|
HC EYE FOR FOREIGN BODY
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
909001113
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.45 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Adventist Health Commercial |
$87.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$128.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.97
|
| Rate for Payer: Blue Shield of California Commercial |
$275.31
|
| Rate for Payer: Blue Shield of California EPN |
$173.49
|
| Rate for Payer: Cash Price |
$196.65
|
| Rate for Payer: Cash Price |
$196.65
|
| Rate for Payer: Central Health Plan Commercial |
$349.60
|
| Rate for Payer: Cigna of CA HMO |
$279.68
|
| Rate for Payer: Cigna of CA PPO |
$323.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$305.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$371.45
|
| Rate for Payer: Global Benefits Group Commercial |
$262.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$393.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$42.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$277.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$327.75
|
| Rate for Payer: Networks By Design Commercial |
$284.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$371.45
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$262.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$262.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC EYE PARACENTESIS W/RELEASE AQU
|
Facility
|
IP
|
$9,492.00
|
|
|
Service Code
|
CPT 65800
|
| Hospital Charge Code |
900501304
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,898.40 |
| Max. Negotiated Rate |
$8,542.80 |
| Rate for Payer: Adventist Health Commercial |
$1,898.40
|
| Rate for Payer: Cash Price |
$4,271.40
|
| Rate for Payer: Central Health Plan Commercial |
$7,593.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,644.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,796.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,796.80
|
| Rate for Payer: Galaxy Health WC |
$8,068.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,695.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,542.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,027.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,600.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,898.40
|
| Rate for Payer: Multiplan Commercial |
$7,119.00
|
| Rate for Payer: Networks By Design Commercial |
$6,169.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,068.20
|
|
|
HC EYE PARACENTESIS W/RELEASE AQU
|
Facility
|
OP
|
$9,492.00
|
|
|
Service Code
|
CPT 65800
|
| Hospital Charge Code |
900501304
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.26 |
| Max. Negotiated Rate |
$8,542.80 |
| Rate for Payer: Adventist Health Commercial |
$1,898.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,617.28
|
| Rate for Payer: Cash Price |
$4,271.40
|
| Rate for Payer: Cash Price |
$4,271.40
|
| Rate for Payer: Cash Price |
$4,271.40
|
| Rate for Payer: Cash Price |
$4,271.40
|
| Rate for Payer: Central Health Plan Commercial |
$7,593.60
|
| Rate for Payer: Cigna of CA HMO |
$6,074.88
|
| Rate for Payer: Cigna of CA PPO |
$7,024.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,644.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| Rate for Payer: Galaxy Health WC |
$8,068.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,695.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,542.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,027.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,190.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,898.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$7,119.00
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$6,169.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Preferred Health Network WC |
$4,711.51
|
| Rate for Payer: Prime Health Services Commercial |
$8,068.20
|
| Rate for Payer: Prime Health Services Medicare |
$3,146.34
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,265.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,695.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,746.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,746.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,746.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,746.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
HC EYE PARACENTESIS W/RML VITREOU
|
Facility
|
IP
|
$10,888.00
|
|
|
Service Code
|
CPT 65810
|
| Hospital Charge Code |
900501528
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,177.60 |
| Max. Negotiated Rate |
$9,799.20 |
| Rate for Payer: Adventist Health Commercial |
$2,177.60
|
| Rate for Payer: Cash Price |
$4,899.60
|
| Rate for Payer: Central Health Plan Commercial |
$8,710.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,621.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,355.20
|
| Rate for Payer: Galaxy Health WC |
$9,254.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,532.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,799.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,913.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,423.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,177.60
|
| Rate for Payer: Multiplan Commercial |
$8,166.00
|
| Rate for Payer: Networks By Design Commercial |
$7,077.20
|
| Rate for Payer: Prime Health Services Commercial |
$9,254.80
|
|
|
HC EYE PARACENTESIS W/RML VITREOU
|
Facility
|
OP
|
$10,888.00
|
|
|
Service Code
|
CPT 65810
|
| Hospital Charge Code |
900501528
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$9,799.20 |
| Rate for Payer: Adventist Health Commercial |
$2,177.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,617.28
|
| Rate for Payer: Cash Price |
$4,899.60
|
| Rate for Payer: Cash Price |
$4,899.60
|
| Rate for Payer: Cash Price |
$4,899.60
|
| Rate for Payer: Cash Price |
$4,899.60
|
| Rate for Payer: Central Health Plan Commercial |
$8,710.40
|
| Rate for Payer: Cigna of CA HMO |
$6,968.32
|
| Rate for Payer: Cigna of CA PPO |
$8,057.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,621.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| Rate for Payer: Galaxy Health WC |
