|
HC SMOKING CESSATION GT 10 MIN
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
905199407
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$43.46
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.66
|
| Rate for Payer: Blue Shield of California Commercial |
$67.20
|
| Rate for Payer: Blue Shield of California EPN |
$42.29
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: Cigna of CA HMO |
$67.84
|
| Rate for Payer: Cigna of CA PPO |
$78.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.51
|
| Rate for Payer: EPIC Health Plan Senior |
$53.01
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$79.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.57
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.19
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: Prime Health Services Medicare |
$51.08
|
| Rate for Payer: Riverside University Health System MISP |
$53.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Vantage Medical Group Senior |
$48.19
|
|
|
HC SMOKING CESSATION GT 10 MIN
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
905199407
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
|
|
HC SMOKING/TOBACCO INTENS >10 MIN
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
900201907
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$31.80 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$65.19
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$76.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.49
|
| Rate for Payer: Blue Shield of California Commercial |
$100.81
|
| Rate for Payer: Blue Shield of California EPN |
$63.44
|
| Rate for Payer: Cash Price |
$71.55
|
| Rate for Payer: Cash Price |
$71.55
|
| Rate for Payer: Cash Price |
$71.55
|
| Rate for Payer: Central Health Plan Commercial |
$127.20
|
| Rate for Payer: Cigna of CA HMO |
$101.76
|
| Rate for Payer: Cigna of CA PPO |
$117.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$111.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.51
|
| Rate for Payer: EPIC Health Plan Senior |
$53.01
|
| Rate for Payer: Galaxy Health WC |
$135.15
|
| Rate for Payer: Global Benefits Group Commercial |
$95.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$143.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$79.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$100.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.57
|
| Rate for Payer: Multiplan Commercial |
$119.25
|
| Rate for Payer: Networks By Design Commercial |
$103.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.19
|
| Rate for Payer: Prime Health Services Commercial |
$135.15
|
| Rate for Payer: Prime Health Services Medicare |
$51.08
|
| Rate for Payer: Riverside University Health System MISP |
$53.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$95.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$95.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Vantage Medical Group Senior |
$48.19
|
|
|
HC SMOKING/TOBACCO INTENS >10 MIN
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
900201907
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$31.80 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Adventist Health Commercial |
$31.80
|
| Rate for Payer: Cash Price |
$71.55
|
| Rate for Payer: Central Health Plan Commercial |
$127.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$111.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.60
|
| Rate for Payer: EPIC Health Plan Senior |
$63.60
|
| Rate for Payer: Galaxy Health WC |
$135.15
|
| Rate for Payer: Global Benefits Group Commercial |
$95.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$143.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$100.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.80
|
| Rate for Payer: Multiplan Commercial |
$119.25
|
| Rate for Payer: Networks By Design Commercial |
$103.35
|
| Rate for Payer: Prime Health Services Commercial |
$135.15
|
|
|
HC SMOKING/TOBACCO VISIT 3-10 MIN
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
900201906
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$17.91 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$43.46
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.66
|
| Rate for Payer: Blue Shield of California Commercial |
$67.20
|
| Rate for Payer: Blue Shield of California EPN |
$42.29
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: Cigna of CA HMO |
$67.84
|
| Rate for Payer: Cigna of CA PPO |
$78.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.51
|
| Rate for Payer: EPIC Health Plan Senior |
$53.01
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$79.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.57
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.19
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: Prime Health Services Medicare |
$51.08
|
| Rate for Payer: Riverside University Health System MISP |
$53.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Vantage Medical Group Senior |
$48.19
|
|
|
HC SMOKING/TOBACCO VISIT 3-10 MIN
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
900201906
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
|
|
HC SM (SMITH) ANTIBODY
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913523
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$154.02 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$110.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$110.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.02
|
| Rate for Payer: Blue Shield of California Commercial |
$27.72
|
| Rate for Payer: Blue Shield of California Commercial |
$107.73
|
| Rate for Payer: Blue Shield of California EPN |
$17.47
|
| Rate for Payer: Blue Shield of California EPN |
$67.89
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Central Health Plan Commercial |
$136.80
|
| Rate for Payer: Central Health Plan Commercial |
$35.20
|
| Rate for Payer: Cigna of CA HMO |
$28.16
|
| Rate for Payer: Cigna of CA HMO |
$109.44
|
| Rate for Payer: Cigna of CA PPO |
$32.56
|
| Rate for Payer: Cigna of CA PPO |
$126.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SM (SMITH) ANTIBODY
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913523
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Central Health Plan Commercial |
$136.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.20
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
|
|
HC SNGL AXIS ANKLE/FLEXIBLE KEEL
|
Facility
|
IP
|
$654.00
|
|
|
Service Code
|
CPT L5975
|
| Hospital Charge Code |
915355975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.80 |
| Max. Negotiated Rate |
$588.60 |
| Rate for Payer: Adventist Health Commercial |
$130.80
|
