|
HC FACTOR V LEIDEN MUTATION
|
Facility
|
OP
|
$386.00
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
900912323
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$59.43 |
| Max. Negotiated Rate |
$407.52 |
| Rate for Payer: Adventist Health Commercial |
$77.20
|
| Rate for Payer: Adventist Health Commercial |
$145.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$73.37
|
| Rate for Payer: Adventist Health Medi-Cal |
$73.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$110.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$110.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$293.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$293.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$407.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$407.52
|
| Rate for Payer: Blue Shield of California Commercial |
$458.01
|
| Rate for Payer: Blue Shield of California Commercial |
$243.18
|
| Rate for Payer: Blue Shield of California EPN |
$288.62
|
| Rate for Payer: Blue Shield of California EPN |
$153.24
|
| Rate for Payer: Cash Price |
$327.15
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cash Price |
$327.15
|
| Rate for Payer: Central Health Plan Commercial |
$308.80
|
| Rate for Payer: Central Health Plan Commercial |
$581.60
|
| Rate for Payer: Cigna of CA HMO |
$465.28
|
| Rate for Payer: Cigna of CA HMO |
$247.04
|
| Rate for Payer: Cigna of CA PPO |
$285.64
|
| Rate for Payer: Cigna of CA PPO |
$537.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$508.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$270.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.06
|
| Rate for Payer: EPIC Health Plan Senior |
$80.71
|
| Rate for Payer: EPIC Health Plan Senior |
$80.71
|
| Rate for Payer: Galaxy Health WC |
$617.95
|
| Rate for Payer: Galaxy Health WC |
$328.10
|
| Rate for Payer: Global Benefits Group Commercial |
$231.60
|
| Rate for Payer: Global Benefits Group Commercial |
$436.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$347.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$654.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$120.33
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$120.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$461.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$245.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$263.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.32
|
| Rate for Payer: Multiplan Commercial |
$289.50
|
| Rate for Payer: Multiplan Commercial |
$545.25
|
| Rate for Payer: Networks By Design Commercial |
$472.55
|
| Rate for Payer: Networks By Design Commercial |
$250.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$73.37
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$73.37
|
| Rate for Payer: Prime Health Services Commercial |
$328.10
|
| Rate for Payer: Prime Health Services Commercial |
$617.95
|
| Rate for Payer: Prime Health Services Medicare |
$77.77
|
| Rate for Payer: Prime Health Services Medicare |
$77.77
|
| Rate for Payer: Riverside University Health System MISP |
$80.71
|
| Rate for Payer: Riverside University Health System MISP |
$80.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$231.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$436.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$231.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$436.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.43
|
| Rate for Payer: United Healthcare All Other HMO |
$59.43
|
| Rate for Payer: United Healthcare All Other HMO |
$59.43
|
| Rate for Payer: United Healthcare HMO Rider |
$59.43
|
| Rate for Payer: United Healthcare HMO Rider |
$59.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$73.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$73.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.71
|
| Rate for Payer: Vantage Medical Group Senior |
$73.37
|
| Rate for Payer: Vantage Medical Group Senior |
$73.37
|
|
|
HC FACTOR V LEIDEN MUTATION
|
Facility
|
IP
|
$727.00
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
900912323
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$145.40 |
| Max. Negotiated Rate |
$654.30 |
| Rate for Payer: Adventist Health Commercial |
$145.40
|
| Rate for Payer: Cash Price |
$327.15
|
| Rate for Payer: Central Health Plan Commercial |
$581.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$508.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.80
|
| Rate for Payer: EPIC Health Plan Senior |
$290.80
|
| Rate for Payer: Galaxy Health WC |
$617.95
|
| Rate for Payer: Global Benefits Group Commercial |
$436.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$654.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$461.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$428.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.40
|
| Rate for Payer: Multiplan Commercial |
$545.25
|
| Rate for Payer: Networks By Design Commercial |
$472.55
|
| Rate for Payer: Prime Health Services Commercial |
$617.95
|
|
|
HC FACTOR V LEIDEN MUTATN B INDI
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
900913619
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.43 |
| Max. Negotiated Rate |
$407.52 |
| Rate for Payer: Adventist Health Commercial |
$86.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$73.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$110.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$293.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$407.52
|
| Rate for Payer: Blue Shield of California Commercial |
$271.53
|
| Rate for Payer: Blue Shield of California EPN |
$171.11
|
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: Central Health Plan Commercial |
$344.80
|
| Rate for Payer: Cigna of CA HMO |
$275.84
|
| Rate for Payer: Cigna of CA PPO |
$318.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$301.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.06
|
| Rate for Payer: EPIC Health Plan Senior |
$80.71
|
| Rate for Payer: Galaxy Health WC |
$366.35
|
| Rate for Payer: Global Benefits Group Commercial |