$9,254.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,532.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,799.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,913.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,190.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,177.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$8,166.00
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$7,077.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Preferred Health Network WC |
$4,711.51
|
| Rate for Payer: Prime Health Services Commercial |
$9,254.80
|
| Rate for Payer: Prime Health Services Medicare |
$3,146.34
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,265.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,532.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,444.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,444.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,444.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
HC EYE SERVICE ORPROCEDURE
|
Facility
|
IP
|
$369.00
|
|
|
Service Code
|
CPT 92499
|
| Hospital Charge Code |
900501542
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.80 |
| Max. Negotiated Rate |
$332.10 |
| Rate for Payer: Adventist Health Commercial |
$73.80
|
| Rate for Payer: Cash Price |
$166.05
|
| Rate for Payer: Central Health Plan Commercial |
$295.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$258.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.60
|
| Rate for Payer: EPIC Health Plan Senior |
$147.60
|
| Rate for Payer: Galaxy Health WC |
$313.65
|
| Rate for Payer: Global Benefits Group Commercial |
$221.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$332.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$234.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$217.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.80
|
| Rate for Payer: Multiplan Commercial |
$276.75
|
| Rate for Payer: Networks By Design Commercial |
$239.85
|
| Rate for Payer: Prime Health Services Commercial |
$313.65
|
|
|
HC EYE SERVICE ORPROCEDURE
|
Facility
|
OP
|
$369.00
|
|
|
Service Code
|
CPT 92499
|
| Hospital Charge Code |
900501542
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$73.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$49.59
|
| Rate for Payer: Cash Price |
$166.05
|
| Rate for Payer: Cash Price |
$166.05
|
| Rate for Payer: Cash Price |
$166.05
|
| Rate for Payer: Cash Price |
$166.05
|
| Rate for Payer: Central Health Plan Commercial |
$295.20
|
| Rate for Payer: Cigna of CA HMO |
$236.16
|
| Rate for Payer: Cigna of CA PPO |
$273.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$258.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.38
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$313.65
|
| Rate for Payer: Global Benefits Group Commercial |
$221.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$332.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$234.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$276.75
|
| Rate for Payer: Multiplan WC |
$49.59
|
| Rate for Payer: Networks By Design Commercial |
$239.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.20
|
| Rate for Payer: Preferred Health Network WC |
$50.60
|
| Rate for Payer: Prime Health Services Commercial |
$313.65
|
| Rate for Payer: Prime Health Services Medicare |
$39.43
|
| Rate for Payer: Prime Health Services WC |
$49.08
|
| Rate for Payer: Riverside University Health System MISP |
$40.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$221.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$184.50
|
| Rate for Payer: United Healthcare All Other HMO |
$184.50
|
| Rate for Payer: United Healthcare HMO Rider |
$184.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$184.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC FACIAL BONES COMPLETE
|
Facility
|
OP
|
$1,695.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
909001101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.12 |
| Max. Negotiated Rate |
$1,525.50 |
| Rate for Payer: Adventist Health Commercial |
$339.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$191.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$163.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$227.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,067.85
|
| Rate for Payer: Blue Shield of California EPN |
$672.91
|
| Rate for Payer: Cash Price |
$762.75
|
| Rate for Payer: Cash Price |
$762.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,356.00
|
| Rate for Payer: Cigna of CA HMO |
$1,084.80
|
| Rate for Payer: Cigna of CA PPO |
$1,254.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,186.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,440.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,525.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$64.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,076.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,271.25
|
| Rate for Payer: Networks By Design Commercial |
$1,101.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,440.75
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,017.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,017.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC FACIAL BONES COMPLETE
|
Facility
|
IP
|
$1,695.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
909001101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$339.00 |
| Max. Negotiated Rate |
$1,525.50 |
| Rate for Payer: Adventist Health Commercial |
$339.00
|
| Rate for Payer: Cash Price |
$762.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,356.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,186.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.00
|
| Rate for Payer: EPIC Health Plan Senior |
$678.00
|
| Rate for Payer: Galaxy Health WC |
$1,440.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,525.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,076.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,000.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.00
|
| Rate for Payer: Multiplan Commercial |
$1,271.25
|
| Rate for Payer: Networks By Design Commercial |
$1,101.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,440.75
|
|
|
HC FACIAL BONES LIMITED
|
Facility
|
OP
|
