|
HC HELMET SOFT SHELL X-LRG TAN
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901698209
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC HELMET SOFT SHELL X-LRG TAN
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901698209
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$337.39
|
| Rate for Payer: Blue Shield of California Commercial |
$367.72
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC HELMET SOFT SHELL X-SMALL TAN
|
Facility
|
OP
|
$502.63
|
|
| Hospital Charge Code |
901698205
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$452.37 |
| Rate for Payer: Adventist Health Commercial |
$100.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$305.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$276.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$376.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$243.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$292.38
|
| Rate for Payer: Blue Shield of California Commercial |
$318.67
|
| Rate for Payer: Blue Shield of California EPN |
$200.55
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Central Health Plan Commercial |
$402.10
|
| Rate for Payer: Cigna of CA HMO |
$321.68
|
| Rate for Payer: Cigna of CA PPO |
$371.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$427.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$427.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.05
|
| Rate for Payer: EPIC Health Plan Senior |
$201.05
|
| Rate for Payer: Galaxy Health WC |
$427.24
|
| Rate for Payer: Global Benefits Group Commercial |
$301.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$452.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$182.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$351.84
|
| Rate for Payer: Multiplan Commercial |
$376.97
|
| Rate for Payer: Networks By Design Commercial |
$326.71
|
| Rate for Payer: Prime Health Services Commercial |
$427.24
|
| Rate for Payer: Riverside University Health System MISP |
$201.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$301.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.31
|
| Rate for Payer: United Healthcare All Other HMO |
$251.31
|
| Rate for Payer: United Healthcare HMO Rider |
$251.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$251.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$427.24
|
| Rate for Payer: Vantage Medical Group Senior |
$427.24
|
|
|
HC HELMET SOFT SHELL X-SMALL TAN
|
Facility
|
IP
|
$502.63
|
|
| Hospital Charge Code |
901698205
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$452.37 |
| Rate for Payer: Adventist Health Commercial |
$100.53
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Central Health Plan Commercial |
$402.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.05
|
| Rate for Payer: EPIC Health Plan Senior |
$201.05
|
| Rate for Payer: Galaxy Health WC |
$427.24
|
| Rate for Payer: Global Benefits Group Commercial |
$301.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$452.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.53
|
| Rate for Payer: Multiplan Commercial |
$376.97
|
| Rate for Payer: Networks By Design Commercial |
$326.71
|
| Rate for Payer: Prime Health Services Commercial |
$427.24
|
|
|
HC HELMET SOFT SHELL XXLG
|
Facility
|
OP
|
$393.99
|
|
| Hospital Charge Code |
901692013
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$78.80 |
| Max. Negotiated Rate |
$354.59 |
| Rate for Payer: Adventist Health Commercial |
$78.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$239.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$334.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$216.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$190.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$229.18
|
| Rate for Payer: Blue Shield of California Commercial |
$249.79
|
| Rate for Payer: Blue Shield of California EPN |
$157.20
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Central Health Plan Commercial |
$315.19
|
| Rate for Payer: Cigna of CA HMO |
$252.15
|
| Rate for Payer: Cigna of CA PPO |
$291.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$334.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$334.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$334.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$275.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.60
|
| Rate for Payer: EPIC Health Plan Senior |
$157.60
|
| Rate for Payer: Galaxy Health WC |
$334.89
|
| Rate for Payer: Global Benefits Group Commercial |
$236.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$354.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$250.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$232.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$275.79
|
| Rate for Payer: Multiplan Commercial |
$295.49
|
| Rate for Payer: Networks By Design Commercial |
$256.09
|
| Rate for Payer: Prime Health Services Commercial |
$334.89
|
| Rate for Payer: Riverside University Health System MISP |
$157.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$236.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$236.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.00
|
| Rate for Payer: United Healthcare All Other HMO |
$197.00
|
| Rate for Payer: United Healthcare HMO Rider |
$197.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$197.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$334.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$334.89
|
| Rate for Payer: Vantage Medical Group Senior |
$334.89
|
|
|
HC HELMET SOFT SHELL XXLG
|
Facility
|
IP
|
$393.99
|
|
| Hospital Charge Code |
901692013
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$78.80 |
| Max. Negotiated Rate |
$354.59 |
