotiated Rate |
$1,870.20 |
| Rate for Payer: Adventist Health Commercial |
$415.60
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,662.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,454.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$831.20
|
| Rate for Payer: EPIC Health Plan Senior |
$831.20
|
| Rate for Payer: Galaxy Health WC |
$1,766.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,870.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,319.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,226.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.60
|
| Rate for Payer: Multiplan Commercial |
$1,558.50
|
| Rate for Payer: Networks By Design Commercial |
$1,350.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,766.30
|
|
|
HC PREP/HARVEST CELL CON/MONO/BUF
|
Facility
|
OP
|
$2,078.00
|
|
|
Service Code
|
CPT 38215
|
| Hospital Charge Code |
911800311
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$288.75 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$415.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$567.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$288.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$885.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,317.45
|
| Rate for Payer: Blue Shield of California EPN |
$829.12
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,662.40
|
| Rate for Payer: Cigna of CA HMO |
$1,329.92
|
| Rate for Payer: Cigna of CA PPO |
$1,537.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$567.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,454.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.24
|
| Rate for Payer: EPIC Health Plan Senior |
$624.16
|
| Rate for Payer: Galaxy Health WC |
$1,766.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,870.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$930.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,319.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$760.34
|
| Rate for Payer: Multiplan Commercial |
$1,558.50
|
| Rate for Payer: Multiplan WC |
$885.06
|
| Rate for Payer: Networks By Design Commercial |
$1,350.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$567.42
|
| Rate for Payer: Preferred Health Network WC |
$903.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,766.30
|
| Rate for Payer: Prime Health Services Medicare |
$601.47
|
| Rate for Payer: Prime Health Services WC |
$876.03
|
| Rate for Payer: Riverside University Health System MISP |
$624.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,246.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,246.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$567.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$567.42
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC PREP/HARVEST W PLASMA VOL DEP
|
Facility
|
OP
|
$2,078.00
|
|
|
Service Code
|
CPT 38214
|
| Hospital Charge Code |
911800310
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$249.23 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$415.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$567.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$249.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$885.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,317.45
|
| Rate for Payer: Blue Shield of California EPN |
$829.12
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,662.40
|
| Rate for Payer: Cigna of CA HMO |
$1,329.92
|
| Rate for Payer: Cigna of CA PPO |
$1,537.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$567.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,454.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.24
|
| Rate for Payer: EPIC Health Plan Senior |
$624.16
|
| Rate for Payer: Galaxy Health WC |
$1,766.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,870.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$930.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,319.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$760.34
|
| Rate for Payer: Multiplan Commercial |
$1,558.50
|
| Rate for Payer: Multiplan WC |
$885.06
|
| Rate for Payer: Networks By Design Commercial |
$1,350.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$567.42
|
| Rate for Payer: Preferred Health Network WC |
$903.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,766.30
|
| Rate for Payer: Prime Health Services Medicare |
$601.47
|
| Rate for Payer: Prime Health Services WC |
$876.03
|
| Rate for Payer: Riverside University Health System MISP |
$624.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,246.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,246.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$567.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$567.42
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC PREP/HARVEST W PLASMA VOL DEP
|
Facility
|
IP
|
$2,078.00
|
|
|
Service Code
|
CPT 38214
|
| Hospital Charge Code |
911800310
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$415.60 |
| Max. Negotiated Rate |
$1,870.20 |
| Rate for Payer: Adventist Health Commercial |
$415.60
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,662.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,454.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$831.20
|
| Rate for Payer: EPIC Health Plan Senior |
$831.20
|
| Rate for Payer: Galaxy Health WC |
$1,766.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,870.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,319.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,226.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.60
|
| Rate for Payer: Multiplan Commercial |
$1,558.50
|
| Rate for Payer: Networks By Design Commercial |
$1,350.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,766.30
|
|
|
HC PREP/HARVEST W PLATELET DEPLET
|
Facility
|
OP
|
$2,078.00
|
|
|
Service Code
|
CPT 38213
