|
HC HEMATOCRIT HCT POC
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
900912115
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$113.05 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.39
|
| Rate for Payer: Blue Shield of California Commercial |
$61.31
|
| Rate for Payer: Blue Shield of California Commercial |
$92.70
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Cigna of CA HMO |
$85.12
|
| Rate for Payer: Cigna of CA PPO |
$98.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.91
|
| Rate for Payer: EPIC Health Plan Senior |
$2.61
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$84.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.18
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: Networks By Design Commercial |
$86.45
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1.92
|
| Rate for Payer: United Healthcare HMO Rider |
$1.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.92
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.61
|
| Rate for Payer: Vantage Medical Group Senior |
$2.37
|
|
|
HC HEMATOPOIETIC PROGENITOR CELLS
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900912029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$374.85 |
| Rate for Payer: Adventist Health Commercial |
$88.20
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$308.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.40
|
| Rate for Payer: EPIC Health Plan Senior |
$176.40
|
| Rate for Payer: Galaxy Health WC |
$374.85
|
| Rate for Payer: Global Benefits Group Commercial |
$264.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$280.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$260.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.84
|
| Rate for Payer: Multiplan Commercial |
$352.80
|
| Rate for Payer: Networks By Design Commercial |
$286.65
|
| Rate for Payer: Prime Health Services Commercial |
$374.85
|
|
|
HC HEMATOPOIETIC PROGENITOR CELLS
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900912029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$70.86 |
| Max. Negotiated Rate |
$760.68 |
| Rate for Payer: Cigna of CA PPO |
$326.34
|
| Rate for Payer: Adventist Health Commercial |
$88.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$604.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$402.62
|
| Rate for Payer: Blue Shield of California Commercial |
$203.30
|
| Rate for Payer: Blue Shield of California Commercial |
$307.38
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Cigna of CA HMO |
$282.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$691.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$461.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$308.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$760.68
|
| Rate for Payer: EPIC Health Plan Senior |
$507.12
|
| Rate for Payer: Galaxy Health WC |
$374.85
|
| Rate for Payer: Global Benefits Group Commercial |
$264.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$756.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$280.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$645.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$580.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$617.77
|
| Rate for Payer: Multiplan Commercial |
$352.80
|
| Rate for Payer: Networks By Design Commercial |
$286.65
|
| Rate for Payer: Prime Health Services Commercial |
$374.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$264.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$264.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$461.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Vantage Medical Group Senior |
$461.02
|
|
|
HC HEMECH-EPINEPHRINE
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900910197
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$311.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$282.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$262.55
|
| 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 HEMECH-EPINEPHRINE
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900910197
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$188.38 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$178.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$178.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.38
|
| Rate for Payer: Blue Shield of California Commercial |
$205.15
|
| Rate for Payer: Blue Shield of California Commercial |
$108.73
|
| Rate for Payer: Blue Shield of California Commercial |
$310.17
|
| Rate for Payer: Blue Shield of California Commercial |
$71.92
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna of CA HMO |
$284.80
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Cigna of CA PPO |
$329.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$311.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.10
|
| Rate for Payer: EPIC Health Plan Senior |
$27.40
|
| Rate for Payer: EPIC Health Plan Senior |
$27.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$40.85
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$40.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$282.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.38
|
| Rate for Payer: Multiplan Commercial |
$356.00
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$267.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$267.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.18
|
| Rate for Payer: United Healthcare All Other HMO |
$20.18
|
| Rate for Payer: United Healthcare All Other HMO |
$20.18
|
| Rate for Payer: United Healthcare HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Senior |
$24.91