| Rate for Payer: Blue Shield of California Commercial |
$524.51
|
| Rate for Payer: Blue Shield of California EPN |
$329.62
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Central Health Plan Commercial |
$523.20
|
| Rate for Payer: Cigna of CA HMO |
$457.80
|
| Rate for Payer: Cigna of CA PPO |
$457.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$457.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.60
|
| Rate for Payer: EPIC Health Plan Senior |
$261.60
|
| Rate for Payer: Galaxy Health WC |
$555.90
|
| Rate for Payer: Global Benefits Group Commercial |
$392.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$588.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$415.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$385.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.80
|
| Rate for Payer: Multiplan Commercial |
$490.50
|
| Rate for Payer: Networks By Design Commercial |
$425.10
|
| Rate for Payer: Prime Health Services Commercial |
$555.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.45
|
| Rate for Payer: United Healthcare All Other HMO |
$238.91
|
| Rate for Payer: United Healthcare HMO Rider |
$233.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.19
|
|
|
HC SNGL AXIS ANKLE/FLEXIBLE KEEL
|
Facility
|
OP
|
$654.00
|
|
|
Service Code
|
CPT L5975
|
| Hospital Charge Code |
915355975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$214.19 |
| Max. Negotiated Rate |
$588.60 |
| Rate for Payer: Adventist Health Commercial |
$268.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$359.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$490.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$380.43
|
| Rate for Payer: Blue Shield of California Commercial |
$524.51
|
| Rate for Payer: Blue Shield of California EPN |
$329.62
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Central Health Plan Commercial |
$523.20
|
| Rate for Payer: Cigna of CA HMO |
$457.80
|
| Rate for Payer: Cigna of CA PPO |
$457.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$555.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$457.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.60
|
| Rate for Payer: EPIC Health Plan Senior |
$261.60
|
| Rate for Payer: Galaxy Health WC |
$555.90
|
| Rate for Payer: Global Benefits Group Commercial |
$392.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$588.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$356.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$415.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$393.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$385.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$457.80
|
| Rate for Payer: Multiplan Commercial |
$490.50
|
| Rate for Payer: Networks By Design Commercial |
$327.00
|
| Rate for Payer: Prime Health Services Commercial |
$555.90
|
| Rate for Payer: Riverside University Health System MISP |
$261.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$392.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$392.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.45
|
| Rate for Payer: United Healthcare All Other HMO |
$238.91
|
| Rate for Payer: United Healthcare HMO Rider |
$233.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$555.90
|
| Rate for Payer: Vantage Medical Group Senior |
$555.90
|
|
|
HC SNGL AXIS ANKLE/FLEXIBLE KEEL
|
Facility
|
OP
|
$654.00
|
|
|
Service Code
|
CPT L5975
|
| Hospital Charge Code |
905355975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$214.19 |
| Max. Negotiated Rate |
$588.60 |
| Rate for Payer: Adventist Health Commercial |
$268.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$359.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$490.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$380.43
|
| Rate for Payer: Blue Shield of California Commercial |
$524.51
|
| Rate for Payer: Blue Shield of California EPN |
$329.62
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Central Health Plan Commercial |
$523.20
|
| Rate for Payer: Cigna of CA HMO |
$457.80
|
| Rate for Payer: Cigna of CA PPO |
$457.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$555.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$457.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.60
|
| Rate for Payer: EPIC Health Plan Senior |
$261.60
|
| Rate for Payer: Galaxy Health WC |
$555.90
|
| Rate for Payer: Global Benefits Group Commercial |
$392.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$588.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$356.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$415.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$393.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$385.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$457.80
|
| Rate for Payer: Multiplan Commercial |
$490.50
|
| Rate for Payer: Networks By Design Commercial |
$327.00
|
| Rate for Payer: Prime Health Services Commercial |
$555.90
|
| Rate for Payer: Riverside University Health System MISP |
$261.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$392.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$392.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.45
|
| Rate for Payer: United Healthcare All Other HMO |
$238.91
|
| Rate for Payer: United Healthcare HMO Rider |
$233.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$555.90
|
| Rate for Payer: Vantage Medical Group Senior |
$555.90
|
|
|
HC SNGL AXIS ANKLE/FLEXIBLE KEEL
|
Facility
|
IP
|
$654.00
|
|
|
Service Code
|
CPT L5975
|
| Hospital Charge Code |
905355975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.80 |
| Max. Negotiated Rate |
$588.60 |
| Rate for Payer: Adventist Health Commercial |
$130.80
|
| Rate for Payer: Blue Shield of California Commercial |
$524.51
|
| Rate for Payer: Blue Shield of California EPN |
$329.62
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Central Health Plan Commercial |
$523.20
|
| Rate for Payer: Cigna of CA HMO |
$457.80
|
| Rate for Payer: Cigna of CA PPO |
$457.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$457.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.60
|
| Rate for Payer: EPIC Health Plan Senior |
$261.60
|
| Rate for Payer: Galaxy Health WC |
$555.90
|
| Rate for Payer: Global Benefits Group Commercial |
$392.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$588.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$415.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$385.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.80
|
| Rate for Payer: Multiplan Commercial |
$490.50
|
| Rate for Payer: Networks By Design Commercial |
$425.10
|