|
| Hospital Charge Code |
911800309
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$74.43 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$415.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$567.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$885.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,317.45
|
| Rate for Payer: Blue Shield of California EPN |
$829.12
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,662.40
|
| Rate for Payer: Cigna of CA HMO |
$1,329.92
|
| Rate for Payer: Cigna of CA PPO |
$1,537.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$567.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,454.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.24
|
| Rate for Payer: EPIC Health Plan Senior |
$624.16
|
| Rate for Payer: Galaxy Health WC |
$1,766.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,870.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$930.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,319.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$760.34
|
| Rate for Payer: Multiplan Commercial |
$1,558.50
|
| Rate for Payer: Multiplan WC |
$885.06
|
| Rate for Payer: Networks By Design Commercial |
$1,350.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$567.42
|
| Rate for Payer: Preferred Health Network WC |
$903.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,766.30
|
| Rate for Payer: Prime Health Services Medicare |
$601.47
|
| Rate for Payer: Prime Health Services WC |
$876.03
|
| Rate for Payer: Riverside University Health System MISP |
$624.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,246.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,246.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$567.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$567.42
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC PREP/HARVEST W PLATELET DEPLET
|
Facility
|
IP
|
$2,078.00
|
|
|
Service Code
|
CPT 38213
|
| Hospital Charge Code |
911800309
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$415.60 |
| Max. Negotiated Rate |
$1,870.20 |
| Rate for Payer: Adventist Health Commercial |
$415.60
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,662.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,454.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$831.20
|
| Rate for Payer: EPIC Health Plan Senior |
$831.20
|
| Rate for Payer: Galaxy Health WC |
$1,766.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,870.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,319.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,226.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.60
|
| Rate for Payer: Multiplan Commercial |
$1,558.50
|
| Rate for Payer: Networks By Design Commercial |
$1,350.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,766.30
|
|
|
HC PREP/HARVEST W RBC REMOVAL
|
Facility
|
OP
|
$2,078.00
|
|
|
Service Code
|
CPT 38212
|
| Hospital Charge Code |
911800308
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$288.75 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$415.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$567.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$288.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$885.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,317.45
|
| Rate for Payer: Blue Shield of California EPN |
$829.12
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,662.40
|
| Rate for Payer: Cigna of CA HMO |
$1,329.92
|
| Rate for Payer: Cigna of CA PPO |
$1,537.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$567.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,454.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.24
|
| Rate for Payer: EPIC Health Plan Senior |
$624.16
|
| Rate for Payer: Galaxy Health WC |
$1,766.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,870.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$930.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,319.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$760.34
|
| Rate for Payer: Multiplan Commercial |
$1,558.50
|
| Rate for Payer: Multiplan WC |
$885.06
|
| Rate for Payer: Networks By Design Commercial |
$1,350.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$567.42
|
| Rate for Payer: Preferred Health Network WC |
$903.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,766.30
|
| Rate for Payer: Prime Health Services Medicare |
$601.47
|
| Rate for Payer: Prime Health Services WC |
$876.03
|
| Rate for Payer: Riverside University Health System MISP |
$624.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,246.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,246.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$567.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$567.42
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC PREP/HARVEST W RBC REMOVAL
|
Facility
|
IP
|
$2,078.00
|
|
|
Service Code
|
CPT 38212
|
| Hospital Charge Code |
911800308
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$415.60 |
| Max. Negotiated Rate |
$1,870.20 |
| Rate for Payer: Adventist Health Commercial |
$415.60
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,662.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,454.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$831.20
|
| Rate for Payer: EPIC Health Plan Senior |
$831.20
|
| Rate for Payer: Galaxy Health WC |
$1,766.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,870.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,319.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,226.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.60
|
| Rate for Payer: Multiplan Commercial |
$1,558.50
|
| Rate for Payer: Networks By Design Commercial |
$1,350.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,766.30
|
|
|
HC PREP/HARVEST W T-CELL DEPLETIO
|
Facility
