|
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 |
$289.85
|
| 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
|
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 |
$264.00
|
| 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 IX PTC
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
900910029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.83
|
| 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 |
$321.12
|
| Rate for Payer: Blue Shield of California EPN |
$212.16
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna of CA HMO |
$307.20
|
| Rate for Payer: Cigna of CA PPO |
$355.20
|
| 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 |
$408.00
|
| Rate for Payer: Global Benefits Group Commercial |
$288.00
|
| 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 |
$320.16
|
| 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 |
$115.20
|
| 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 |
$384.00
|
| Rate for Payer: Networks By Design Commercial |
$312.00
|
| Rate for Payer: Prime Health Services Commercial |
$408.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$288.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$288.00
|
| 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 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 |
$177.10
|
| 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 V, ACG
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT 85220
|
| Hospital Charge Code |
900910060
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$273.70 |
| Rate for Payer: Adventist Health Commercial |
$64.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.20
|
| 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 |
$215.42
|
| Rate for Payer: Blue Shield of California EPN |
$142.32
|
| Rate for Payer: Cash Price |
$177.10
|
| Rate for Payer: Cash Price |
$177.10
|
| Rate for Payer: Cigna of CA HMO |
$206.08
|
| Rate for Payer: Cigna of CA PPO |
$238.28
|
| 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 |
$273.70
|
| Rate for Payer: Global Benefits Group Commercial |
$193.20
|
| 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 |
$214.77
|
| 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 |
$77.28
|
| 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 |
$257.60
|
| Rate for Payer: Networks By Design Commercial |
$209.30
|
| Rate for Payer: Prime Health Services Commercial |
$273.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$193.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$193.20
|
| 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 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 |
$200.20
|
| 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
|
$364.00
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
900910028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$309.40 |
| Rate for Payer: Adventist Health Commercial |
$72.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$238.75
|
| 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 |
$243.52
|
| Rate for Payer: Blue Shield of California EPN |
$160.89
|
| Rate for Payer: Cash Price |
$200.20
|
| Rate for Payer: Cash Price |
$200.20
|
| Rate for Payer: Cigna of CA HMO |
$232.96
|
| Rate for Payer: Cigna of CA PPO |
$269.36
|
| 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 |
$309.40
|
| Rate for Payer: Global Benefits Group Commercial |
$218.40
|
| 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 |
$242.79
|
| 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 |
$87.36
|
| 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 |
$291.20
|
| Rate for Payer: Networks By Design Commercial |
$236.60
|
| Rate for Payer: Prime Health Services Commercial |
$309.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$218.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$218.40
|
| 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 |
$244.75
|
| 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
|
$445.00
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
900910027
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$378.25 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.88
|
| 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 |
$297.70
|
| Rate for Payer: Blue Shield of California EPN |
$196.69
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: Cigna of CA HMO |
$284.80
|
| Rate for Payer: Cigna of CA PPO |
$329.30
|
| 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 |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| 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 |
$296.81
|
| 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 |
$106.80
|
| 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 |
$356.00
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$267.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$267.00
|
| 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
|
OP
|
$727.00
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
900912323
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$59.43 |
| Max. Negotiated Rate |
$617.95 |
| Rate for Payer: Adventist Health Commercial |
$145.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$476.84
|
| 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 |
$486.36
|
| Rate for Payer: Blue Shield of California EPN |
$321.33
|
| Rate for Payer: Cash Price |
$399.85
|
| Rate for Payer: Cash Price |
$399.85
|
| Rate for Payer: Cigna of CA HMO |
$465.28
|
| Rate for Payer: Cigna of CA PPO |
$537.98
|
| 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 |
$617.95
|
| Rate for Payer: Global Benefits Group Commercial |
$436.20
|
| 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 |
$484.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.48
|
| 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 |
$581.60
|
| Rate for Payer: Networks By Design Commercial |