| Rate for Payer: Prime Health Services Commercial |
$555.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.45
|
| Rate for Payer: United Healthcare All Other HMO |
$238.91
|
| Rate for Payer: United Healthcare HMO Rider |
$233.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.19
|
|
|
HC SNRE ENDOS 2.3MMX240CM
|
Facility
|
IP
|
$163.88
|
|
| Hospital Charge Code |
900100349
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.78 |
| Max. Negotiated Rate |
$147.49 |
| Rate for Payer: Adventist Health Commercial |
$32.78
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Central Health Plan Commercial |
$131.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$114.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.55
|
| Rate for Payer: EPIC Health Plan Senior |
$65.55
|
| Rate for Payer: Galaxy Health WC |
$139.30
|
| Rate for Payer: Global Benefits Group Commercial |
$98.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$147.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$104.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$96.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.78
|
| Rate for Payer: Multiplan Commercial |
$122.91
|
| Rate for Payer: Networks By Design Commercial |
$106.52
|
| Rate for Payer: Prime Health Services Commercial |
$139.30
|
|
|
HC SNRE ENDOS 2.3MMX240CM
|
Facility
|
OP
|
$163.88
|
|
| Hospital Charge Code |
900100349
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.78 |
| Max. Negotiated Rate |
$147.49 |
| Rate for Payer: Adventist Health Commercial |
$32.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$139.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$90.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.33
|
| Rate for Payer: Blue Shield of California Commercial |
$103.90
|
| Rate for Payer: Blue Shield of California EPN |
$65.39
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Central Health Plan Commercial |
$131.10
|
| Rate for Payer: Cigna of CA HMO |
$104.88
|
| Rate for Payer: Cigna of CA PPO |
$121.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$139.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$139.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$114.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.55
|
| Rate for Payer: EPIC Health Plan Senior |
$65.55
|
| Rate for Payer: Galaxy Health WC |
$139.30
|
| Rate for Payer: Global Benefits Group Commercial |
$98.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$147.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$104.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$96.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$114.72
|
| Rate for Payer: Multiplan Commercial |
$122.91
|
| Rate for Payer: Networks By Design Commercial |
$106.52
|
| Rate for Payer: Prime Health Services Commercial |
$139.30
|
| Rate for Payer: Riverside University Health System MISP |
$65.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.94
|
| Rate for Payer: United Healthcare All Other HMO |
$81.94
|
| Rate for Payer: United Healthcare HMO Rider |
$81.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$139.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$139.30
|
| Rate for Payer: Vantage Medical Group Senior |
$139.30
|
|
|
HC SNRE POLYPECTOMY 3X4.5CM
|
Facility
|
IP
|
$522.01
|
|
| Hospital Charge Code |
900100353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$469.81 |
| Rate for Payer: Adventist Health Commercial |
$104.40
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Central Health Plan Commercial |
$417.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$365.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.80
|
| Rate for Payer: EPIC Health Plan Senior |
$208.80
|
| Rate for Payer: Galaxy Health WC |
$443.71
|
| Rate for Payer: Global Benefits Group Commercial |
$313.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$469.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$331.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$307.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Multiplan Commercial |
$391.51
|
| Rate for Payer: Networks By Design Commercial |
$339.31
|
| Rate for Payer: Prime Health Services Commercial |
$443.71
|
|
|
HC SNRE POLYPECTOMY 3X4.5CM
|
Facility
|
OP
|
$522.01
|
|
| Hospital Charge Code |
900100353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$469.81 |
| Rate for Payer: Adventist Health Commercial |
$104.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$317.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$443.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$287.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$252.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$303.65
|
| Rate for Payer: Blue Shield of California Commercial |
$330.95
|
| Rate for Payer: Blue Shield of California EPN |
$208.28
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Central Health Plan Commercial |
$417.61
|
| Rate for Payer: Cigna of CA HMO |
$334.09
|
| Rate for Payer: Cigna of CA PPO |
$386.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$443.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$443.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$443.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$365.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.80
|
| Rate for Payer: EPIC Health Plan Senior |
$208.80
|
| Rate for Payer: Galaxy Health WC |
$443.71
|
| Rate for Payer: Global Benefits Group Commercial |
$313.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$469.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$331.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$307.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$365.41
|
| Rate for Payer: Multiplan Commercial |
$391.51
|
| Rate for Payer: Networks By Design Commercial |
$339.31
|
| Rate for Payer: Prime Health Services Commercial |
$443.71
|
| Rate for Payer: Riverside University Health System MISP |
$208.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$313.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$313.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$261.00
|
| Rate for Payer: United Healthcare HMO Rider |
$261.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$261.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$443.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$443.71
|
| Rate for Payer: Vantage Medical Group Senior |
$443.71
|
|
|
HC SOA 55284 CYSTICER AB IGG
|
Facility
|
OP
|
$59.10
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900914796
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$132.78 |
| Rate for Payer: Adventist Health Commercial |