|
OP
|
$2,078.00
|
|
|
Service Code
|
CPT 38210
|
| Hospital Charge Code |
911800306
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$415.60 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$415.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$567.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$484.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$885.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,317.45
|
| Rate for Payer: Blue Shield of California EPN |
$829.12
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,662.40
|
| Rate for Payer: Cigna of CA HMO |
$1,329.92
|
| Rate for Payer: Cigna of CA PPO |
$1,537.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$567.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,454.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.24
|
| Rate for Payer: EPIC Health Plan Senior |
$624.16
|
| Rate for Payer: Galaxy Health WC |
$1,766.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,870.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$930.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,319.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$760.34
|
| Rate for Payer: Multiplan Commercial |
$1,558.50
|
| Rate for Payer: Multiplan WC |
$885.06
|
| Rate for Payer: Networks By Design Commercial |
$1,350.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$567.42
|
| Rate for Payer: Preferred Health Network WC |
$903.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,766.30
|
| Rate for Payer: Prime Health Services Medicare |
$601.47
|
| Rate for Payer: Prime Health Services WC |
$876.03
|
| Rate for Payer: Riverside University Health System MISP |
$624.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,246.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,246.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$567.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$567.42
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC PREP/HARVEST W T-CELL DEPLETIO
|
Facility
|
IP
|
$2,078.00
|
|
|
Service Code
|
CPT 38210
|
| Hospital Charge Code |
911800306
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$415.60 |
| Max. Negotiated Rate |
$1,870.20 |
| Rate for Payer: Adventist Health Commercial |
$415.60
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,662.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,454.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$831.20
|
| Rate for Payer: EPIC Health Plan Senior |
$831.20
|
| Rate for Payer: Galaxy Health WC |
$1,766.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,870.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,319.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,226.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.60
|
| Rate for Payer: Multiplan Commercial |
$1,558.50
|
| Rate for Payer: Networks By Design Commercial |
$1,350.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,766.30
|
|
|
HC PREP/HARVEST W TUMOR CELL DEP
|
Facility
|
OP
|
$2,078.00
|
|
|
Service Code
|
CPT 38211
|
| Hospital Charge Code |
911800307
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$415.60 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$415.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$567.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$439.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$885.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,317.45
|
| Rate for Payer: Blue Shield of California EPN |
$829.12
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,662.40
|
| Rate for Payer: Cigna of CA HMO |
$1,329.92
|
| Rate for Payer: Cigna of CA PPO |
$1,537.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$567.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,454.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.24
|
| Rate for Payer: EPIC Health Plan Senior |
$624.16
|
| Rate for Payer: Galaxy Health WC |
$1,766.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,870.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$930.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,319.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$760.34
|
| Rate for Payer: Multiplan Commercial |
$1,558.50
|
| Rate for Payer: Multiplan WC |
$885.06
|
| Rate for Payer: Networks By Design Commercial |
$1,350.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$567.42
|
| Rate for Payer: Preferred Health Network WC |
$903.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,766.30
|
| Rate for Payer: Prime Health Services Medicare |
$601.47
|
| Rate for Payer: Prime Health Services WC |
$876.03
|
| Rate for Payer: Riverside University Health System MISP |
$624.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,246.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,246.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$567.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$567.42
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC PREP/HARVEST W TUMOR CELL DEP
|
Facility
|
IP
|
$2,078.00
|
|
|
Service Code
|
CPT 38211
|
| Hospital Charge Code |
911800307
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$415.60 |
| Max. Negotiated Rate |
$1,870.20 |
| Rate for Payer: Adventist Health Commercial |
$415.60
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,662.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,454.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$831.20
|
| Rate for Payer: EPIC Health Plan Senior |
$831.20
|
| Rate for Payer: Galaxy Health WC |
$1,766.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,870.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,319.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,226.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.60
|
| Rate for Payer: Multiplan Commercial |
$1,558.50
|
| Rate for Payer: Networks By Design Commercial |
