|
HC EYE SERVICE ORPROCEDURE
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 92499
|
| Hospital Charge Code |
900501542
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$31.12 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna of CA HMO |
$157.44
|
| Rate for Payer: Cigna of CA PPO |
$182.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.01
|
| Rate for Payer: EPIC Health Plan Senior |
$31.12
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.70
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: Multiplan WC |
$49.59
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
| Rate for Payer: Prime Health Services WC |
$49.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.00
|
| Rate for Payer: United Healthcare All Other HMO |
$123.00
|
| Rate for Payer: United Healthcare HMO Rider |
$123.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$31.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC EYE SERVICE ORPROCEDURE
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 92499
|
| Hospital Charge Code |
900501542
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$209.10 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Senior |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.04
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
|
|
HC FAC DIR VEN LYMPHANGIOMATOSIS MAL THER
|
Facility
|
OP
|
$23,534.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
906811799
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$785.56 |
| Max. Negotiated Rate |
$20,003.90 |
| Rate for Payer: Adventist Health Commercial |
$4,706.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,452.23
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$10,590.30
|
| Rate for Payer: Cash Price |
$10,590.30
|
| Rate for Payer: Cash Price |
$10,590.30
|
| Rate for Payer: Cigna of CA HMO |
$15,061.76
|
| Rate for Payer: Cigna of CA PPO |
$17,415.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$20,003.90
|
| Rate for Payer: Global Benefits Group Commercial |
$14,120.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,697.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,648.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$18,827.20
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$15,297.10
|
| Rate for Payer: Prime Health Services Commercial |
$20,003.90
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,120.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| 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 |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC FAC DIR VEN LYMPHANGIOMATOSIS MAL THER
|
Facility
|
IP
|
$23,534.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
906811799
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,706.80 |
| Max. Negotiated Rate |
$20,003.90 |
| Rate for Payer: Adventist Health Commercial |
$4,706.80
|
| Rate for Payer: Cash Price |
$10,590.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,413.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9,413.60
|
| Rate for Payer: Galaxy Health WC |
$20,003.90
|
| Rate for Payer: Global Benefits Group Commercial |
$14,120.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,697.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,966.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,567.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,648.16
|
| Rate for Payer: Multiplan Commercial |
$18,827.20
|
| Rate for Payer: Networks By Design Commercial |
$15,297.10
|
| Rate for Payer: Prime Health Services Commercial |
$20,003.90
|
|
|
HC FACIAL BONES COMPLETE
|
Facility
|
IP
|
$1,193.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
909001101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$238.60 |
| Max. Negotiated Rate |
$1,014.05 |
| Rate for Payer: Adventist Health Commercial |
$238.60
|
| Rate for Payer: Cash Price |
$536.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$477.20
|
| Rate for Payer: EPIC Health Plan Senior |
$477.20
|
| Rate for Payer: Galaxy Health WC |
$1,014.05
|
| Rate for Payer: Global Benefits Group Commercial |
$715.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$795.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$454.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$738.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.32
|
| Rate for Payer: Multiplan Commercial |
$954.40
|
| Rate for Payer: Networks By Design Commercial |
$775.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,014.05
|
|
|
HC FACIAL BONES COMPLETE
|
Facility
|
OP
|
$1,193.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
909001101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.63 |
| Max. Negotiated Rate |
$1,014.05 |
| Rate for Payer: Adventist Health Commercial |
$238.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$782.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.43
|
| Rate for Payer: Blue Shield of California Commercial |
$730.12
|
| Rate for Payer: Blue Shield of California EPN |
$481.97
|
| Rate for Payer: Cash Price |
$536.85
|
| Rate for Payer: Cash Price |
$536.85
|
| Rate for Payer: Cigna of CA HMO |
$763.52
|
| Rate for Payer: Cigna of CA PPO |
$882.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,014.05
|
| Rate for Payer: Global Benefits Group Commercial |
$715.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$62.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$795.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$954.40
|
| Rate for Payer: Networks By Design Commercial |
$775.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,014.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$715.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$715.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC FACIAL BONES LIMITED
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
909001102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$676.60 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$318.40
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$492.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.04
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: Networks By Design Commercial |
$517.40
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
|
|
HC FACIAL BONES LIMITED
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
909001102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.65 |
| Max. Negotiated Rate |
$676.60 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$522.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.95
|
| Rate for Payer: Blue Shield of California Commercial |
$487.15
|
| Rate for Payer: Blue Shield of California EPN |
$321.58
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cigna of CA HMO |
$509.44
|
| Rate for Payer: Cigna of CA PPO |
$589.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: Networks By Design Commercial |
$517.40
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$477.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC FACTOR II (2) ASSAY
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
900910075
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$128.27 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.27
|