$1,133.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
909001102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.69 |
| Max. Negotiated Rate |
$1,019.70 |
| Rate for Payer: Adventist Health Commercial |
$226.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$128.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.14
|
| Rate for Payer: Blue Shield of California Commercial |
$713.79
|
| Rate for Payer: Blue Shield of California EPN |
$449.80
|
| Rate for Payer: Cash Price |
$509.85
|
| Rate for Payer: Cash Price |
$509.85
|
| Rate for Payer: Central Health Plan Commercial |
$906.40
|
| Rate for Payer: Cigna of CA HMO |
$725.12
|
| Rate for Payer: Cigna of CA PPO |
$838.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$793.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$963.05
|
| Rate for Payer: Global Benefits Group Commercial |
$679.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,019.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$719.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$849.75
|
| Rate for Payer: Networks By Design Commercial |
$736.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$963.05
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$679.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$679.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC FACIAL BONES LIMITED
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
909001102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$226.60 |
| Max. Negotiated Rate |
$1,019.70 |
| Rate for Payer: Adventist Health Commercial |
$226.60
|
| Rate for Payer: Cash Price |
$509.85
|
| Rate for Payer: Central Health Plan Commercial |
$906.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$793.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$453.20
|
| Rate for Payer: EPIC Health Plan Senior |
$453.20
|
| Rate for Payer: Galaxy Health WC |
$963.05
|
| Rate for Payer: Global Benefits Group Commercial |
$679.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,019.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$719.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$668.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.60
|
| Rate for Payer: Multiplan Commercial |
$849.75
|
| Rate for Payer: Networks By Design Commercial |
$736.45
|
| Rate for Payer: Prime Health Services Commercial |
$963.05
|
|
|
HC FACILITY CHARGE RESEARCH ONLY
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
CPT 99999
|
| Hospital Charge Code |
910400998
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$583.20 |
| Rate for Payer: Adventist Health Commercial |
$129.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$393.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$550.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$356.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$486.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$313.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$376.94
|
| Rate for Payer: Blue Shield of California Commercial |
$410.83
|
| Rate for Payer: Blue Shield of California EPN |
$258.55
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Central Health Plan Commercial |
$518.40
|
| Rate for Payer: Cigna of CA HMO |
$414.72
|
| Rate for Payer: Cigna of CA PPO |
$479.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$550.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$550.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$550.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$453.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$259.20
|
| Rate for Payer: EPIC Health Plan Senior |
$259.20
|
| Rate for Payer: Galaxy Health WC |
$550.80
|
| Rate for Payer: Global Benefits Group Commercial |
$388.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$583.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$411.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$235.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$382.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$453.60
|
| Rate for Payer: Multiplan Commercial |
$486.00
|
| Rate for Payer: Networks By Design Commercial |
$421.20
|
| Rate for Payer: Prime Health Services Commercial |
$550.80
|
| Rate for Payer: Riverside University Health System MISP |
$259.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$388.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$388.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.00
|
| Rate for Payer: United Healthcare All Other HMO |
$324.00
|
| Rate for Payer: United Healthcare HMO Rider |
$324.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$324.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$550.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$550.80
|
| Rate for Payer: Vantage Medical Group Senior |
$550.80
|
|
|
HC FACILITY CHARGE RESEARCH ONLY
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
CPT 99999
|
| Hospital Charge Code |
910400997
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Commercial |
$150.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$455.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$562.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$363.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$436.27
|
| Rate for Payer: Blue Shield of California Commercial |
$475.50
|
| Rate for Payer: Blue Shield of California EPN |
$299.25
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Central Health Plan Commercial |
$600.00
|
| Rate for Payer: Cigna of CA HMO |
$480.00
|
| Rate for Payer: Cigna of CA PPO |
$555.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$637.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$637.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$300.00
|
| Rate for Payer: Galaxy Health WC |
$637.50
|
| Rate for Payer: Global Benefits Group Commercial |
$450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$675.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$476.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$272.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$442.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$525.00
|
| Rate for Payer: Multiplan Commercial |
$562.50
|
| Rate for Payer: Networks By Design Commercial |
$487.50
|