$11.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.78
|
| Rate for Payer: Blue Shield of California Commercial |
$37.23
|
| Rate for Payer: Blue Shield of California EPN |
$23.46
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Central Health Plan Commercial |
$47.28
|
| Rate for Payer: Cigna of CA HMO |
$37.82
|
| Rate for Payer: Cigna of CA PPO |
$43.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.47
|
| Rate for Payer: EPIC Health Plan Senior |
$14.31
|
| Rate for Payer: Galaxy Health WC |
$50.23
|
| Rate for Payer: Global Benefits Group Commercial |
$35.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.19
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.43
|
| Rate for Payer: Multiplan Commercial |
$44.33
|
| Rate for Payer: Networks By Design Commercial |
$38.41
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.01
|
| Rate for Payer: Prime Health Services Commercial |
$50.23
|
| Rate for Payer: Prime Health Services Medicare |
$13.79
|
| Rate for Payer: Riverside University Health System MISP |
$14.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.54
|
| Rate for Payer: United Healthcare All Other HMO |
$10.54
|
| Rate for Payer: United Healthcare HMO Rider |
$10.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13.01
|
|
|
HC SOA 55284 CYSTICER AB IGG
|
Facility
|
IP
|
$59.10
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900914796
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.82 |
| Max. Negotiated Rate |
$53.19 |
| Rate for Payer: Adventist Health Commercial |
$11.82
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Central Health Plan Commercial |
$47.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.64
|
| Rate for Payer: EPIC Health Plan Senior |
$23.64
|
| Rate for Payer: Galaxy Health WC |
$50.23
|
| Rate for Payer: Global Benefits Group Commercial |
$35.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.82
|
| Rate for Payer: Multiplan Commercial |
$44.33
|
| Rate for Payer: Networks By Design Commercial |
$38.41
|
| Rate for Payer: Prime Health Services Commercial |
$50.23
|
|
|
HC SOA 837 CEL MODY8 MUT
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914773
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Commercial |
$150.00
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Central Health Plan Commercial |
$600.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$300.00
|
| Rate for Payer: Galaxy Health WC |
$637.50
|
| Rate for Payer: Global Benefits Group Commercial |
$450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$675.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$476.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$442.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.00
|
| Rate for Payer: Multiplan Commercial |
$562.50
|
| Rate for Payer: Networks By Design Commercial |
$487.50
|
| Rate for Payer: Prime Health Services Commercial |
$637.50
|
|
|
HC SOA 837 CEL MODY8 MUT
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914773
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$1,513.57 |
| Rate for Payer: Adventist Health Commercial |
$150.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$185.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$368.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,088.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,513.57
|
| Rate for Payer: Blue Shield of California Commercial |
$472.50
|
| Rate for Payer: Blue Shield of California EPN |
$297.75
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Central Health Plan Commercial |
$600.00
|
| Rate for Payer: Cigna of CA HMO |
$480.00
|
| Rate for Payer: Cigna of CA PPO |
$555.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$185.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.58
|
| Rate for Payer: EPIC Health Plan Senior |
$203.72
|
| Rate for Payer: Galaxy Health WC |
$637.50
|
| Rate for Payer: Global Benefits Group Commercial |
$450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$675.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$303.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$318.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$185.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$476.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$351.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$248.17
|
| Rate for Payer: Multiplan Commercial |
$562.50
|
| Rate for Payer: Networks By Design Commercial |
$487.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$185.20
|
| Rate for Payer: Prime Health Services Commercial |
$637.50
|
| Rate for Payer: Prime Health Services Medicare |
$196.31
|
| Rate for Payer: Riverside University Health System MISP |
$203.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$450.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$450.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.01
|
| Rate for Payer: United Healthcare All Other HMO |
$150.01
|
| Rate for Payer: United Healthcare HMO Rider |
$150.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$185.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Vantage Medical Group Senior |
$185.20
|
|
|
HC SOA 885 MONOGEN EVL 81405
|
Facility
|
OP
|
$1,053.75
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914774
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$2,383.56 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Adventist Health Medi-Cal |
$301.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$644.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$331.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$301.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,714.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,383.56
|
| Rate for Payer: Blue Shield of California Commercial |
$663.86
|
| Rate for Payer: Blue Shield of California EPN |
$418.34
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Central Health Plan Commercial |
$843.00
|
| Rate for Payer: Cigna of CA HMO |
$674.40
|
| Rate for Payer: Cigna of CA PPO |
$779.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$452.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$331.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$301.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$737.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.23
|
| Rate for Payer: EPIC Health Plan Senior |
$331.49
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$948.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$494.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$518.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$301.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$669.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$572.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$421.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$403.81