$472.55
|
| Rate for Payer: Prime Health Services Commercial |
$617.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$436.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$436.20
|
| 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 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 |
$399.85
|
| 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 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: EPIC Health Plan Senior |
$73.37
|
| Rate for Payer: Galaxy Health WC |
$366.35
|
| 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 |
$237.05
|
| Rate for Payer: Cash Price |
$237.05
|
| 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: 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 |
$237.05
|
| 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
|
OP
|
$512.00
|
|
|
Service Code
|
CPT 85280
|
| Hospital Charge Code |
900910062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$435.20 |
| Rate for Payer: Adventist Health Commercial |
$102.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$335.82
|
| 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 |
$342.53
|
| Rate for Payer: Blue Shield of California EPN |
$226.30
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cigna of CA HMO |
$327.68
|
| Rate for Payer: Cigna of CA PPO |
$378.88
|
| 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 |
$435.20
|
| Rate for Payer: Global Benefits Group Commercial |
$307.20
|
| 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 |
$341.50
|
| 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 |
$122.88
|
| 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 |
$409.60
|
| Rate for Payer: Networks By Design Commercial |
$332.80
|
| Rate for Payer: Prime Health Services Commercial |
$435.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$307.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$307.20
|
| 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 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 |
$281.60
|
| 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 XIII ANTIGEN
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900912036
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$50.94 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.94
|
| Rate for Payer: Blue Shield of California Commercial |
$32.78
|
| Rate for Payer: Blue Shield of California EPN |
$21.66
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.90
|
| Rate for Payer: EPIC Health Plan Senior |
$15.48
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.74
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.54
|
| Rate for Payer: United Healthcare All Other HMO |
$12.54
|
| Rate for Payer: United Healthcare HMO Rider |
$12.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Vantage Medical Group Senior |
$15.48
|
|
|
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 |
$26.95
|
| 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
|
|
|
HC FACTOR XIII SCREEN
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 85291
|
| Hospital Charge Code |
900910023
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$128.35 |
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.78
|
| Rate for Payer: Blue Shield of California Commercial |
$101.02
|
| Rate for Payer: Blue Shield of California EPN |
$66.74
|
| Rate for Payer: Cash Price |
$83.05
|
| Rate for Payer: Cash Price |
$83.05
|
| Rate for Payer: Cigna of CA HMO |
$96.64
|
| Rate for Payer: Cigna of CA PPO |
$111.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.30
|
| Rate for Payer: EPIC Health Plan Senior |
$9.11
|
| Rate for Payer: Galaxy Health WC |
$128.35
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.21
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: Networks By Design Commercial |
$98.15
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.38
|
| Rate for Payer: United Healthcare All Other HMO |
$7.38
|
| Rate for Payer: United Healthcare HMO Rider |
$7.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.02
|
| Rate for Payer: Vantage Medical Group Senior |
$9.11
|
|
|
HC FACTOR XIII SCREEN
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 85291
|
| Hospital Charge Code |
900910023
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.20 |
| Max. Negotiated Rate |
$128.35 |
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Cash Price |
$83.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.40
|
| Rate for Payer: EPIC Health Plan Senior |
$60.40
|
| Rate for Payer: Galaxy Health WC |
$128.35
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$93.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.24
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: Networks By Design Commercial |
$98.15
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
|
|
HC FACTOR XI PTA
|
Facility
|
OP
|
$461.00
|
|
|
Service Code
|
CPT 85270
|
| Hospital Charge Code |
900910061
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$391.85 |
| Rate for Payer: Adventist Health Commercial |
$92.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$302.37
|
| 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 |
$308.41
|
| Rate for Payer: Blue Shield of California EPN |
$203.76
|
| Rate for Payer: Cash Price |
$253.55
|
| Rate for Payer: Cash Price |
$253.55
|
| Rate for Payer: Cigna of CA HMO |
$295.04
|
| Rate for Payer: Cigna of CA PPO |
$341.14
|
| 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 |
$391.85
|
| Rate for Payer: Global Benefits Group Commercial |
$276.60
|
| 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 |
$307.49
|
| 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 |
$110.64
|
| 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 |
$368.80
|
| Rate for Payer: Networks By Design Commercial |
$299.65
|
| Rate for Payer: Prime Health Services Commercial |
