|
HC RESUSCITATOR MANUAL PEDS
|
Facility
|
OP
|
$122.74
|
|
| Hospital Charge Code |
901607888
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.55 |
| Max. Negotiated Rate |
$110.47 |
| Rate for Payer: Adventist Health Commercial |
$24.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$104.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$59.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.40
|
| Rate for Payer: Blue Shield of California Commercial |
$77.82
|
| Rate for Payer: Blue Shield of California EPN |
$48.97
|
| Rate for Payer: Cash Price |
$55.23
|
| Rate for Payer: Central Health Plan Commercial |
$98.19
|
| Rate for Payer: Cigna of CA HMO |
$78.55
|
| Rate for Payer: Cigna of CA PPO |
$90.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$104.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$104.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$104.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.10
|
| Rate for Payer: EPIC Health Plan Senior |
$49.10
|
| Rate for Payer: Galaxy Health WC |
$104.33
|
| Rate for Payer: Global Benefits Group Commercial |
$73.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$110.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$77.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$72.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$85.92
|
| Rate for Payer: Multiplan Commercial |
$92.06
|
| Rate for Payer: Networks By Design Commercial |
$79.78
|
| Rate for Payer: Prime Health Services Commercial |
$104.33
|
| Rate for Payer: Riverside University Health System MISP |
$49.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.37
|
| Rate for Payer: United Healthcare All Other HMO |
$61.37
|
| Rate for Payer: United Healthcare HMO Rider |
$61.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$104.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$104.33
|
| Rate for Payer: Vantage Medical Group Senior |
$104.33
|
|
|
HC RESUSCITATOR MANUAL PEDS
|
Facility
|
IP
|
$128.82
|
|
| Hospital Charge Code |
901605544
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.76 |
| Max. Negotiated Rate |
$115.94 |
| Rate for Payer: Adventist Health Commercial |
$25.76
|
| Rate for Payer: Cash Price |
$57.97
|
| Rate for Payer: Central Health Plan Commercial |
$103.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.53
|
| Rate for Payer: EPIC Health Plan Senior |
$51.53
|
| Rate for Payer: Galaxy Health WC |
$109.50
|
| Rate for Payer: Global Benefits Group Commercial |
$77.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.76
|
| Rate for Payer: Multiplan Commercial |
$96.61
|
| Rate for Payer: Networks By Design Commercial |
$83.73
|
| Rate for Payer: Prime Health Services Commercial |
$109.50
|
|
|
HC RESUSCITATOR MANUAL PEDS
|
Facility
|
IP
|
$122.74
|
|
| Hospital Charge Code |
901607888
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.55 |
| Max. Negotiated Rate |
$110.47 |
| Rate for Payer: Adventist Health Commercial |
$24.55
|
| Rate for Payer: Cash Price |
$55.23
|
| Rate for Payer: Central Health Plan Commercial |
$98.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.10
|
| Rate for Payer: EPIC Health Plan Senior |
$49.10
|
| Rate for Payer: Galaxy Health WC |
$104.33
|
| Rate for Payer: Global Benefits Group Commercial |
$73.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$110.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$77.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$72.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.55
|
| Rate for Payer: Multiplan Commercial |
$92.06
|
| Rate for Payer: Networks By Design Commercial |
$79.78
|
| Rate for Payer: Prime Health Services Commercial |
$104.33
|
|
|
HC RESUSCITATOR PEDS MANUAL
|
Facility
|
OP
|
$82.69
|
|
| Hospital Charge Code |
901698464
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.54 |
| Max. Negotiated Rate |
$74.42 |
| Rate for Payer: Adventist Health Commercial |
$16.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$40.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.10
|
| Rate for Payer: Blue Shield of California Commercial |
$52.43
|
| Rate for Payer: Blue Shield of California EPN |
$32.99
|
| Rate for Payer: Cash Price |
$37.21
|
| Rate for Payer: Central Health Plan Commercial |
$66.15
|
| Rate for Payer: Cigna of CA HMO |
$52.92
|
| Rate for Payer: Cigna of CA PPO |
$61.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$70.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.08
|
| Rate for Payer: EPIC Health Plan Senior |
$33.08
|
| Rate for Payer: Galaxy Health WC |
$70.29
|
| Rate for Payer: Global Benefits Group Commercial |
$49.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$74.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.88
|
| Rate for Payer: Multiplan Commercial |
$62.02
|
| Rate for Payer: Networks By Design Commercial |
$53.75
|
| Rate for Payer: Prime Health Services Commercial |
$70.29
|
| Rate for Payer: Riverside University Health System MISP |
$33.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.34
|
| Rate for Payer: United Healthcare All Other HMO |
$41.34
|
| Rate for Payer: United Healthcare HMO Rider |
$41.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.29
|
| Rate for Payer: Vantage Medical Group Senior |
$70.29
|
|
|
HC RESUSCITATOR PEDS MANUAL
|
Facility
|
IP
|
$82.69
|
|
| Hospital Charge Code |
901698464
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.54 |
| Max. Negotiated Rate |
$74.42 |
| Rate for Payer: Adventist Health Commercial |
$16.54
|
| Rate for Payer: Cash Price |
$37.21
|
| Rate for Payer: Central Health Plan Commercial |
$66.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.08
|
| Rate for Payer: EPIC Health Plan Senior |
$33.08
|
| Rate for Payer: Galaxy Health WC |
$70.29
|
| Rate for Payer: Global Benefits Group Commercial |
$49.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$74.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.54
|
| Rate for Payer: Multiplan Commercial |
$62.02
|
| Rate for Payer: Networks By Design Commercial |
$53.75
|
| Rate for Payer: Prime Health Services Commercial |
$70.29
|
|
|
HC RESUSCITATOR PEDS SIZE 1 & 2
|
Facility
|
OP
|
$231.70
|
|
| Hospital Charge Code |
901698718
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$46.34 |
| Max. Negotiated Rate |
$208.53 |
| Rate for Payer: Adventist Health Commercial |
$46.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$140.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$196.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.78