| Rate for Payer: Adventist Health Commercial |
$78.80
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Central Health Plan Commercial |
$315.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$275.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.60
|
| Rate for Payer: EPIC Health Plan Senior |
$157.60
|
| Rate for Payer: Galaxy Health WC |
$334.89
|
| Rate for Payer: Global Benefits Group Commercial |
$236.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$354.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$250.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$232.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.80
|
| Rate for Payer: Multiplan Commercial |
$295.49
|
| Rate for Payer: Networks By Design Commercial |
$256.09
|
| Rate for Payer: Prime Health Services Commercial |
$334.89
|
|
|
HC HEMATOCRIT HCT POC
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
900912115
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Central Health Plan Commercial |
$106.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.20
|
| Rate for Payer: EPIC Health Plan Senior |
$53.20
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$84.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$78.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.60
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: Networks By Design Commercial |
$86.45
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
|
|
HC HEMATOCRIT HCT POC
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
900912115
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.90
|
| Rate for Payer: Blue Shield of California Commercial |
$83.79
|
| Rate for Payer: Blue Shield of California EPN |
$52.80
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Central Health Plan Commercial |
$106.40
|
| Rate for Payer: Cigna of CA HMO |
$85.12
|
| Rate for Payer: Cigna of CA PPO |
$98.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.91
|
| Rate for Payer: EPIC Health Plan Senior |
$2.61
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$84.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.18
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: Networks By Design Commercial |
$86.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2.37
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
| Rate for Payer: Prime Health Services Medicare |
$2.51
|
| Rate for Payer: Riverside University Health System MISP |
$2.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1.92
|
| Rate for Payer: United Healthcare HMO Rider |
$1.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.92
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.61
|
| Rate for Payer: Vantage Medical Group Senior |
$2.37
|
|
|
HC HEMATOPOIETIC PROGENITOR CELLS
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900912029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$72.55 |
| Max. Negotiated Rate |
$760.68 |
| Rate for Payer: Adventist Health Commercial |
$88.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$461.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$533.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$283.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$394.51
|
| Rate for Payer: Blue Shield of California Commercial |
$277.83
|
| Rate for Payer: Blue Shield of California EPN |
$175.08
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Central Health Plan Commercial |
$352.80
|
| Rate for Payer: Cigna of CA HMO |
$282.24
|
| Rate for Payer: Cigna of CA PPO |
$326.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$691.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$461.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$308.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$760.68
|
| Rate for Payer: EPIC Health Plan Senior |
$507.12
|
| Rate for Payer: Galaxy Health WC |
$374.85
|
| Rate for Payer: Global Benefits Group Commercial |
$264.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$396.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$756.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$280.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$645.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$617.77
|
| Rate for Payer: Multiplan Commercial |
$330.75
|
| Rate for Payer: Networks By Design Commercial |
$286.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$461.02
|
| Rate for Payer: Prime Health Services Commercial |
$374.85
|
| Rate for Payer: Prime Health Services Medicare |
$488.68
|
| Rate for Payer: Riverside University Health System MISP |
$507.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$264.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$264.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$461.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Vantage Medical Group Senior |
$461.02
|
|
|
HC HEMATOPOIETIC PROGENITOR CELLS
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900912029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Adventist Health Commercial |
$88.20
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Central Health Plan Commercial |
$352.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$308.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.40
|
| Rate for Payer: EPIC Health Plan Senior |
$176.40
|
| Rate for Payer: Galaxy Health WC |
$374.85
|
| Rate for Payer: Global Benefits Group Commercial |
$264.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$396.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$280.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$260.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.20
|
| Rate for Payer: Multiplan Commercial |
$330.75
|
| Rate for Payer: Networks By Design Commercial |