$258.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$120.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$273.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$156.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.32
|
| Rate for Payer: Multiplan Commercial |
$323.25
|
| Rate for Payer: Networks By Design Commercial |
$280.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$73.37
|
| Rate for Payer: Prime Health Services Commercial |
$366.35
|
| Rate for Payer: Prime Health Services Medicare |
$77.77
|
| Rate for Payer: Riverside University Health System MISP |
$80.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$258.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$258.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.43
|
| Rate for Payer: United Healthcare All Other HMO |
$59.43
|
| Rate for Payer: United Healthcare HMO Rider |
$59.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$73.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.71
|
| Rate for Payer: Vantage Medical Group Senior |
$73.37
|
|
|
HC FACTOR V LEIDEN MUTATN B INDI
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
900913619
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$86.20 |
| Max. Negotiated Rate |
$387.90 |
| Rate for Payer: Adventist Health Commercial |
$86.20
|
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: Central Health Plan Commercial |
$344.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$301.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.40
|
| Rate for Payer: EPIC Health Plan Senior |
$172.40
|
| Rate for Payer: Galaxy Health WC |
$366.35
|
| Rate for Payer: Global Benefits Group Commercial |
$258.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$273.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$254.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.20
|
| Rate for Payer: Multiplan Commercial |
$323.25
|
| Rate for Payer: Networks By Design Commercial |
$280.15
|
| Rate for Payer: Prime Health Services Commercial |
$366.35
|
|
|
HC FACTOR XII HAGEMANN
|
Facility
|
IP
|
$512.00
|
|
|
Service Code
|
CPT 85280
|
| Hospital Charge Code |
900910062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$102.40 |
| Max. Negotiated Rate |
$460.80 |
| Rate for Payer: Adventist Health Commercial |
$102.40
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Central Health Plan Commercial |
$409.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$358.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.80
|
| Rate for Payer: EPIC Health Plan Senior |
$204.80
|
| Rate for Payer: Galaxy Health WC |
$435.20
|
| Rate for Payer: Global Benefits Group Commercial |
$307.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$460.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$325.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$302.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: Networks By Design Commercial |
$332.80
|
| Rate for Payer: Prime Health Services Commercial |
$435.20
|
|
|
HC FACTOR XII HAGEMANN
|
Facility
|
OP
|
$512.00
|
|
|
Service Code
|
CPT 85280
|
| Hospital Charge Code |
900910062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$460.80 |
| Rate for Payer: Adventist Health Commercial |
$102.40
|
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$19.35
|
| Rate for Payer: Adventist Health Medi-Cal |
$19.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.69
|
| Rate for Payer: Blue Shield of California Commercial |
$44.10
|
| Rate for Payer: Blue Shield of California Commercial |
$322.56
|
| Rate for Payer: Blue Shield of California EPN |
$27.79
|
| Rate for Payer: Blue Shield of California EPN |
$203.26
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Central Health Plan Commercial |
$409.60
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA HMO |
$327.68
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Cigna of CA PPO |
$378.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$358.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.93
|
| Rate for Payer: EPIC Health Plan Senior |
$21.29
|
| Rate for Payer: EPIC Health Plan Senior |
$21.29
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Galaxy Health WC |
$435.20
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Global Benefits Group Commercial |
$307.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$460.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.73
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$325.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.93
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: Networks By Design Commercial |
$332.80
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19.35
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Prime Health Services Commercial |
$435.20
|
| Rate for Payer: Prime Health Services Medicare |
$20.51
|
| Rate for Payer: Prime Health Services Medicare |
$20.51
|
| Rate for Payer: Riverside University Health System MISP |
$21.29
|
| Rate for Payer: Riverside University Health System MISP |
$21.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$307.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$307.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.68
|
| Rate for Payer: United Healthcare All Other HMO |
$15.68
|
| Rate for Payer: United Healthcare All Other HMO |
$15.68
|
| Rate for Payer: United Healthcare HMO Rider |
$15.68
|
| Rate for Payer: United Healthcare HMO Rider |
$15.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC FACTOR XIII ANTIGEN
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900912036
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$52.16 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.48
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.16
|
| Rate for Payer: Blue Shield of California Commercial |
$30.87
|
| Rate for Payer: Blue Shield of California Commercial |
$17.01
|
| Rate for Payer: Blue Shield of California EPN |
$19.45
|
| Rate for Payer: Blue Shield of California EPN |
$10.72
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Central Health Plan Commercial |