| Rate for Payer: Blue Shield of California Commercial |
$39.47
|
| Rate for Payer: Blue Shield of California EPN |
$26.08
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cigna of CA HMO |
$37.76
|
| Rate for Payer: Cigna of CA PPO |
$43.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.52
|
| Rate for Payer: EPIC Health Plan Senior |
$12.98
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.39
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.51
|
| Rate for Payer: United Healthcare All Other HMO |
$10.51
|
| Rate for Payer: United Healthcare HMO Rider |
$10.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Vantage Medical Group Senior |
$12.98
|
|
|
HC FACTOR II (2) ASSAY
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
900910075
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$105.40 |
| Max. Negotiated Rate |
$447.95 |
| Rate for Payer: Adventist Health Commercial |
$105.40
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.80
|
| Rate for Payer: EPIC Health Plan Senior |
$210.80
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$351.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$326.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.48
|
| Rate for Payer: Multiplan Commercial |
$421.60
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
|
|
HC FACTOR IX PTC
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
900910029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$188.05 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.05
|
| Rate for Payer: Blue Shield of California Commercial |
$112.39
|
| Rate for Payer: Blue Shield of California EPN |
$74.26
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna of CA HMO |
$107.52
|
| Rate for Payer: Cigna of CA PPO |
$124.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.70
|
| Rate for Payer: EPIC Health Plan Senior |
$19.04
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.51
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.43
|
| Rate for Payer: United Healthcare All Other HMO |
$15.43
|
| Rate for Payer: United Healthcare HMO Rider |
$15.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.94
|
| Rate for Payer: Vantage Medical Group Senior |
$19.04
|
|
|
HC FACTOR IX PTC
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
900910029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.00
|
| Rate for Payer: EPIC Health Plan Senior |
$192.00
|
| Rate for Payer: Galaxy Health WC |
$408.00
|
| Rate for Payer: Global Benefits Group Commercial |
$288.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$320.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$297.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.20
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: Networks By Design Commercial |
$312.00
|
| Rate for Payer: Prime Health Services Commercial |
$408.00
|
|
|
HC FACTOR V, ACG
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 85220
|
| Hospital Charge Code |
900910060
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$174.36 |
| Rate for Payer: Adventist Health Commercial |
$30.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$101.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.36
|
| Rate for Payer: Blue Shield of California Commercial |
$103.03
|
| Rate for Payer: Blue Shield of California EPN |
$68.07
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna of CA HMO |
$98.56
|
| Rate for Payer: Cigna of CA PPO |
$113.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.83
|
| Rate for Payer: EPIC Health Plan Senior |
$17.65
|
| Rate for Payer: Galaxy Health WC |
$130.90
|
| Rate for Payer: Global Benefits Group Commercial |
$92.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.65
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: Networks By Design Commercial |
$100.10
|
| Rate for Payer: Prime Health Services Commercial |
$130.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$92.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$92.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.30
|
| Rate for Payer: United Healthcare All Other HMO |
$14.30
|
| Rate for Payer: United Healthcare HMO Rider |
$14.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.41
|
| Rate for Payer: Vantage Medical Group Senior |
$17.65
|
|
|
HC FACTOR V, ACG
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 85220
|
| Hospital Charge Code |
900910060
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$273.70 |
| Rate for Payer: Adventist Health Commercial |
$64.40
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.80
|
| Rate for Payer: EPIC Health Plan Senior |
$128.80
|
| Rate for Payer: Galaxy Health WC |
$273.70
|
| Rate for Payer: Global Benefits Group Commercial |
$193.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$214.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$199.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.28
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: Networks By Design Commercial |
$209.30
|
| Rate for Payer: Prime Health Services Commercial |
$273.70
|
|
|
HC FACTOR VIII AHG
|
Facility
|
IP
|
$364.00
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
900910028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$309.40 |
| Rate for Payer: Adventist Health Commercial |
$72.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.60
|
| Rate for Payer: EPIC Health Plan Senior |
$145.60
|
| Rate for Payer: Galaxy Health WC |
$309.40
|
| Rate for Payer: Global Benefits Group Commercial |
$218.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$242.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$225.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.36
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: Networks By Design Commercial |
$236.60
|
| Rate for Payer: Prime Health Services Commercial |
$309.40
|
|
|
HC FACTOR VIII AHG
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
900910028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$176.88 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.88
|
| Rate for Payer: Blue Shield of California Commercial |
$104.36
|
| Rate for Payer: Blue Shield of California EPN |
$68.95
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.16
|
| Rate for Payer: EPIC Health Plan Senior |
$17.90
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.99
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO |
$14.50
|
| Rate for Payer: United Healthcare HMO Rider |
$14.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
|
|
HC FACTOR VII, (PROCONVERTIN)
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
900910027
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$378.25 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$275.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.80
|
| Rate for Payer: Multiplan Commercial |
$356.00
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
|
|
HC FACTOR VII, (PROCONVERTIN)
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
900910027
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$176.88 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.88
|
| Rate for Payer: Blue Shield of California Commercial |
$104.36
|