$286.65
|
| Rate for Payer: Prime Health Services Commercial |
$374.85
|
|
|
HC HEMECH-EPINEPHRINE
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900910197
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$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 HEMECH-EPINEPHRINE
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900910197
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.18 |
| Max. Negotiated Rate |
$184.59 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.91
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.59
|
| 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 |
$37.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$311.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.10
|
| Rate for Payer: EPIC Health Plan Senior |
$27.40
|
| Rate for Payer: EPIC Health Plan Senior |
$27.40
|
| Rate for Payer: Galaxy Health WC |
$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 |
$40.85
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$40.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$282.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33.38
|
| 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 |
$24.91
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.91
|
| 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 |
$26.40
|
| Rate for Payer: Prime Health Services Medicare |
$26.40
|
| Rate for Payer: Riverside University Health System MISP |
$27.40
|
| Rate for Payer: Riverside University Health System MISP |
$27.40
|
| 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 |
$20.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.18
|
| Rate for Payer: United Healthcare All Other HMO |
$20.18
|
| Rate for Payer: United Healthcare All Other HMO |
$20.18
|
| Rate for Payer: United Healthcare HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Senior |
$24.91
|
| Rate for Payer: Vantage Medical Group Senior |
$24.91
|
|
|
HC HEMECH SCRN-ARACHEDONIC ACID A
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.18 |
| Max. Negotiated Rate |
$184.59 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.91
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.59
|
| Rate for Payer: Blue Shield of California Commercial |
$233.10
|
| Rate for Payer: Blue Shield of California Commercial |
$98.28
|
| Rate for Payer: Blue Shield of California EPN |
$146.89
|
| Rate for Payer: Blue Shield of California EPN |
$61.93
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: Central Health Plan Commercial |
$296.00
|
| Rate for Payer: Cigna of CA HMO |
$236.80
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$273.80
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$259.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.10
|
| Rate for Payer: EPIC Health Plan Senior |
$27.40
|
| Rate for Payer: EPIC Health Plan Senior |
$27.40
|
| Rate for Payer: Galaxy Health WC |
$314.50
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$222.00
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$333.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$40.85
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$40.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$234.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33.38
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Networks By Design Commercial |
$240.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.91
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.91
|
| Rate for Payer: Prime Health Services Commercial |
$314.50
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Medicare |
$26.40
|
| Rate for Payer: Prime Health Services Medicare |
$26.40
|
| Rate for Payer: Riverside University Health System MISP |
$27.40
|
| Rate for Payer: Riverside University Health System MISP |
$27.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$222.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$222.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.18
|
| Rate for Payer: United Healthcare All Other HMO |
$20.18
|
| Rate for Payer: United Healthcare All Other HMO |
$20.18
|
| Rate for Payer: United Healthcare HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Senior |
$24.91
|
| Rate for Payer: Vantage Medical Group Senior |
$24.91
|
|
|
HC HEMECH SCRN-ARACHEDONIC ACID A
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Central Health Plan Commercial |
$296.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$259.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.00
|
| Rate for Payer: EPIC Health Plan Senior |
$148.00
|
| Rate for Payer: Galaxy Health WC |
$314.50
|
| Rate for Payer: Global Benefits Group Commercial |
$222.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$333.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$234.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$218.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.00
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: Networks By Design Commercial |
$240.50
|
| Rate for Payer: Prime Health Services Commercial |
$314.50
|
|
|
HC HEMIC/LYMPHATIC SYSTM PROCEDURE
|
Facility
|
IP
|
$1,955.00
|
|
|
Service Code
|
CPT 38999
|
| Hospital Charge Code |
909008999
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$391.00 |
| Max. Negotiated Rate |
$1,759.50 |
| Rate for Payer: Adventist Health Commercial |
$391.00
|
| Rate for Payer: Cash Price |
$879.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,564.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,368.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$782.00
|
| Rate for Payer: EPIC Health Plan Senior |
$782.00
|
| Rate for Payer: Galaxy Health WC |