$21.60
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA HMO |
$17.28
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Cigna of CA PPO |
$19.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.54
|
| Rate for Payer: EPIC Health Plan Senior |
$17.03
|
| Rate for Payer: EPIC Health Plan Senior |
$17.03
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.39
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.74
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: Networks By Design Commercial |
$17.55
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.48
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.48
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Prime Health Services Medicare |
$16.41
|
| Rate for Payer: Prime Health Services Medicare |
$16.41
|
| Rate for Payer: Riverside University Health System MISP |
$17.03
|
| Rate for Payer: Riverside University Health System MISP |
$17.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.54
|
| Rate for Payer: United Healthcare All Other HMO |
$12.54
|
| Rate for Payer: United Healthcare All Other HMO |
$12.54
|
| Rate for Payer: United Healthcare HMO Rider |
$12.54
|
| Rate for Payer: United Healthcare HMO Rider |
$12.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Vantage Medical Group Senior |
$15.48
|
| Rate for Payer: Vantage Medical Group Senior |
$15.48
|
|
|
HC FACTOR XIII ANTIGEN
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900912036
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
|
|
HC FACTOR XIII SCREEN
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 85291
|
| Hospital Charge Code |
900910023
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.20 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Central Health Plan Commercial |
$120.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.40
|
| Rate for Payer: EPIC Health Plan Senior |
$60.40
|
| Rate for Payer: Galaxy Health WC |
$128.35
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.20
|
| Rate for Payer: Multiplan Commercial |
$113.25
|
| Rate for Payer: Networks By Design Commercial |
$98.15
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
|
|
HC FACTOR XIII SCREEN
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 85291
|
| Hospital Charge Code |
900910023
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.11
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$64.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$64.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.88
|
| Rate for Payer: Blue Shield of California Commercial |
$27.72
|
| Rate for Payer: Blue Shield of California Commercial |
$95.13
|
| Rate for Payer: Blue Shield of California EPN |
$17.47
|
| Rate for Payer: Blue Shield of California EPN |
$59.95
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Central Health Plan Commercial |
$120.80
|
| Rate for Payer: Central Health Plan Commercial |
$35.20
|
| Rate for Payer: Cigna of CA HMO |
$28.16
|
| Rate for Payer: Cigna of CA HMO |
$96.64
|
| Rate for Payer: Cigna of CA PPO |
$32.56
|
| Rate for Payer: Cigna of CA PPO |
$111.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.03
|
| Rate for Payer: EPIC Health Plan Senior |
$10.02
|
| Rate for Payer: EPIC Health Plan Senior |
$10.02
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Galaxy Health WC |
$128.35
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.94
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.21
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$113.25
|
| Rate for Payer: Networks By Design Commercial |
$98.15
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.11
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.11
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
| Rate for Payer: Prime Health Services Medicare |
$9.66
|
| Rate for Payer: Prime Health Services Medicare |
$9.66
|
| Rate for Payer: Riverside University Health System MISP |
$10.02
|
| Rate for Payer: Riverside University Health System MISP |
$10.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.38
|
| Rate for Payer: United Healthcare All Other HMO |
$7.38
|
| Rate for Payer: United Healthcare All Other HMO |
$7.38
|
| Rate for Payer: United Healthcare HMO Rider |
$7.38
|
| Rate for Payer: United Healthcare HMO Rider |
$7.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.02
|
| Rate for Payer: Vantage Medical Group Senior |
$9.11
|
| Rate for Payer: Vantage Medical Group Senior |
$9.11
|
|
|
HC FACTOR XI PTA
|
Facility
|
IP
|
$461.00
|
|
|
Service Code
|
CPT 85270
|
| Hospital Charge Code |
900910061
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$92.20 |
| Max. Negotiated Rate |
$414.90 |
| Rate for Payer: Adventist Health Commercial |
$92.20
|
| Rate for Payer: Cash Price |
$207.45
|
| Rate for Payer: Central Health Plan Commercial |
$368.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$322.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.40
|
| Rate for Payer: EPIC Health Plan Senior |
$184.40
|
| Rate for Payer: Galaxy Health WC |
$391.85
|
| Rate for Payer: Global Benefits Group Commercial |
$276.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$414.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$292.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$271.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.20
|
| Rate for Payer: Multiplan Commercial |
$345.75
|
| Rate for Payer: Networks By Design Commercial |
$299.65
|
| Rate for Payer: Prime Health Services Commercial |
$391.85
|
|
|
HC FACTOR XI PTA
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 85270
|
| Hospital Charge Code |
900910061
|
|
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 |
$92.20
|
| 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 |
$290.43
|
| Rate for Payer: Blue Shield of California Commercial |
$98.28
|
| Rate for Payer: Blue Shield of California EPN |
$183.02
|
| Rate for Payer: Blue Shield of California EPN |
$61.93
|
| Rate for Payer: Cash Price |
$207.45
|
| Rate for Payer: Cash Price |
$207.45
|