| Rate for Payer: Prime Health Services Commercial |
$637.50
|
| Rate for Payer: Riverside University Health System MISP |
$300.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$450.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$450.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$375.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$375.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$637.50
|
| Rate for Payer: Vantage Medical Group Senior |
$637.50
|
|
|
HC FACILITY CHARGE RESEARCH ONLY
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
CPT 99999
|
| Hospital Charge Code |
910400997
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Commercial |
$150.00
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Central Health Plan Commercial |
$600.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$300.00
|
| Rate for Payer: Galaxy Health WC |
$637.50
|
| Rate for Payer: Global Benefits Group Commercial |
$450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$675.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$476.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$442.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.00
|
| Rate for Payer: Multiplan Commercial |
$562.50
|
| Rate for Payer: Networks By Design Commercial |
$487.50
|
| Rate for Payer: Prime Health Services Commercial |
$637.50
|
|
|
HC FACILITY CHARGE RESEARCH ONLY
|
Facility
|
IP
|
$648.00
|
|
|
Service Code
|
CPT 99999
|
| Hospital Charge Code |
910400998
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$583.20 |
| Rate for Payer: Adventist Health Commercial |
$129.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Central Health Plan Commercial |
$518.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$453.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$259.20
|
| Rate for Payer: EPIC Health Plan Senior |
$259.20
|
| Rate for Payer: Galaxy Health WC |
$550.80
|
| Rate for Payer: Global Benefits Group Commercial |
$388.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$583.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$411.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$382.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.60
|
| Rate for Payer: Multiplan Commercial |
$486.00
|
| Rate for Payer: Networks By Design Commercial |
$421.20
|
| Rate for Payer: Prime Health Services Commercial |
$550.80
|
|
|
HC FACTOR II (2) ASSAY
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
900910075
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$474.30 |
| Rate for Payer: Adventist Health Commercial |
$105.40
|
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.98
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.35
|
| Rate for Payer: Blue Shield of California Commercial |
$37.17
|
| Rate for Payer: Blue Shield of California Commercial |
$332.01
|
| Rate for Payer: Blue Shield of California EPN |
$23.42
|
| Rate for Payer: Blue Shield of California EPN |
$209.22
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Central Health Plan Commercial |
$421.60
|
| Rate for Payer: Central Health Plan Commercial |
$47.20
|
| Rate for Payer: Cigna of CA HMO |
$37.76
|
| Rate for Payer: Cigna of CA HMO |
$337.28
|
| Rate for Payer: Cigna of CA PPO |
$43.66
|
| Rate for Payer: Cigna of CA PPO |
$389.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$368.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.42
|
| Rate for Payer: EPIC Health Plan Senior |
$14.28
|
| Rate for Payer: EPIC Health Plan Senior |
$14.28
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$474.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.29
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$334.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.39
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.98
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.98
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
| Rate for Payer: Prime Health Services Medicare |
$13.76
|
| Rate for Payer: Prime Health Services Medicare |
$13.76
|
| Rate for Payer: Riverside University Health System MISP |
$14.28
|
| Rate for Payer: Riverside University Health System MISP |
$14.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$316.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$316.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.51
|
| Rate for Payer: United Healthcare All Other HMO |
$10.51
|
| Rate for Payer: United Healthcare All Other HMO |
$10.51
|
| Rate for Payer: United Healthcare HMO Rider |
$10.51
|
| Rate for Payer: United Healthcare HMO Rider |
$10.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Vantage Medical Group Senior |
$12.98
|
| Rate for Payer: Vantage Medical Group Senior |
$12.98
|
|
|
HC FACTOR II (2) ASSAY
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
900910075
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$105.40 |
| Max. Negotiated Rate |
$474.30 |
| Rate for Payer: Adventist Health Commercial |
$105.40
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Central Health Plan Commercial |
$421.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$368.90
|
| 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: Health Management Network EPO/PPO |
$474.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$334.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$310.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.40
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
|
|
HC FACTOR IX PTC
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
900910029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$192.56 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$19.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$19.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.56
|
| 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 Medi-Cal |
$20.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$138.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$138.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.56
|
| Rate for Payer: Blue Shield of California Commercial |
$302.40
|
| Rate for Payer: Blue Shield of California Commercial |
$105.84
|
| Rate for Payer: Blue Shield of California EPN |
$190.56
|
| Rate for Payer: Blue Shield of California EPN |