|
| Rate for Payer: Vantage Medical Group Senior |
$24.91
|
|
|
HC HEMECH SCRN-ARACHEDONIC ACID A
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$314.50 |
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$259.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.00
|
| Rate for Payer: EPIC Health Plan Senior |
$148.00
|
| Rate for Payer: Galaxy Health WC |
$314.50
|
| Rate for Payer: Global Benefits Group Commercial |
$222.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$234.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$218.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.80
|
| Rate for Payer: Multiplan Commercial |
$296.00
|
| Rate for Payer: Networks By Design Commercial |
$240.50
|
| Rate for Payer: Prime Health Services Commercial |
$314.50
|
|
|
HC HEMECH SCRN-ARACHEDONIC ACID A
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$188.38 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$178.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$178.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.38
|
| Rate for Payer: Blue Shield of California Commercial |
$170.57
|
| Rate for Payer: Blue Shield of California Commercial |
$108.73
|
| Rate for Payer: Blue Shield of California Commercial |
$257.89
|
| Rate for Payer: Blue Shield of California Commercial |
$71.92
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna of CA HMO |
$236.80
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Cigna of CA PPO |
$273.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$259.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.10
|
| Rate for Payer: EPIC Health Plan Senior |
$27.40
|
| Rate for Payer: EPIC Health Plan Senior |
$27.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Galaxy Health WC |
$314.50
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Global Benefits Group Commercial |
$222.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$40.85
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$40.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$234.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.38
|
| Rate for Payer: Multiplan Commercial |
$296.00
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$240.50
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$314.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$222.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$222.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.18
|
| Rate for Payer: United Healthcare All Other HMO |
$20.18
|
| Rate for Payer: United Healthcare All Other HMO |
$20.18
|
| Rate for Payer: United Healthcare HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Senior |
$24.91
|
| Rate for Payer: Vantage Medical Group Senior |
$24.91
|
|
|
HC HEMODIALYSIS KIT 2LUMEN 12FR
|
Facility
|
OP
|
$692.71
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.54 |
| Max. Negotiated Rate |
$588.80 |
| Rate for Payer: Adventist Health Commercial |
$138.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$380.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$519.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$419.30
|
| Rate for Payer: Blue Shield of California Commercial |
$351.20
|
| Rate for Payer: Blue Shield of California Commercial |
$532.69
|
| Rate for Payer: Cash Price |
$311.72
|
| Rate for Payer: Cigna of CA HMO |
$484.90
|
| Rate for Payer: Cigna of CA PPO |
$484.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$588.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$588.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$484.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.08
|
| Rate for Payer: EPIC Health Plan Senior |
$277.08
|
| Rate for Payer: Galaxy Health WC |
$588.80
|
| Rate for Payer: Global Benefits Group Commercial |
$415.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$439.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$251.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$408.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$484.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$484.90
|
| Rate for Payer: Multiplan Commercial |
$554.17
|
| Rate for Payer: Networks By Design Commercial |
$346.36
|
| Rate for Payer: Prime Health Services Commercial |
$588.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$415.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$415.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$259.97
|
| Rate for Payer: United Healthcare All Other HMO |
$253.05
|
| Rate for Payer: United Healthcare HMO Rider |
$247.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$226.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$588.80
|
| Rate for Payer: Vantage Medical Group Senior |
$588.80
|
|
|
HC HEMODIALYSIS KIT 2LUMEN 12FR
|
Facility
|
IP
|
$849.16
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698819
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.83 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$169.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$382.12
|
| Rate for Payer: Cash Price |
$382.12
|
| Rate for Payer: Cigna of CA HMO |
$594.41
|
| Rate for Payer: Cigna of CA PPO |
$594.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$594.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$339.66
|
| Rate for Payer: EPIC Health Plan Senior |
$339.66
|
| Rate for Payer: Galaxy Health WC |
$721.79
|
| Rate for Payer: Global Benefits Group Commercial |
$509.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$539.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$501.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.80
|