| Rate for Payer: Blue Shield of California EPN |
$68.95
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.16
|
| Rate for Payer: EPIC Health Plan Senior |
$17.90
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.99
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO |
$14.50
|
| Rate for Payer: United Healthcare HMO Rider |
$14.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
|
|
HC FACTOR V LEIDEN MUTATION
|
Facility
|
IP
|
$727.00
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
900912323
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$145.40 |
| Max. Negotiated Rate |
$617.95 |
| Rate for Payer: Adventist Health Commercial |
$145.40
|
| Rate for Payer: Cash Price |
$327.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.80
|
| Rate for Payer: EPIC Health Plan Senior |
$290.80
|
| Rate for Payer: Galaxy Health WC |
$617.95
|
| Rate for Payer: Global Benefits Group Commercial |
$436.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$484.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$450.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.48
|
| Rate for Payer: Multiplan Commercial |
$581.60
|
| Rate for Payer: Networks By Design Commercial |
$472.55
|
| Rate for Payer: Prime Health Services Commercial |
$617.95
|
|
|
HC FACTOR V LEIDEN MUTATION
|
Facility
|
OP
|
$386.00
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
900912323
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$59.43 |
| Max. Negotiated Rate |
$397.98 |
| Rate for Payer: Adventist Health Commercial |
$77.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$253.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$110.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$397.98
|
| Rate for Payer: Blue Shield of California Commercial |
$258.23
|
| Rate for Payer: Blue Shield of California EPN |
$170.61
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna of CA HMO |
$247.04
|
| Rate for Payer: Cigna of CA PPO |
$285.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.05
|
| Rate for Payer: EPIC Health Plan Senior |
$73.37
|
| Rate for Payer: Galaxy Health WC |
$328.10
|
| Rate for Payer: Global Benefits Group Commercial |
$231.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$257.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.32
|
| Rate for Payer: Multiplan Commercial |
$308.80
|
| Rate for Payer: Networks By Design Commercial |
$250.90
|
| Rate for Payer: Prime Health Services Commercial |
$328.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$231.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$231.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.43
|
| Rate for Payer: United Healthcare All Other HMO |
$59.43
|
| Rate for Payer: United Healthcare HMO Rider |
$59.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$73.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.71
|
| Rate for Payer: Vantage Medical Group Senior |
$73.37
|
|
|
HC FACTOR V LEIDEN MUTATN B INDI
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
900913619
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.43 |
| Max. Negotiated Rate |
$397.98 |
| Rate for Payer: Adventist Health Commercial |
$86.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$282.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$110.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$397.98
|
| Rate for Payer: Blue Shield of California Commercial |
$288.34
|
| Rate for Payer: Blue Shield of California EPN |
$190.50
|
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: Cigna of CA HMO |
$275.84
|
| Rate for Payer: Cigna of CA PPO |
$318.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.05
|
| Rate for Payer: EPIC Health Plan Senior |
$73.37
|
| Rate for Payer: Galaxy Health WC |
$366.35
|
| Rate for Payer: Global Benefits Group Commercial |
$258.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$287.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.32
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: Networks By Design Commercial |
$280.15
|
| Rate for Payer: Prime Health Services Commercial |
$366.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$258.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$258.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.43
|
| Rate for Payer: United Healthcare All Other HMO |
$59.43
|
| Rate for Payer: United Healthcare HMO Rider |
$59.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$73.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.71
|
| Rate for Payer: Vantage Medical Group Senior |
$73.37
|
|
|
HC FACTOR V LEIDEN MUTATN B INDI
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
900913619
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$86.20 |
| Max. Negotiated Rate |
$366.35 |
| Rate for Payer: Adventist Health Commercial |
$86.20
|
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.40
|
| Rate for Payer: EPIC Health Plan Senior |
$172.40
|
| Rate for Payer: Galaxy Health WC |
$366.35
|
| Rate for Payer: Global Benefits Group Commercial |
$258.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$287.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.44
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: Networks By Design Commercial |
$280.15
|
| Rate for Payer: Prime Health Services Commercial |
$366.35
|
|
|
HC FACTOR XII HAGEMANN
|
Facility
|
IP
|
$512.00
|
|
|
Service Code
|
CPT 85280
|
| Hospital Charge Code |
900910062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$102.40 |
| Max. Negotiated Rate |
$435.20 |
| Rate for Payer: Adventist Health Commercial |
$102.40
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.80
|
| Rate for Payer: EPIC Health Plan Senior |
$204.80
|
| Rate for Payer: Galaxy Health WC |
$435.20
|
| Rate for Payer: Global Benefits Group Commercial |
$307.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$341.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$316.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.88
|
| Rate for Payer: Multiplan Commercial |
$409.60
|
| Rate for Payer: Networks By Design Commercial |
$332.80
|
| Rate for Payer: Prime Health Services Commercial |
$435.20
|
|
|
HC FACTOR XII HAGEMANN
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 85280
|
| Hospital Charge Code |
900910062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$191.11 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.11
|
| Rate for Payer: Blue Shield of California Commercial |
$46.83
|
| Rate for Payer: Blue Shield of California EPN |
$30.94
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.12
|
| Rate for Payer: EPIC Health Plan Senior |
$19.35
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.93
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.68
|
| Rate for Payer: United Healthcare All Other HMO |
$15.68
|
| Rate for Payer: United Healthcare HMO Rider |
$15.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC FACTOR XIII ANTIGEN
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900912036
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$41.65 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.76
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
|