$66.70
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Central Health Plan Commercial |
$134.40
|
| Rate for Payer: Central Health Plan Commercial |
$384.00
|
| Rate for Payer: Cigna of CA HMO |
$307.20
|
| Rate for Payer: Cigna of CA HMO |
$107.52
|
| Rate for Payer: Cigna of CA PPO |
$355.20
|
| Rate for Payer: Cigna of CA PPO |
$124.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$117.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$336.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.42
|
| Rate for Payer: EPIC Health Plan Senior |
$20.94
|
| Rate for Payer: EPIC Health Plan Senior |
$20.94
|
| Rate for Payer: Galaxy Health WC |
$408.00
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$288.00
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$432.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.23
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$106.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$304.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.51
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: Networks By Design Commercial |
$312.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19.04
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19.04
|
| Rate for Payer: Prime Health Services Commercial |
$408.00
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: Prime Health Services Medicare |
$20.18
|
| Rate for Payer: Prime Health Services Medicare |
$20.18
|
| Rate for Payer: Riverside University Health System MISP |
$20.94
|
| Rate for Payer: Riverside University Health System MISP |
$20.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$288.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$288.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.43
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$15.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.04
|
| 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 Commercial/Exchange |
$28.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.94
|
| Rate for Payer: Vantage Medical Group Senior |
$19.04
|
| Rate for Payer: Vantage Medical Group Senior |
$19.04
|
|
|
HC FACTOR IX PTC
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
900910029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Central Health Plan Commercial |
$384.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$336.00
|
| 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: Health Management Network EPO/PPO |
$432.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$304.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$283.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: Networks By Design Commercial |
$312.00
|
| Rate for Payer: Prime Health Services Commercial |
$408.00
|
|
|
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 |
$289.80 |
| Rate for Payer: Adventist Health Commercial |
$64.40
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Central Health Plan Commercial |
$257.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$225.40
|
| 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: Health Management Network EPO/PPO |
$289.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$204.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$189.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.40
|
| Rate for Payer: Multiplan Commercial |
$241.50
|
| Rate for Payer: Networks By Design Commercial |
$209.30
|
| Rate for Payer: Prime Health Services Commercial |
$273.70
|
|
|
HC FACTOR V, ACG
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 85220
|
| Hospital Charge Code |
900910060
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$178.53 |
| Rate for Payer: Adventist Health Commercial |
$30.80
|
| Rate for Payer: Adventist Health Commercial |
$64.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.65
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$129.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$129.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.48
|
| 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 Medi-Cal |
$19.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$128.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$128.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$178.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$178.53
|
| Rate for Payer: Blue Shield of California Commercial |
$202.86
|
| Rate for Payer: Blue Shield of California Commercial |
$97.02
|
| Rate for Payer: Blue Shield of California EPN |
$127.83
|
| Rate for Payer: Blue Shield of California EPN |
$61.14
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Central Health Plan Commercial |
$123.20
|
| Rate for Payer: Central Health Plan Commercial |
$257.60
|
| Rate for Payer: Cigna of CA HMO |
$206.08
|
| Rate for Payer: Cigna of CA HMO |
$98.56
|
| Rate for Payer: Cigna of CA PPO |
$238.28
|
| Rate for Payer: Cigna of CA PPO |
$113.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$225.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.12
|
| Rate for Payer: EPIC Health Plan Senior |
$19.41
|
| Rate for Payer: EPIC Health Plan Senior |
$19.41
|
| Rate for Payer: Galaxy Health WC |
$273.70
|
| Rate for Payer: Galaxy Health WC |
$130.90
|
| Rate for Payer: Global Benefits Group Commercial |
$193.20
|
| Rate for Payer: Global Benefits Group Commercial |
$92.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$138.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.95
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$97.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$204.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.65
|
| Rate for Payer: Multiplan Commercial |
$241.50
|
| Rate for Payer: Multiplan Commercial |
$115.50
|
| Rate for Payer: Networks By Design Commercial |
$100.10
|
| Rate for Payer: Networks By Design Commercial |
$209.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.65
|
| Rate for Payer: Prime Health Services Commercial |
$273.70
|
| Rate for Payer: Prime Health Services Commercial |
$130.90
|
| Rate for Payer: Prime Health Services Medicare |
$18.71
|
| Rate for Payer: Prime Health Services Medicare |
$18.71
|
| Rate for Payer: Riverside University Health System MISP |
$19.41
|
| Rate for Payer: Riverside University Health System MISP |