|
| Rate for Payer: Blue Shield of California Commercial |
$146.90
|
| Rate for Payer: Blue Shield of California EPN |
$92.45
|
| Rate for Payer: Cash Price |
$104.26
|
| Rate for Payer: Central Health Plan Commercial |
$185.36
|
| Rate for Payer: Cigna of CA HMO |
$148.29
|
| Rate for Payer: Cigna of CA PPO |
$171.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$196.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$196.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$196.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.68
|
| Rate for Payer: EPIC Health Plan Senior |
$92.68
|
| Rate for Payer: Galaxy Health WC |
$196.94
|
| Rate for Payer: Global Benefits Group Commercial |
$139.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$208.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$136.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$162.19
|
| Rate for Payer: Multiplan Commercial |
$173.78
|
| Rate for Payer: Networks By Design Commercial |
$150.60
|
| Rate for Payer: Prime Health Services Commercial |
$196.94
|
| Rate for Payer: Riverside University Health System MISP |
$92.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$115.85
|
| Rate for Payer: United Healthcare All Other HMO |
$115.85
|
| Rate for Payer: United Healthcare HMO Rider |
$115.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$115.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$196.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$196.94
|
| Rate for Payer: Vantage Medical Group Senior |
$196.94
|
|
|
HC RESUSCITATOR PEDS SIZE 1 & 2
|
Facility
|
IP
|
$231.70
|
|
| Hospital Charge Code |
901698718
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$46.34 |
| Max. Negotiated Rate |
$208.53 |
| Rate for Payer: Adventist Health Commercial |
$46.34
|
| Rate for Payer: Cash Price |
$104.26
|
| Rate for Payer: Central Health Plan Commercial |
$185.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.68
|
| Rate for Payer: EPIC Health Plan Senior |
$92.68
|
| Rate for Payer: Galaxy Health WC |
$196.94
|
| Rate for Payer: Global Benefits Group Commercial |
$139.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$208.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$136.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.34
|
| Rate for Payer: Multiplan Commercial |
$173.78
|
| Rate for Payer: Networks By Design Commercial |
$150.60
|
| Rate for Payer: Prime Health Services Commercial |
$196.94
|
|
|
HC RESUSCITATOR PEDS SPUR II
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901698465
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.70
|
| Rate for Payer: Blue Shield of California Commercial |
$51.99
|
| Rate for Payer: Blue Shield of California EPN |
$32.72
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC RESUSCITATOR PEDS SPUR II
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901698465
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC RETICULOCYTE COUNT, AUTO
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 85046
|
| Hospital Charge Code |
900910088
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.57
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$40.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$40.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.24
|
| Rate for Payer: Blue Shield of California Commercial |
$25.20
|
| Rate for Payer: Blue Shield of California Commercial |
$65.52
|
| Rate for Payer: Blue Shield of California EPN |
$15.88
|
| Rate for Payer: Blue Shield of California EPN |
$41.29
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Central Health Plan Commercial |
$83.20
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA HMO |
$66.56
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Cigna of CA PPO |
$76.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$72.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.19
|
| Rate for Payer: EPIC Health Plan Senior |
$6.13
|
| Rate for Payer: EPIC Health Plan Senior |
$6.13
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.13
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.46
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.57
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.57
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Medicare |
$5.90
|
| Rate for Payer: Prime Health Services Medicare |
$5.90
|
| Rate for Payer: Riverside University Health System MISP |
$6.13
|
| Rate for Payer: Riverside University Health System MISP |
$6.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Other HMO |
$4.51
|
| Rate for Payer: United Healthcare All Other HMO |
$4.51
|
| Rate for Payer: United Healthcare HMO Rider |
$4.51
|
| Rate for Payer: United Healthcare HMO Rider |
$4.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.57
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Vantage Medical Group Senior |
$5.57
|
| Rate for Payer: Vantage Medical Group Senior |
$5.57
|
|
|
HC RETICULOCYTE COUNT, AUTO
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 85046
|
| Hospital Charge Code |
900910088
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Central Health Plan Commercial |
$83.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$72.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Senior |
$41.60
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.80
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
|
|
HC RETICULOCYTE COUNT, MANUAL
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 85044
|
| Hospital Charge Code |
900910063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.31
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.51
|
| Rate for Payer: Blue Shield of California Commercial |
$14.49
|
| Rate for Payer: Blue Shield of California Commercial |
$78.12
|
| Rate for Payer: Blue Shield of California EPN |
$9.13
|
| Rate for Payer: Blue Shield of California EPN |
$49.23
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Central Health Plan Commercial |
$99.20
|
| Rate for Payer: Central Health Plan Commercial |
$18.40
|
| Rate for Payer: Cigna of CA HMO |
$14.72
|
| Rate for Payer: Cigna of CA HMO |
$79.36
|
| Rate for Payer: Cigna of CA PPO |
$17.02
|
| Rate for Payer: Cigna of CA PPO |
$91.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.11
|
| Rate for Payer: EPIC Health Plan Senior |
$4.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4.74