$1,350.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,766.30
|
|
|
HC PRE POST CHALLENGE SPIROMETRY
|
Facility
|
IP
|
$1,289.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
900801002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$257.80 |
| Max. Negotiated Rate |
$1,160.10 |
| Rate for Payer: Adventist Health Commercial |
$257.80
|
| Rate for Payer: Cash Price |
$580.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,031.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$902.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$515.60
|
| Rate for Payer: EPIC Health Plan Senior |
$515.60
|
| Rate for Payer: Galaxy Health WC |
$1,095.65
|
| Rate for Payer: Global Benefits Group Commercial |
$773.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,160.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$818.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$760.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.80
|
| Rate for Payer: Multiplan Commercial |
$966.75
|
| Rate for Payer: Networks By Design Commercial |
$837.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,095.65
|
|
|
HC PRE POST CHALLENGE SPIROMETRY
|
Facility
|
OP
|
$1,289.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
900801002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$77.45 |
| Max. Negotiated Rate |
$1,160.10 |
| Rate for Payer: Adventist Health Commercial |
$257.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$479.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$300.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$241.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$749.81
|
| Rate for Payer: Blue Shield of California Commercial |
$812.07
|
| Rate for Payer: Blue Shield of California EPN |
$511.73
|
| Rate for Payer: Cash Price |
$580.05
|
| Rate for Payer: Cash Price |
$580.05
|
| Rate for Payer: Cash Price |
$580.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,031.20
|
| Rate for Payer: Cigna of CA HMO |
$824.96
|
| Rate for Payer: Cigna of CA PPO |
$953.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$902.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$791.90
|
| Rate for Payer: EPIC Health Plan Senior |
$527.93
|
| Rate for Payer: Galaxy Health WC |
$1,095.65
|
| Rate for Payer: Global Benefits Group Commercial |
$773.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,160.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$787.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$77.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$818.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$671.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$643.12
|
| Rate for Payer: Multiplan Commercial |
$966.75
|
| Rate for Payer: Networks By Design Commercial |
$837.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$479.94
|
| Rate for Payer: Prime Health Services Commercial |
$1,095.65
|
| Rate for Payer: Prime Health Services Medicare |
$508.74
|
| Rate for Payer: Riverside University Health System MISP |
$527.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$773.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$773.40
|
| 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 |
$479.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
|
|
HC PREP SPLIT UNIT
|
Facility
|
OP
|
$537.00
|
|
|
Service Code
|
CPT 86985
|
| Hospital Charge Code |
900904439
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$107.40 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$107.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$219.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$260.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$312.37
|
| Rate for Payer: Blue Shield of California Commercial |
$340.46
|
| Rate for Payer: Blue Shield of California EPN |
$214.26
|
| Rate for Payer: Cash Price |
$241.65
|
| Rate for Payer: Cash Price |
$241.65
|
| Rate for Payer: Cash Price |
$241.65
|
| Rate for Payer: Central Health Plan Commercial |
$429.60
|
| Rate for Payer: Cigna of CA HMO |
$343.68
|
| Rate for Payer: Cigna of CA PPO |
$397.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$375.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.55
|
| Rate for Payer: EPIC Health Plan Senior |
$241.03
|
| Rate for Payer: Galaxy Health WC |
$456.45
|
| Rate for Payer: Global Benefits Group Commercial |
$322.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$483.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$359.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$341.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$194.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$402.75
|
| Rate for Payer: Networks By Design Commercial |
$349.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$219.12
|
| Rate for Payer: Prime Health Services Commercial |
$456.45
|
| Rate for Payer: Prime Health Services Medicare |
$232.27
|
| Rate for Payer: Riverside University Health System MISP |
$241.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$322.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$322.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$219.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC PREP SPLIT UNIT
|
Facility
|
IP
|
$537.00
|
|
|
Service Code
|
CPT 86985
|
| Hospital Charge Code |
900904439
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$107.40 |
| Max. Negotiated Rate |
$483.30 |
| Rate for Payer: Adventist Health Commercial |
$107.40
|
| Rate for Payer: Cash Price |
$241.65
|
| Rate for Payer: Central Health Plan Commercial |
$429.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$375.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.80
|
| Rate for Payer: EPIC Health Plan Senior |
$214.80
|
| Rate for Payer: Galaxy Health WC |
$456.45
|
| Rate for Payer: Global Benefits Group Commercial |