$19.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$92.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$193.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$193.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$92.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.30
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$14.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.65
|
| 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 Commercial/Exchange |
$26.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.41
|
| Rate for Payer: Vantage Medical Group Senior |
$17.65
|
| 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 |
$327.60 |
| Rate for Payer: Adventist Health Commercial |
$72.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Central Health Plan Commercial |
$291.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$254.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.60
|
| Rate for Payer: EPIC Health Plan Senior |
$145.60
|
| Rate for Payer: Galaxy Health WC |
$309.40
|
| Rate for Payer: Global Benefits Group Commercial |
$218.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$327.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$231.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$214.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.80
|
| Rate for Payer: Multiplan Commercial |
$273.00
|
| Rate for Payer: Networks By Design Commercial |
$236.60
|
| Rate for Payer: Prime Health Services Commercial |
$309.40
|
|
|
HC FACTOR VIII AHG
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
900910028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$181.12 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Adventist Health Commercial |
$72.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.90
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.85
|
| 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 Medi-Cal |
$19.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.12
|
| Rate for Payer: Blue Shield of California Commercial |
$229.32
|
| Rate for Payer: Blue Shield of California Commercial |
$98.28
|
| Rate for Payer: Blue Shield of California EPN |
$144.51
|
| Rate for Payer: Blue Shield of California EPN |
$61.93
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: Central Health Plan Commercial |
$291.20
|
| Rate for Payer: Cigna of CA HMO |
$232.96
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$269.36
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$254.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.54
|
| Rate for Payer: EPIC Health Plan Senior |
$19.69
|
| Rate for Payer: EPIC Health Plan Senior |
$19.69
|
| Rate for Payer: Galaxy Health WC |
$309.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$218.40
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$327.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.36
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$231.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.99
|
| Rate for Payer: Multiplan Commercial |
$273.00
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Networks By Design Commercial |
$236.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.90
|
| Rate for Payer: Prime Health Services Commercial |
$309.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Medicare |
$18.97
|
| Rate for Payer: Prime Health Services Medicare |
$18.97
|
| Rate for Payer: Riverside University Health System MISP |
$19.69
|
| Rate for Payer: Riverside University Health System MISP |
$19.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$218.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$218.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$14.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.90
|
| 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 Commercial/Exchange |
$26.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
| 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 |
$400.50 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| 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: Health Management Network EPO/PPO |
$400.50
|
| 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 |
$89.00
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
|
|
HC FACTOR VII, (PROCONVERTIN)
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
900910027
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$181.12 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.90
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.85
|
| 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 Medi-Cal |
$19.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.12
|
| Rate for Payer: Blue Shield of California Commercial |
$280.35
|
| Rate for Payer: Blue Shield of California Commercial |
$98.28
|
| Rate for Payer: Blue Shield of California EPN |
$176.66
|
| Rate for Payer: Blue Shield of California EPN |
$61.93
|
| 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: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| 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 |
$329.30
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.90
|
| 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 |
$29.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.54
|
| Rate for Payer: EPIC Health Plan Senior |
$19.69
|
| Rate for Payer: EPIC Health Plan Senior |
$19.69
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.36
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.90
|
| 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 |
$30.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.99
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.90
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Medicare |
$18.97
|
| Rate for Payer: Prime Health Services Medicare |
$18.97
|
| Rate for Payer: Riverside University Health System MISP |
$19.69
|
| Rate for Payer: Riverside University Health System MISP |
$19.69
|
| 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 |
$267.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$14.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.90
|
| 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 Commercial/Exchange |
$26.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
|