| 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 |
$368.80
|
| Rate for Payer: Cigna of CA HMO |
$295.04
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$341.14
|
| 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 |
$322.70
|
| 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 |
$391.85
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$276.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$414.90
|
| 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 |
$292.74
|
| 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 |
$92.20
|
| 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 |
$345.75
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Networks By Design Commercial |
$299.65
|
| 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 |
$391.85
|
| 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 |
$276.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$276.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other 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 X STUART-PROWER
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
900910076
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$465.30 |
| Rate for Payer: Adventist Health Commercial |
$103.40
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Central Health Plan Commercial |
$413.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$361.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.80
|
| Rate for Payer: EPIC Health Plan Senior |
$206.80
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$465.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$328.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$305.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.40
|
| Rate for Payer: Multiplan Commercial |
$387.75
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
|
|
HC FACTOR X STUART-PROWER
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
900910076
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$465.30 |
| Rate for Payer: Adventist Health Commercial |
$103.40
|
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| 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 |
$49.14
|
| Rate for Payer: Blue Shield of California Commercial |
$325.71
|
| Rate for Payer: Blue Shield of California EPN |
$30.97
|
| Rate for Payer: Blue Shield of California EPN |
$205.25
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Central Health Plan Commercial |
$413.60
|
| Rate for Payer: Central Health Plan Commercial |
$62.40
|
| Rate for Payer: Cigna of CA HMO |
$49.92
|
| Rate for Payer: Cigna of CA HMO |
$330.88
|
| Rate for Payer: Cigna of CA PPO |
$57.72
|
| Rate for Payer: Cigna of CA PPO |
$382.58
|
| 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 |
$361.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$54.60
|
| 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 |
$66.30
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$465.30
|
| 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 |
$328.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$49.53
|
| 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 |
$103.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.60
|
| 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 |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$387.75
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Networks By Design Commercial |
$50.70
|
| 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 |
$66.30
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
| 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 |
$310.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$310.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other 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 FALLOPIAN TUBE CATHETERIZATION
|
Facility
|
IP
|
$1,054.00
|
|
|
Service Code
|
CPT 74742
|
| Hospital Charge Code |
909001872
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.80 |
| Max. Negotiated Rate |
$948.60 |
| Rate for Payer: Adventist Health Commercial |
$210.80
|
| Rate for Payer: Cash Price |
$474.30
|
| Rate for Payer: Central Health Plan Commercial |
$843.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$737.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.60
|
| Rate for Payer: EPIC Health Plan Senior |
$421.60
|
| Rate for Payer: Galaxy Health WC |
$895.90
|
| Rate for Payer: Global Benefits Group Commercial |
$632.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$948.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$669.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$621.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.80
|
| Rate for Payer: Multiplan Commercial |
$790.50
|
| Rate for Payer: Networks By Design Commercial |
$685.10
|
| Rate for Payer: Prime Health Services Commercial |
$895.90
|
|
|
HC FALLOPIAN TUBE CATHETERIZATION
|
Facility
|
OP
|
$1,054.00
|
|
|
Service Code
|
CPT 74742
|
| Hospital Charge Code |
909001872
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.80 |
| Max. Negotiated Rate |
$948.60 |
| Rate for Payer: Adventist Health Commercial |
$210.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$358.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$895.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$579.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$790.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$652.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$906.48
|
| Rate for Payer: Blue Shield of California Commercial |
$664.02
|
| Rate for Payer: Blue Shield of California EPN |
$418.44
|
| Rate for Payer: Cash Price |
$474.30
|
| Rate for Payer: Cash Price |
$474.30
|
| Rate for Payer: Central Health Plan Commercial |
$843.20
|
| Rate for Payer: Cigna of CA HMO |
$674.56
|
| Rate for Payer: Cigna of CA PPO |
$779.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$895.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$895.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$895.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$737.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.60