$1,661.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,173.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,759.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,241.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,153.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.00
|
| Rate for Payer: Multiplan Commercial |
$1,466.25
|
| Rate for Payer: Networks By Design Commercial |
$1,270.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,661.75
|
|
|
HC HEMIC/LYMPHATIC SYSTM PROCEDURE
|
Facility
|
OP
|
$1,955.00
|
|
|
Service Code
|
CPT 38999
|
| Hospital Charge Code |
909008999
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$391.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$391.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$567.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$946.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,137.22
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$885.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$879.75
|
| Rate for Payer: Cash Price |
$879.75
|
| Rate for Payer: Cash Price |
$879.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,564.00
|
| Rate for Payer: Cigna of CA HMO |
$1,251.20
|
| Rate for Payer: Cigna of CA PPO |
$1,446.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,368.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.24
|
| Rate for Payer: EPIC Health Plan Senior |
$624.16
|
| Rate for Payer: Galaxy Health WC |
$1,661.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,173.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,759.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$930.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,241.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$760.34
|
| Rate for Payer: Multiplan Commercial |
$1,466.25
|
| Rate for Payer: Multiplan WC |
$885.06
|
| Rate for Payer: Networks By Design Commercial |
$1,270.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$567.42
|
| Rate for Payer: Preferred Health Network WC |
$903.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,661.75
|
| Rate for Payer: Prime Health Services Medicare |
$601.47
|
| Rate for Payer: Prime Health Services WC |
$876.03
|
| Rate for Payer: Riverside University Health System MISP |
$624.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,173.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$977.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$567.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC HEMODIALYSIS KIT 2LUMEN 12FR
|
Facility
|
IP
|
$849.16
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698819
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.83 |
| Max. Negotiated Rate |
$764.24 |
| Rate for Payer: Adventist Health Commercial |
$169.83
|
| Rate for Payer: Blue Shield of California Commercial |
$681.03
|
| Rate for Payer: Blue Shield of California EPN |
$427.98
|
| Rate for Payer: Cash Price |
$382.12
|
| Rate for Payer: Central Health Plan Commercial |
$679.33
|
| Rate for Payer: Cigna of CA HMO |
$594.41
|
| Rate for Payer: Cigna of CA PPO |
$594.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$594.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$339.66
|
| Rate for Payer: EPIC Health Plan Senior |
$339.66
|
| Rate for Payer: Galaxy Health WC |
$721.79
|
| Rate for Payer: Global Benefits Group Commercial |
$509.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$764.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$539.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$501.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.83
|
| Rate for Payer: Multiplan Commercial |
$636.87
|
| Rate for Payer: Networks By Design Commercial |
$424.58
|
| Rate for Payer: Prime Health Services Commercial |
$721.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$318.69
|
| Rate for Payer: United Healthcare All Other HMO |
$310.20
|
| Rate for Payer: United Healthcare HMO Rider |
$303.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.10
|
|
|
HC HEMODIALYSIS KIT 2LUMEN 12FR
|
Facility
|
OP
|
$691.06
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.21 |
| Max. Negotiated Rate |
$621.95 |
| Rate for Payer: Adventist Health Commercial |
$138.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$380.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$518.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$315.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$378.98
|
| Rate for Payer: Blue Shield of California Commercial |
$554.23
|
| Rate for Payer: Blue Shield of California EPN |
$348.29
|
| Rate for Payer: Cash Price |
$310.98
|
| Rate for Payer: Central Health Plan Commercial |
$552.85
|
| Rate for Payer: Cigna of CA HMO |
$483.74
|
| Rate for Payer: Cigna of CA PPO |
$483.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$587.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$587.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$483.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$276.42
|
| Rate for Payer: EPIC Health Plan Senior |
$276.42
|
| Rate for Payer: Galaxy Health WC |
$587.40
|
| Rate for Payer: Global Benefits Group Commercial |
$414.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$621.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$438.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$250.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$407.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$483.74
|
| Rate for Payer: Multiplan Commercial |
$518.29
|
| Rate for Payer: Networks By Design Commercial |
$345.53
|
| Rate for Payer: Prime Health Services Commercial |
$587.40
|
| Rate for Payer: Riverside University Health System MISP |
$276.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$414.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$414.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$259.35