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$111.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.31
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.31
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
| Rate for Payer: Prime Health Services Medicare |
$4.57
|
| Rate for Payer: Prime Health Services Medicare |
$4.57
|
| Rate for Payer: Riverside University Health System MISP |
$4.74
|
| Rate for Payer: Riverside University Health System MISP |
$4.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.49
|
| Rate for Payer: United Healthcare All Other HMO |
$3.49
|
| Rate for Payer: United Healthcare All Other HMO |
$3.49
|
| Rate for Payer: United Healthcare HMO Rider |
$3.49
|
| Rate for Payer: United Healthcare HMO Rider |
$3.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Vantage Medical Group Senior |
$4.31
|
| Rate for Payer: Vantage Medical Group Senior |
$4.31
|
|
|
HC RETICULOCYTE COUNT, MANUAL
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 85044
|
| Hospital Charge Code |
900910063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Central Health Plan Commercial |
$99.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.60
|
| Rate for Payer: EPIC Health Plan Senior |
$49.60
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$111.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.80
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
|
|
HC RETINAL REPAIR LASER, PHOTOCOAG
|
Facility
|
OP
|
$9,408.00
|
|
|
Service Code
|
CPT 67105
|
| Hospital Charge Code |
988167105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$452.08 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,881.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$707.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,061.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$778.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$707.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,110.63
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$4,233.60
|
| Rate for Payer: Cash Price |
$4,233.60
|
| Rate for Payer: Cash Price |
$4,233.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,526.40
|
| Rate for Payer: Cigna of CA HMO |
$6,021.12
|
| Rate for Payer: Cigna of CA PPO |
$6,961.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,061.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$778.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$707.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,585.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,167.19
|
| Rate for Payer: EPIC Health Plan Senior |
$778.13
|
| Rate for Payer: Galaxy Health WC |
$7,996.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,644.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,467.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,160.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$452.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$707.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,974.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$499.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$990.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,881.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$947.90
|
| Rate for Payer: Multiplan Commercial |
$7,056.00
|
| Rate for Payer: Multiplan WC |
$1,110.63
|
| Rate for Payer: Networks By Design Commercial |
$6,115.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$707.39
|
| Rate for Payer: Preferred Health Network WC |
$1,133.30
|
| Rate for Payer: Prime Health Services Commercial |
$7,996.80
|
| Rate for Payer: Prime Health Services Medicare |
$749.83
|
| Rate for Payer: Prime Health Services WC |
$1,099.30
|
| Rate for Payer: Riverside University Health System MISP |
$778.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,644.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,704.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$707.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,061.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$778.13
|
| Rate for Payer: Vantage Medical Group Senior |
$707.39
|
|
|
HC RETINAL REPAIR LASER, PHOTOCOAG
|
Facility
|
IP
|
$9,408.00
|
|
|
Service Code
|
CPT 67105
|
| Hospital Charge Code |
988167105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,881.60 |
| Max. Negotiated Rate |
$8,467.20 |
| Rate for Payer: Adventist Health Commercial |
$1,881.60
|
| Rate for Payer: Cash Price |
$4,233.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,526.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,585.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,763.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,763.20
|
| Rate for Payer: Galaxy Health WC |
$7,996.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,644.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,467.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,974.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,550.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,881.60
|
| Rate for Payer: Multiplan Commercial |
$7,056.00
|
| Rate for Payer: Networks By Design Commercial |
$6,115.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,996.80
|
|
|
HC RETROBULBAR INJECTION
|
Facility
|
IP
|
$1,136.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
900567500
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$227.20 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Adventist Health Commercial |
$227.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Central Health Plan Commercial |
$908.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$795.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$454.40
|
| Rate for Payer: EPIC Health Plan Senior |
$454.40
|
| Rate for Payer: Galaxy Health WC |
$965.60
|
| Rate for Payer: Global Benefits Group Commercial |
$681.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,022.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$721.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$670.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.20
|
| Rate for Payer: Multiplan Commercial |
$852.00
|
| Rate for Payer: Networks By Design Commercial |
$738.40
|
| Rate for Payer: Prime Health Services Commercial |
$965.60
|
|
|
HC RETROBULBAR INJECTION
|
Facility
|
OP
|
$1,136.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
900567500
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$227.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$227.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$408.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.24