$391.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$276.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$276.60
|
| 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 XI PTA
|
Facility
|
IP
|
$461.00
|
|
|
Service Code
|
CPT 85270
|
| Hospital Charge Code |
900910061
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$92.20 |
| Max. Negotiated Rate |
$391.85 |
| Rate for Payer: Adventist Health Commercial |
$92.20
|
| Rate for Payer: Cash Price |
$253.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.40
|
| Rate for Payer: EPIC Health Plan Senior |
$184.40
|
| Rate for Payer: Galaxy Health WC |
$391.85
|
| Rate for Payer: Global Benefits Group Commercial |
$276.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$307.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$285.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.64
|
| Rate for Payer: Multiplan Commercial |
$368.80
|
| Rate for Payer: Networks By Design Commercial |
$299.65
|
| Rate for Payer: Prime Health Services Commercial |
$391.85
|
|
|
HC FACTOR X STUART-PROWER
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
900910076
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Adventist Health Commercial |
$103.40
|
| Rate for Payer: Cash Price |
$284.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.80
|
| Rate for Payer: EPIC Health Plan Senior |
$206.80
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$344.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$320.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
|
|
HC FACTOR X STUART-PROWER
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
900910076
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Adventist Health Commercial |
$103.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$339.10
|
| 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 |
$345.87
|
| Rate for Payer: Blue Shield of California EPN |
$228.51
|
| Rate for Payer: Cash Price |
$284.35
|
| Rate for Payer: Cash Price |
$284.35
|
| Rate for Payer: Cigna of CA HMO |
$330.88
|
| Rate for Payer: Cigna of CA PPO |
$382.58
|
| 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 |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| 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 |
$344.84
|
| 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 |
$124.08
|
| 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 |
$413.60
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$310.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$310.20
|
| 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 FALLOPIAN TUBE CATHETERIZATION
|
Facility
|
OP
|
$1,159.00
|
|
|
Service Code
|
CPT 74742
|
| Hospital Charge Code |
909001872
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$231.80 |
| Max. Negotiated Rate |
$985.15 |
| Rate for Payer: Adventist Health Commercial |
$231.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$760.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$985.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$637.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$869.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$885.27
|
| Rate for Payer: Blue Shield of California Commercial |
$709.31
|
| Rate for Payer: Blue Shield of California EPN |
$468.24
|
| Rate for Payer: Cash Price |
$637.45
|
| Rate for Payer: Cash Price |
$637.45
|
| Rate for Payer: Cigna of CA HMO |
$741.76
|
| Rate for Payer: Cigna of CA PPO |
$857.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$985.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$985.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$985.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$463.60
|
| Rate for Payer: EPIC Health Plan Senior |
$463.60
|
| Rate for Payer: Galaxy Health WC |
$985.15
|
| Rate for Payer: Global Benefits Group Commercial |
$695.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$773.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$441.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$717.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$278.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$811.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$811.30
|
| Rate for Payer: Multiplan Commercial |
$927.20
|
| Rate for Payer: Networks By Design Commercial |
$753.35
|
| Rate for Payer: Prime Health Services Commercial |
$985.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$695.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$695.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$579.50
|
| Rate for Payer: United Healthcare All Other HMO |
$579.50
|
| Rate for Payer: United Healthcare HMO Rider |
$579.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$579.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$985.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$985.15
|
| Rate for Payer: Vantage Medical Group Senior |
$985.15
|
|
|
HC FALLOPIAN TUBE CATHETERIZATION
|
Facility
|
IP
|
$1,159.00
|
|
|
Service Code
|
CPT 74742
|
| Hospital Charge Code |
909001872
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$231.80 |
| Max. Negotiated Rate |
$985.15 |
| Rate for Payer: Adventist Health Commercial |
$231.80
|
| Rate for Payer: Cash Price |
$637.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$463.60
|
| Rate for Payer: EPIC Health Plan Senior |
$463.60
|
| Rate for Payer: Galaxy Health WC |
$985.15
|
| Rate for Payer: Global Benefits Group Commercial |
$695.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$773.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$441.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$717.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$278.16
|
| Rate for Payer: Multiplan Commercial |
$927.20
|
| Rate for Payer: Networks By Design Commercial |
$753.35
|
| Rate for Payer: Prime Health Services Commercial |
$985.15
|
|