|
| Rate for Payer: United Healthcare All Other HMO |
$252.44
|
| Rate for Payer: United Healthcare HMO Rider |
$246.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$226.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$587.40
|
| Rate for Payer: Vantage Medical Group Senior |
$587.40
|
|
|
HC HEMODIALYSIS KIT 2LUMEN 12FR
|
Facility
|
OP
|
$849.16
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698819
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.83 |
| Max. Negotiated Rate |
$764.24 |
| Rate for Payer: Adventist Health Commercial |
$169.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$721.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$636.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$387.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.68
|
| Rate for Payer: Blue Shield of California Commercial |
$681.03
|
| Rate for Payer: Blue Shield of California EPN |
$427.98
|
| Rate for Payer: Cash Price |
$382.12
|
| Rate for Payer: Central Health Plan Commercial |
$679.33
|
| Rate for Payer: Cigna of CA HMO |
$594.41
|
| Rate for Payer: Cigna of CA PPO |
$594.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$721.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$721.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$721.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$594.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$339.66
|
| Rate for Payer: EPIC Health Plan Senior |
$339.66
|
| Rate for Payer: Galaxy Health WC |
$721.79
|
| Rate for Payer: Global Benefits Group Commercial |
$509.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$764.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$539.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$308.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$501.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$594.41
|
| Rate for Payer: Multiplan Commercial |
$636.87
|
| Rate for Payer: Networks By Design Commercial |
$424.58
|
| Rate for Payer: Prime Health Services Commercial |
$721.79
|
| Rate for Payer: Riverside University Health System MISP |
$339.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$509.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$509.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$318.69
|
| Rate for Payer: United Healthcare All Other HMO |
$310.20
|
| Rate for Payer: United Healthcare HMO Rider |
$303.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$721.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$721.79
|
| Rate for Payer: Vantage Medical Group Senior |
$721.79
|
|
|
HC HEMODIALYSIS KIT 2LUMEN 12FR
|
Facility
|
IP
|
$691.06
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.21 |
| Max. Negotiated Rate |
$621.95 |
| Rate for Payer: Adventist Health Commercial |
$138.21
|
| Rate for Payer: Blue Shield of California Commercial |
$554.23
|
| Rate for Payer: Blue Shield of California EPN |
$348.29
|
| Rate for Payer: Cash Price |
$310.98
|
| Rate for Payer: Central Health Plan Commercial |
$552.85
|
| Rate for Payer: Cigna of CA HMO |
$483.74
|
| Rate for Payer: Cigna of CA PPO |
$483.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$483.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$276.42
|
| Rate for Payer: EPIC Health Plan Senior |
$276.42
|
| Rate for Payer: Galaxy Health WC |
$587.40
|
| Rate for Payer: Global Benefits Group Commercial |
$414.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$621.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$438.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$407.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.21
|
| Rate for Payer: Multiplan Commercial |
$518.29
|
| Rate for Payer: Networks By Design Commercial |
$345.53
|
| Rate for Payer: Prime Health Services Commercial |
$587.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$259.35
|
| Rate for Payer: United Healthcare All Other HMO |
$252.44
|
| Rate for Payer: United Healthcare HMO Rider |
$246.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$226.32
|
|
|
HC HEMODIALYSIS, ONE EVALUATION
|
Facility
|
IP
|
$2,567.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
900501419
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$513.40 |
| Max. Negotiated Rate |
$2,310.30 |
| Rate for Payer: Adventist Health Commercial |
$513.40
|
| Rate for Payer: Cash Price |
$1,155.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,053.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,796.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,026.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,026.80
|
| Rate for Payer: Galaxy Health WC |
$2,181.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,540.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,310.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,630.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,514.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.40
|
| Rate for Payer: Multiplan Commercial |
$1,925.25
|
| Rate for Payer: Networks By Design Commercial |
$1,668.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,181.95
|
|
|
HC HEMODIALYSIS, ONE EVALUATION
|
Facility
|
OP
|
$2,567.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
900501419
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.54 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$513.40
|
| 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 |
$1,324.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$970.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$882.72
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$1,416.56
|
| Rate for Payer: Cash Price |
$1,155.15
|
| Rate for Payer: Cash Price |