| Rate for Payer: Multiplan Commercial |
$679.33
|
| Rate for Payer: Networks By Design Commercial |
$424.58
|
| Rate for Payer: Prime Health Services Commercial |
$721.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$318.69
|
| Rate for Payer: United Healthcare All Other HMO |
$310.20
|
| Rate for Payer: United Healthcare HMO Rider |
$303.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.10
|
|
|
HC HEMODIALYSIS KIT 2LUMEN 12FR
|
Facility
|
OP
|
$849.16
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698819
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.83 |
| Max. Negotiated Rate |
$721.79 |
| Rate for Payer: Adventist Health Commercial |
$169.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$721.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$636.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$514.00
|
| Rate for Payer: Blue Shield of California Commercial |
$430.52
|
| Rate for Payer: Blue Shield of California Commercial |
$653.00
|
| Rate for Payer: Cash Price |
$382.12
|
| Rate for Payer: Cigna of CA HMO |
$594.41
|
| Rate for Payer: Cigna of CA PPO |
$594.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$721.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$721.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$721.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$594.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$339.66
|
| Rate for Payer: EPIC Health Plan Senior |
$339.66
|
| Rate for Payer: Galaxy Health WC |
$721.79
|
| Rate for Payer: Global Benefits Group Commercial |
$509.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$539.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$308.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$501.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$594.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$594.41
|
| Rate for Payer: Multiplan Commercial |
$679.33
|
| Rate for Payer: Networks By Design Commercial |
$424.58
|
| Rate for Payer: Prime Health Services Commercial |
$721.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$509.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$509.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$318.69
|
| Rate for Payer: United Healthcare All Other HMO |
$310.20
|
| Rate for Payer: United Healthcare HMO Rider |
$303.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$721.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$721.79
|
| Rate for Payer: Vantage Medical Group Senior |
$721.79
|
|
|
HC HEMODIALYSIS KIT 2LUMEN 12FR
|
Facility
|
IP
|
$692.71
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.54 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$138.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$311.72
|
| Rate for Payer: Cash Price |
$311.72
|
| Rate for Payer: Cigna of CA HMO |
$484.90
|
| Rate for Payer: Cigna of CA PPO |
$484.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$484.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.08
|
| Rate for Payer: EPIC Health Plan Senior |
$277.08
|
| Rate for Payer: Galaxy Health WC |
$588.80
|
| Rate for Payer: Global Benefits Group Commercial |
$415.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$439.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$408.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.25
|
| Rate for Payer: Multiplan Commercial |
$554.17
|
| Rate for Payer: Networks By Design Commercial |
$346.36
|
| Rate for Payer: Prime Health Services Commercial |
$588.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$259.97
|
| Rate for Payer: United Healthcare All Other HMO |
$253.05
|
| Rate for Payer: United Healthcare HMO Rider |
$247.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$226.86
|
|
|
HC HEMODIALYSIS, ONE EVALUATION
|
Facility
|
IP
|
$1,421.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
900501419
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$1,207.85 |
| Rate for Payer: Adventist Health Commercial |
$284.20
|
| Rate for Payer: Cash Price |
$639.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$994.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.40
|
| Rate for Payer: EPIC Health Plan Senior |
$568.40
|
| Rate for Payer: Galaxy Health WC |
$1,207.85
|
| Rate for Payer: Global Benefits Group Commercial |
$852.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$902.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$838.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.04
|
| Rate for Payer: Multiplan Commercial |
$1,136.80
|
| Rate for Payer: Networks By Design Commercial |
$923.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.85
|
|
|
HC HEMODIALYSIS, ONE EVALUATION
|
Facility
|
OP
|
$1,421.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
900501419
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.54 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$284.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,324.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$970.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$882.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$639.45
|
| Rate for Payer: Cash Price |
$639.45
|
| Rate for Payer: Cash Price |
$639.45
|
| Rate for Payer: Cigna of CA HMO |
$909.44
|
| Rate for Payer: Cigna of CA PPO |
$1,051.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,324.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$970.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$882.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$994.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,456.49
|
| Rate for Payer: EPIC Health Plan Senior |
$970.99