$322.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$483.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$341.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$316.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.40
|
| Rate for Payer: Multiplan Commercial |
$402.75
|
| Rate for Payer: Networks By Design Commercial |
$349.05
|
| Rate for Payer: Prime Health Services Commercial |
$456.45
|
|
|
HC PRE-TIBIAL SHELL MOLDED ADDITON LE
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
CPT L2340
|
| Hospital Charge Code |
915352340
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$213.00 |
| Max. Negotiated Rate |
$958.50 |
| Rate for Payer: Adventist Health Commercial |
$213.00
|
| Rate for Payer: Blue Shield of California Commercial |
$854.13
|
| Rate for Payer: Blue Shield of California EPN |
$536.76
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Central Health Plan Commercial |
$852.00
|
| Rate for Payer: Cigna of CA HMO |
$745.50
|
| Rate for Payer: Cigna of CA PPO |
$745.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$745.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.00
|
| Rate for Payer: EPIC Health Plan Senior |
$426.00
|
| Rate for Payer: Galaxy Health WC |
$905.25
|
| Rate for Payer: Global Benefits Group Commercial |
$639.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$958.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$676.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.00
|
| Rate for Payer: Multiplan Commercial |
$798.75
|
| Rate for Payer: Networks By Design Commercial |
$692.25
|
| Rate for Payer: Prime Health Services Commercial |
$905.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$399.69
|
| Rate for Payer: United Healthcare All Other HMO |
$389.04
|
| Rate for Payer: United Healthcare HMO Rider |
$380.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$348.79
|
|
|
HC PRE-TIBIAL SHELL MOLDED ADDITON LE
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
CPT L2340
|
| Hospital Charge Code |
915352340
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$348.79 |
| Max. Negotiated Rate |
$958.50 |
| Rate for Payer: Adventist Health Commercial |
$436.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$905.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$585.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$798.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$619.51
|
| Rate for Payer: Blue Shield of California Commercial |
$854.13
|
| Rate for Payer: Blue Shield of California EPN |
$536.76
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Central Health Plan Commercial |
$852.00
|
| Rate for Payer: Cigna of CA HMO |
$745.50
|
| Rate for Payer: Cigna of CA PPO |
$745.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$905.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$905.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$905.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$745.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.00
|
| Rate for Payer: EPIC Health Plan Senior |
$426.00
|
| Rate for Payer: Galaxy Health WC |
$905.25
|
| Rate for Payer: Global Benefits Group Commercial |
$639.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$958.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$450.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$676.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$498.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$436.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$745.50
|
| Rate for Payer: Multiplan Commercial |
$798.75
|
| Rate for Payer: Networks By Design Commercial |
$532.50
|
| Rate for Payer: Prime Health Services Commercial |
$905.25
|
| Rate for Payer: Riverside University Health System MISP |
$426.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$639.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$639.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$399.69
|
| Rate for Payer: United Healthcare All Other HMO |
$389.04
|
| Rate for Payer: United Healthcare HMO Rider |
$380.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$348.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$905.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$905.25
|
| Rate for Payer: Vantage Medical Group Senior |
$905.25
|
|
|
HC PRE-TIBIAL SHELL MOLDED ADDITON LE
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
CPT L2340
|
| Hospital Charge Code |
905352340
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$213.00 |
| Max. Negotiated Rate |
$958.50 |
| Rate for Payer: Adventist Health Commercial |
$213.00
|
| Rate for Payer: Blue Shield of California Commercial |
$854.13
|
| Rate for Payer: Blue Shield of California EPN |
$536.76
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Central Health Plan Commercial |
$852.00
|
| Rate for Payer: Cigna of CA HMO |
$745.50
|
| Rate for Payer: Cigna of CA PPO |
$745.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$745.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.00
|
| Rate for Payer: EPIC Health Plan Senior |
$426.00
|
| Rate for Payer: Galaxy Health WC |
$905.25
|
| Rate for Payer: Global Benefits Group Commercial |
$639.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$958.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$676.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.00
|
| Rate for Payer: Multiplan Commercial |
$798.75
|
| Rate for Payer: Networks By Design Commercial |
$692.25
|
| Rate for Payer: Prime Health Services Commercial |
$905.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$399.69
|
| Rate for Payer: United Healthcare All Other HMO |
$389.04
|
| Rate for Payer: United Healthcare HMO Rider |
$380.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$348.79
|
|
|
HC PRE-TIBIAL SHELL MOLDED ADDITON LE
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
CPT L2340
|