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$301.35
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
| Rate for Payer: Prime Health Services Medicare |
$319.43
|
| Rate for Payer: Riverside University Health System MISP |
$331.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$632.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$632.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$244.10
|
| Rate for Payer: United Healthcare All Other HMO |
$244.10
|
| Rate for Payer: United Healthcare HMO Rider |
$244.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$244.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$301.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$331.49
|
| Rate for Payer: Vantage Medical Group Senior |
$301.35
|
|
|
HC SOA 885 MONOGEN EVL 81405
|
Facility
|
IP
|
$1,053.75
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914774
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$948.38 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Central Health Plan Commercial |
$843.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$737.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.50
|
| Rate for Payer: EPIC Health Plan Senior |
$421.50
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$948.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$669.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$621.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.75
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
|
|
HC SOA 885 MONOGEN EVL 81406
|
Facility
|
IP
|
$1,053.75
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914775
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$948.38 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Central Health Plan Commercial |
$843.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$737.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.50
|
| Rate for Payer: EPIC Health Plan Senior |
$421.50
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$948.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$669.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$621.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.75
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
|
|
HC SOA 885 MONOGEN EVL 81406
|
Facility
|
OP
|
$1,053.75
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914775
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$2,431.36 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Adventist Health Medi-Cal |
$282.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$366.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$282.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,748.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,431.36
|
| Rate for Payer: Blue Shield of California Commercial |
$663.86
|
| Rate for Payer: Blue Shield of California EPN |
$418.34
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Central Health Plan Commercial |
$843.00
|
| Rate for Payer: Cigna of CA HMO |
$674.40
|
| Rate for Payer: Cigna of CA PPO |
$779.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$424.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$282.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$737.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$466.75
|
| Rate for Payer: EPIC Health Plan Senior |
$311.17
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$948.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$463.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$486.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$282.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$669.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$537.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$396.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$379.06
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$282.88
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
| Rate for Payer: Prime Health Services Medicare |
$299.85
|
| Rate for Payer: Riverside University Health System MISP |
$311.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$632.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$632.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$229.13
|
| Rate for Payer: United Healthcare All Other HMO |
$229.13
|
| Rate for Payer: United Healthcare HMO Rider |
$229.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$282.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: Vantage Medical Group Senior |
$282.88
|
|
|
HC SOA 885 MONOGEN EVL 81479
|
Facility
|
OP
|
$1,053.75
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914776
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$948.38 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$895.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$579.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$790.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$510.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$612.97
|
| Rate for Payer: Blue Shield of California Commercial |
$663.86
|
| Rate for Payer: Blue Shield of California EPN |
$418.34
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Central Health Plan Commercial |
$843.00
|
| Rate for Payer: Cigna of CA HMO |
$674.40
|
| Rate for Payer: Cigna of CA PPO |
$779.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$895.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$895.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$895.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$737.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.50
|
| Rate for Payer: EPIC Health Plan Senior |
$421.50
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$948.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$669.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$621.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$737.62
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
| Rate for Payer: Riverside University Health System MISP |
$421.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$632.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$632.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$526.88
|
| Rate for Payer: United Healthcare All Other HMO |
$526.88
|
| Rate for Payer: United Healthcare HMO Rider |
$526.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$526.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$895.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$895.69
|
| Rate for Payer: Vantage Medical Group Senior |
$895.69
|
|