|
| Rate for Payer: Galaxy Health WC |
$1,207.85
|
| Rate for Payer: Global Benefits Group Commercial |
$852.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,447.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$882.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$902.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$948.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,112.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,182.84
|
| Rate for Payer: Multiplan Commercial |
$1,136.80
|
| Rate for Payer: Multiplan WC |
$1,416.56
|
| Rate for Payer: Networks By Design Commercial |
$923.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.85
|
| Rate for Payer: Prime Health Services WC |
$1,402.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$852.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.50
|
| Rate for Payer: United Healthcare All Other HMO |
$710.50
|
| Rate for Payer: United Healthcare HMO Rider |
$710.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$710.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$882.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,324.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$970.99
|
| Rate for Payer: Vantage Medical Group Senior |
$882.72
|
|
|
HC HEMODIALYSIS TREATMENT OUTPT
|
Facility
|
OP
|
$1,634.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
941000105
|
|
Hospital Revenue Code
|
821
|
| Min. Negotiated Rate |
$95.09 |
| Max. Negotiated Rate |
$1,610.00 |
| Rate for Payer: Adventist Health Commercial |
$326.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$488.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,324.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$970.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$882.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,048.54
|
| Rate for Payer: Cash Price |
$735.30
|
| Rate for Payer: Cash Price |
$735.30
|
| Rate for Payer: Cash Price |
$735.30
|
| Rate for Payer: Cigna of CA HMO |
$1,045.76
|
| Rate for Payer: Cigna of CA PPO |
$1,209.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,324.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$970.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$882.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,143.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,456.49
|
| Rate for Payer: EPIC Health Plan Senior |
$970.99
|
| Rate for Payer: Galaxy Health WC |
$1,388.90
|
| Rate for Payer: Global Benefits Group Commercial |
$980.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,447.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$95.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$882.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,037.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,235.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,112.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,182.84
|
| Rate for Payer: Multiplan Commercial |
$1,307.20
|
| Rate for Payer: Networks By Design Commercial |
$1,062.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,388.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$980.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$980.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,610.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,170.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,072.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$882.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,324.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$970.99
|
| Rate for Payer: Vantage Medical Group Senior |
$882.72
|
|
|
HC HEMODIALYSIS TREATMENT OUTPT
|
Facility
|
IP
|
$1,634.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
941000105
|
|
Hospital Revenue Code
|
821
|
| Min. Negotiated Rate |
$326.80 |
| Max. Negotiated Rate |
$1,388.90 |
| Rate for Payer: Adventist Health Commercial |
$326.80
|
| Rate for Payer: Cash Price |
$735.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,143.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$653.60
|
| Rate for Payer: EPIC Health Plan Senior |
$653.60
|
| Rate for Payer: Galaxy Health WC |
$1,388.90
|
| Rate for Payer: Global Benefits Group Commercial |
$980.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,037.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$964.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.16
|
| Rate for Payer: Multiplan Commercial |
$1,307.20
|
| Rate for Payer: Networks By Design Commercial |
$1,062.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,388.90
|
|
|
HC HEMOGLOBIN A1C
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
900912128
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$199.75 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
|
|
HC HEMOGLOBIN A1C
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
900912128
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$199.75 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.20
|
| Rate for Payer: Blue Shield of California Commercial |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$108.33
|
| Rate for Payer: Blue Shield of California Commercial |
$57.15
|
| Rate for Payer: Blue Shield of California Commercial |
$163.79
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA HMO |
$150.40
|
| Rate for Payer: Cigna of CA PPO |
$173.90
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.02
|
| Rate for Payer: EPIC Health Plan Senior |
$10.68
|
| Rate for Payer: EPIC Health Plan Senior |
$10.68
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.92
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.01