| Hospital Charge Code |
905352340
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$348.79 |
| Max. Negotiated Rate |
$958.50 |
| Rate for Payer: Adventist Health Commercial |
$436.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$905.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$585.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$798.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$619.51
|
| Rate for Payer: Blue Shield of California Commercial |
$854.13
|
| Rate for Payer: Blue Shield of California EPN |
$536.76
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Central Health Plan Commercial |
$852.00
|
| Rate for Payer: Cigna of CA HMO |
$745.50
|
| Rate for Payer: Cigna of CA PPO |
$745.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$905.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$905.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$905.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$745.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.00
|
| Rate for Payer: EPIC Health Plan Senior |
$426.00
|
| Rate for Payer: Galaxy Health WC |
$905.25
|
| Rate for Payer: Global Benefits Group Commercial |
$639.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$958.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$450.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$676.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$498.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$436.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$745.50
|
| Rate for Payer: Multiplan Commercial |
$798.75
|
| Rate for Payer: Networks By Design Commercial |
$532.50
|
| Rate for Payer: Prime Health Services Commercial |
$905.25
|
| Rate for Payer: Riverside University Health System MISP |
$426.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$639.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$639.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$399.69
|
| Rate for Payer: United Healthcare All Other HMO |
$389.04
|
| Rate for Payer: United Healthcare HMO Rider |
$380.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$348.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$905.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$905.25
|
| Rate for Payer: Vantage Medical Group Senior |
$905.25
|
|
|
HC PREVIEW TRT PLANNING
|
Facility
|
OP
|
$2,658.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201982
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$531.60 |
| Max. Negotiated Rate |
$2,392.20 |
| Rate for Payer: Adventist Health Commercial |
$531.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,259.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,461.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,993.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$739.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,546.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,674.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,055.23
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,126.40
|
| Rate for Payer: Cigna of CA HMO |
$1,701.12
|
| Rate for Payer: Cigna of CA PPO |
$1,966.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,259.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,259.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,259.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,860.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,063.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,063.20
|
| Rate for Payer: Galaxy Health WC |
$2,259.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,594.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,392.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,687.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$964.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,568.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$531.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,860.60
|
| Rate for Payer: Multiplan Commercial |
$1,993.50
|
| Rate for Payer: Networks By Design Commercial |
$1,727.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,259.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,063.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,594.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,594.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,329.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,329.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,329.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,329.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,259.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,259.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,259.30
|
|
|
HC PREVIEW TRT PLANNING
|
Facility
|
IP
|
$2,658.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201982
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$531.60 |
| Max. Negotiated Rate |
$2,392.20 |
| Rate for Payer: Adventist Health Commercial |
$531.60
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,126.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,860.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,063.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,063.20
|
| Rate for Payer: Galaxy Health WC |
$2,259.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,594.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,392.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,687.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,568.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$531.60
|
| Rate for Payer: Multiplan Commercial |
$1,993.50
|
| Rate for Payer: Networks By Design Commercial |
$1,727.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,259.30
|
|
|
HC PREVNAR ADMINISTRATION
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
902890224
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