|
| 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 |
$605.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Central Health Plan Commercial |
$908.80
|
| Rate for Payer: Cigna of CA HMO |
$727.04
|
| Rate for Payer: Cigna of CA PPO |
$840.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$795.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$673.60
|
| Rate for Payer: EPIC Health Plan Senior |
$449.06
|
| Rate for Payer: Galaxy Health WC |
$965.60
|
| Rate for Payer: Global Benefits Group Commercial |
$681.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,022.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$669.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$256.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$408.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$721.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$283.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$571.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$547.04
|
| Rate for Payer: Multiplan Commercial |
$852.00
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$738.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$408.24
|
| Rate for Payer: Preferred Health Network WC |
$617.53
|
| Rate for Payer: Prime Health Services Commercial |
$965.60
|
| Rate for Payer: Prime Health Services Medicare |
$432.73
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Riverside University Health System MISP |
$449.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$681.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$568.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$408.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Vantage Medical Group Senior |
$408.24
|
|
|
HC RETROBULBAR INJECTION
|
Facility
|
IP
|
$1,136.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
900567500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$227.20 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Adventist Health Commercial |
$227.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Central Health Plan Commercial |
$908.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$795.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$454.40
|
| Rate for Payer: EPIC Health Plan Senior |
$454.40
|
| Rate for Payer: Galaxy Health WC |
$965.60
|
| Rate for Payer: Global Benefits Group Commercial |
$681.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,022.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$721.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$670.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.20
|
| Rate for Payer: Multiplan Commercial |
$852.00
|
| Rate for Payer: Networks By Design Commercial |
$738.40
|
| Rate for Payer: Prime Health Services Commercial |
$965.60
|
|
|
HC RETROBULBAR INJECTION
|
Facility
|
OP
|
$1,136.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
900567500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$227.20 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$227.20
|
| 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 |
$612.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$605.18
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Central Health Plan Commercial |
$908.80
|
| Rate for Payer: Cigna of CA HMO |
$727.04
|
| Rate for Payer: Cigna of CA PPO |
$840.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$795.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$673.60
|
| Rate for Payer: EPIC Health Plan Senior |
$449.06
|
| Rate for Payer: Galaxy Health WC |
$965.60
|
| Rate for Payer: Global Benefits Group Commercial |
$681.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,022.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$669.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$408.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$721.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$283.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$438.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$547.04
|
| Rate for Payer: Multiplan Commercial |
$852.00
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$738.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$408.24
|
| Rate for Payer: Preferred Health Network WC |
$617.53
|
| Rate for Payer: Prime Health Services Commercial |
$965.60
|
| Rate for Payer: Prime Health Services Medicare |
$432.73
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Riverside University Health System MISP |
$449.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$681.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$568.00
|
| Rate for Payer: United Healthcare All Other HMO |
$568.00
|
| Rate for Payer: United Healthcare HMO Rider |
$568.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$568.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$408.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Vantage Medical Group Senior |
$408.24
|
|
|
HC RETROBULBAR INJECTION
|
Facility
|
OP
|
$1,136.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
900567500
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$227.20 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$465.76
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$393.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$605.18
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Central Health Plan Commercial |
$908.80
|
| Rate for Payer: Cigna of CA HMO |
$727.04
|
| Rate for Payer: Cigna of CA PPO |
$840.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$795.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$673.60
|
| Rate for Payer: EPIC Health Plan Senior |
$449.06
|
| Rate for Payer: Galaxy Health WC |
$965.60
|
| Rate for Payer: Global Benefits Group Commercial |
$681.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,022.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$669.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$408.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$721.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$283.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$438.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$547.04
|
| Rate for Payer: Multiplan Commercial |
$852.00
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$738.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$408.24
|
| Rate for Payer: Preferred Health Network WC |
$617.53
|