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.87
|
| Rate for Payer: United Healthcare All Other HMO |
$7.87
|
| Rate for Payer: United Healthcare All Other HMO |
$7.87
|
| Rate for Payer: United Healthcare HMO Rider |
$7.87
|
| Rate for Payer: United Healthcare HMO Rider |
$7.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Vantage Medical Group Senior |
$9.71
|
| Rate for Payer: Vantage Medical Group Senior |
$9.71
|
|
|
HC HEMOGLOBIN A1C (POC)
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
900912157
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$199.75 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.20
|
| Rate for Payer: Blue Shield of California Commercial |
$108.33
|
| Rate for Payer: Blue Shield of California Commercial |
$163.79
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cigna of CA HMO |
$150.40
|
| Rate for Payer: Cigna of CA PPO |
$173.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.02
|
| Rate for Payer: EPIC Health Plan Senior |
$10.68
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.01
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.87
|
| Rate for Payer: United Healthcare All Other HMO |
$7.87
|
| Rate for Payer: United Healthcare HMO Rider |
$7.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Vantage Medical Group Senior |
$9.71
|
|
|
HC HEMOGLOBIN A1C (POC)
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
900912157
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$199.75 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
|
|
HC HEMOGLOBIN CH
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
900912187
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$70.55 |
| Rate for Payer: Adventist Health Commercial |
$16.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.39
|
| Rate for Payer: Blue Shield of California Commercial |
$38.26
|
| Rate for Payer: Blue Shield of California Commercial |
$57.85
|
| Rate for Payer: Cash Price |
$37.35
|
| Rate for Payer: Cash Price |
$37.35
|
| Rate for Payer: Cigna of CA HMO |
$53.12
|
| Rate for Payer: Cigna of CA PPO |
$61.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.91
|
| Rate for Payer: EPIC Health Plan Senior |
$2.61
|
| Rate for Payer: Galaxy Health WC |
$70.55
|
| Rate for Payer: Global Benefits Group Commercial |
$49.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.18
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: Networks By Design Commercial |
$53.95
|
| Rate for Payer: Prime Health Services Commercial |
$70.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1.92
|
| Rate for Payer: United Healthcare HMO Rider |
$1.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.92
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.61
|
| Rate for Payer: Vantage Medical Group Senior |
$2.37
|
|
|
HC HEMOGLOBIN CH
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
900912187
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.60 |
| Max. Negotiated Rate |
$70.55 |
| Rate for Payer: Adventist Health Commercial |
$16.60
|
| Rate for Payer: Cash Price |
$37.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.20
|
| Rate for Payer: EPIC Health Plan Senior |
$33.20
|
| Rate for Payer: Galaxy Health WC |
$70.55
|
| Rate for Payer: Global Benefits Group Commercial |
$49.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.92
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: Networks By Design Commercial |
$53.95
|
| Rate for Payer: Prime Health Services Commercial |
$70.55
|
|
|
HC HEMOGLOBIN CITRATE
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900910898
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
|
|
HC HEMOGLOBIN CITRATE
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900910898
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$112.85 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.85
|
| Rate for Payer: Blue Shield of California Commercial |
$31.35
|
| Rate for Payer: Blue Shield of California Commercial |
$51.63
|
| Rate for Payer: Blue Shield of California Commercial |
$47.40
|
| Rate for Payer: Blue Shield of California Commercial |
$78.06
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna of CA HMO |
$43.52
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Cigna of CA PPO |
$50.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.16
|
| Rate for Payer: EPIC Health Plan Senior |
$14.16
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$54.40
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$44.20
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Prime Health Services Commercial |
$57.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900910897
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$112.85 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.85
|
| Rate for Payer: Blue Shield of California Commercial |
$31.35
|
| Rate for Payer: Blue Shield of California Commercial |
$51.63
|
| Rate for Payer: Blue Shield of California Commercial |
$47.40
|
| Rate for Payer: Blue Shield of California Commercial |
$78.06
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna of CA HMO |
$43.52
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Cigna of CA PPO |
$50.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.16
|
| Rate for Payer: EPIC Health Plan Senior |
$14.16
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$54.40
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$44.20
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Prime Health Services Commercial |
$57.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900910897
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
|