|
| Rate for Payer: EPIC Health Plan Senior |
$421.60
|
| Rate for Payer: Galaxy Health WC |
$895.90
|
| Rate for Payer: Global Benefits Group Commercial |
$632.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$948.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$669.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$382.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$621.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$737.80
|
| Rate for Payer: Multiplan Commercial |
$790.50
|
| Rate for Payer: Networks By Design Commercial |
$685.10
|
| Rate for Payer: Prime Health Services Commercial |
$895.90
|
| Rate for Payer: Riverside University Health System MISP |
$421.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$632.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$632.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$527.00
|
| Rate for Payer: United Healthcare All Other HMO |
$527.00
|
| Rate for Payer: United Healthcare HMO Rider |
$527.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$527.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$895.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$895.90
|
| Rate for Payer: Vantage Medical Group Senior |
$895.90
|
|
|
HC FALLOPIAN TUBE RECANALIZATION
|
Facility
|
OP
|
$9,197.00
|
|
|
Service Code
|
CPT 58345
|
| Hospital Charge Code |
909000177
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,839.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,839.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,163.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,436.87
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$4,138.65
|
| Rate for Payer: Cash Price |
$4,138.65
|
| Rate for Payer: Cash Price |
$4,138.65
|
| Rate for Payer: Central Health Plan Commercial |
$7,357.60
|
| Rate for Payer: Cigna of CA HMO |
$5,886.08
|
| Rate for Payer: Cigna of CA PPO |
$6,805.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,437.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Galaxy Health WC |
$7,817.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,518.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,277.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,840.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,338.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,828.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,839.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$6,897.75
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$5,978.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Preferred Health Network WC |
$6,568.23
|
| Rate for Payer: Prime Health Services Commercial |
$7,817.45
|
| Rate for Payer: Prime Health Services Medicare |
$4,413.29
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Riverside University Health System MISP |
$4,579.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,518.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,598.50
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC FALLOPIAN TUBE RECANALIZATION
|
Facility
|
IP
|
$9,197.00
|
|
|
Service Code
|
CPT 58345
|
| Hospital Charge Code |
909000177
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,839.40 |
| Max. Negotiated Rate |
$8,277.30 |
| Rate for Payer: Adventist Health Commercial |
$1,839.40
|
| Rate for Payer: Cash Price |
$4,138.65
|
| Rate for Payer: Central Health Plan Commercial |
$7,357.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,437.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,678.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,678.80
|
| Rate for Payer: Galaxy Health WC |
$7,817.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,518.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,277.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,840.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,426.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,839.40
|
| Rate for Payer: Multiplan Commercial |
$6,897.75
|
| Rate for Payer: Networks By Design Commercial |
$5,978.05
|
| Rate for Payer: Prime Health Services Commercial |
$7,817.45
|
|
|
HC FAMILY PSYCH WO PT 50 MIN
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
900100708
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$338.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$306.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
|
|
HC FAMILY PSYCH WO PT 50 MIN
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
900100708
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$338.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$306.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.97
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
|
|
HC FAMILY PSYCH WO PT 50 MIN
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
900100708
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$797.64 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$228.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$797.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$342.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$233.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$280.96
|
| Rate for Payer: Blue Shield of California Commercial |
$306.22
|
| Rate for Payer: Blue Shield of California EPN |
$192.72
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Cigna of CA HMO |
$309.12
|
| Rate for Payer: Cigna of CA PPO |
$357.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$342.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$251.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$338.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.68
|
| Rate for Payer: EPIC Health Plan Senior |
$251.12
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$374.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$149.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$228.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$306.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$305.91
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$228.29