| Rate for Payer: Prime Health Services Commercial |
$965.60
|
| Rate for Payer: Prime Health Services Medicare |
$432.73
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Riverside University Health System MISP |
$449.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$681.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$681.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$408.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Vantage Medical Group Senior |
$408.24
|
|
|
HC RETROBULBAR INJECTION
|
Facility
|
IP
|
$1,136.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
900567500
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$227.20 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Adventist Health Commercial |
$227.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Central Health Plan Commercial |
$908.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$795.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$454.40
|
| Rate for Payer: EPIC Health Plan Senior |
$454.40
|
| Rate for Payer: Galaxy Health WC |
$965.60
|
| Rate for Payer: Global Benefits Group Commercial |
$681.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,022.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$721.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$670.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.20
|
| Rate for Payer: Multiplan Commercial |
$852.00
|
| Rate for Payer: Networks By Design Commercial |
$738.40
|
| Rate for Payer: Prime Health Services Commercial |
$965.60
|
|
|
HC RETROGRADE DBL BLLN ENTSCPY
|
Facility
|
OP
|
$9,256.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745435
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,166.53 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,851.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,481.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,384.22
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$4,165.20
|
| Rate for Payer: Cash Price |
$4,165.20
|
| Rate for Payer: Cash Price |
$4,165.20
|
| Rate for Payer: Central Health Plan Commercial |
$7,404.80
|
| Rate for Payer: Cigna of CA HMO |
$5,923.84
|
| Rate for Payer: Cigna of CA PPO |
$6,849.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,479.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$7,867.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,553.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,330.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,877.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,851.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$6,942.00
|
| Rate for Payer: Networks By Design Commercial |
$6,016.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Prime Health Services Commercial |
$7,867.60
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,553.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,628.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC RETROGRADE DBL BLLN ENTSCPY
|
Facility
|
IP
|
$9,256.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745435
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,851.20 |
| Max. Negotiated Rate |
$8,330.40 |
| Rate for Payer: Adventist Health Commercial |
$1,851.20
|
| Rate for Payer: Cash Price |
$4,165.20
|
| Rate for Payer: Central Health Plan Commercial |
$7,404.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,479.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,702.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,702.40
|
| Rate for Payer: Galaxy Health WC |
$7,867.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,553.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,330.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,877.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,461.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,851.20
|
| Rate for Payer: Multiplan Commercial |
$6,942.00
|
| Rate for Payer: Networks By Design Commercial |
$6,016.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,867.60
|
|
|
HC RETROGRADE SNGL BLLN ENTSCPY
|
Facility
|
OP
|
$9,256.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745434
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,166.53 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,851.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,481.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,384.22
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$4,165.20
|
| Rate for Payer: Cash Price |
$4,165.20
|
| Rate for Payer: Cash Price |
$4,165.20
|
| Rate for Payer: Central Health Plan Commercial |
$7,404.80
|
| Rate for Payer: Cigna of CA HMO |
$5,923.84
|
| Rate for Payer: Cigna of CA PPO |
$6,849.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,479.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$7,867.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,553.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,330.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,877.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,851.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$6,942.00
|
| Rate for Payer: Networks By Design Commercial |
$6,016.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Prime Health Services Commercial |
$7,867.60
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,553.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,628.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC RETROGRADE SNGL BLLN ENTSCPY
|
Facility
|
IP
|
$9,256.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745434
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,851.20 |
| Max. Negotiated Rate |
$8,330.40 |
| Rate for Payer: Adventist Health Commercial |
$1,851.20
|
| Rate for Payer: Cash Price |
$4,165.20
|
| Rate for Payer: Central Health Plan Commercial |
$7,404.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,479.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,702.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,702.40
|
| Rate for Payer: Galaxy Health WC |
$7,867.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,553.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,330.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,877.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,461.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,851.20
|
| Rate for Payer: Multiplan Commercial |
$6,942.00
|
| Rate for Payer: Networks By Design Commercial |
$6,016.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,867.60
|
|