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
| Rate for Payer: Prime Health Services Medicare |
$241.99
|
| Rate for Payer: Riverside University Health System MISP |
$251.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$241.50
|
| Rate for Payer: United Healthcare All Other HMO |
$241.50
|
| Rate for Payer: United Healthcare HMO Rider |
$241.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$228.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$342.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Vantage Medical Group Senior |
$228.29
|
|
|
HC FAMILY PSYCH WO PT 50 MIN
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
900100708
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$797.64 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$228.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$797.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$342.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$233.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$280.96
|
| Rate for Payer: Blue Shield of California Commercial |
$306.22
|
| Rate for Payer: Blue Shield of California EPN |
$192.72
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Cigna of CA HMO |
$309.12
|
| Rate for Payer: Cigna of CA PPO |
$357.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$342.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$251.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$338.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.68
|
| Rate for Payer: EPIC Health Plan Senior |
$251.12
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$374.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$149.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$228.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$306.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$305.91
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$228.29
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
| Rate for Payer: Prime Health Services Medicare |
$241.99
|
| Rate for Payer: Riverside University Health System MISP |
$251.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$228.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$342.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Vantage Medical Group Senior |
$228.29
|
|
|
HC FAMILY PSYCH W PT 50 MIN
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
CPT 90847
|
| Hospital Charge Code |
900100709
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$454.50 |
| Rate for Payer: Adventist Health Commercial |
$101.00
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Central Health Plan Commercial |
$404.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$353.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Senior |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$454.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$320.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$297.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.00
|
| Rate for Payer: Multiplan Commercial |
$378.75
|
| Rate for Payer: Networks By Design Commercial |
$328.25
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
|
|
HC FAMILY PSYCH W PT 50 MIN
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
CPT 90847
|
| Hospital Charge Code |
900100709
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$87.72 |
| Max. Negotiated Rate |
$797.64 |
| Rate for Payer: Adventist Health Commercial |
$101.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$228.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$797.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$342.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$244.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$293.76
|
| Rate for Payer: Blue Shield of California Commercial |
$320.17
|
| Rate for Payer: Blue Shield of California EPN |
$201.50
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Central Health Plan Commercial |
$404.00
|
| Rate for Payer: Cigna of CA HMO |
$323.20
|
| Rate for Payer: Cigna of CA PPO |
$373.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$342.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$251.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$353.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.68
|
| Rate for Payer: EPIC Health Plan Senior |
$251.12
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$454.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$374.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$87.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$228.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$320.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$305.91
|
| Rate for Payer: Multiplan Commercial |
$378.75
|
| Rate for Payer: Networks By Design Commercial |
$328.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$228.29
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: Prime Health Services Medicare |
$241.99
|
| Rate for Payer: Riverside University Health System MISP |
$251.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$303.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$228.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$342.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Vantage Medical Group Senior |
$228.29
|
|
|
HC FAMILY PSYCH W PT 50 MIN
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
CPT 90847
|
| Hospital Charge Code |
900100709
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$454.50 |
| Rate for Payer: Adventist Health Commercial |
$101.00
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Central Health Plan Commercial |
$404.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$353.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Senior |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$454.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$320.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$297.95
|
| Rate for Payer: Multiplan Commercial |
$378.75
|
| Rate for Payer: Networks By Design Commercial |
$328.25
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
|