$1,155.15
|
| Rate for Payer: Cash Price |
$1,155.15
|
| Rate for Payer: Cash Price |
$1,155.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,053.60
|
| Rate for Payer: Cigna of CA HMO |
$1,642.88
|
| Rate for Payer: Cigna of CA PPO |
$1,899.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,324.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$970.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$882.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,796.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,456.49
|
| Rate for Payer: EPIC Health Plan Senior |
$970.99
|
| Rate for Payer: Galaxy Health WC |
$2,181.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,540.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,310.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,447.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$882.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,630.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$948.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,182.84
|
| Rate for Payer: Multiplan Commercial |
$1,925.25
|
| Rate for Payer: Multiplan WC |
$1,416.56
|
| Rate for Payer: Networks By Design Commercial |
$1,668.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$882.72
|
| Rate for Payer: Preferred Health Network WC |
$1,445.47
|
| Rate for Payer: Prime Health Services Commercial |
$2,181.95
|
| Rate for Payer: Prime Health Services Medicare |
$935.68
|
| Rate for Payer: Prime Health Services WC |
$1,402.11
|
| Rate for Payer: Riverside University Health System MISP |
$970.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,540.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,283.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,283.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,283.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,283.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$882.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,324.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$970.99
|
| Rate for Payer: Vantage Medical Group Senior |
$882.72
|
|
|
HC HEMODIALYSIS TREATMENT OUTPT
|
Facility
|
OP
|
$2,567.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
941000105
|
|
Hospital Revenue Code
|
821
|
| Min. Negotiated Rate |
$97.35 |
| Max. Negotiated Rate |
$2,310.30 |
| Rate for Payer: Adventist Health Commercial |
$513.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$882.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$430.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,324.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$970.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$882.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,242.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,493.22
|
| Rate for Payer: Cash Price |
$1,155.15
|
| Rate for Payer: Cash Price |
$1,155.15
|
| Rate for Payer: Cash Price |
$1,155.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,053.60
|
| Rate for Payer: Cigna of CA HMO |
$1,642.88
|
| Rate for Payer: Cigna of CA PPO |
$1,899.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,324.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$970.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$882.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,796.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,456.49
|
| Rate for Payer: EPIC Health Plan Senior |
$970.99
|
| Rate for Payer: Galaxy Health WC |
$2,181.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,540.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,310.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,447.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$882.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,630.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,235.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,182.84
|
| Rate for Payer: Multiplan Commercial |
$1,925.25
|
| Rate for Payer: Networks By Design Commercial |
$1,668.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$882.72
|
| Rate for Payer: Prime Health Services Commercial |
$2,181.95
|
| Rate for Payer: Prime Health Services Medicare |
$935.68
|
| Rate for Payer: Riverside University Health System MISP |
$970.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,540.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,540.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,610.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,170.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,072.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$882.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,324.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$970.99
|
| Rate for Payer: Vantage Medical Group Senior |
$882.72
|
|
|
HC HEMODIALYSIS TREATMENT OUTPT
|
Facility
|
IP
|
$2,567.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
941000105
|
|
Hospital Revenue Code
|
821
|
| Min. Negotiated Rate |
$513.40 |
| Max. Negotiated Rate |
$2,310.30 |
| Rate for Payer: Adventist Health Commercial |
$513.40
|
| Rate for Payer: Cash Price |
$1,155.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,053.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,796.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,026.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,026.80
|
| Rate for Payer: Galaxy Health WC |
$2,181.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,540.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,310.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,630.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,514.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.40
|
| Rate for Payer: Multiplan Commercial |
$1,925.25
|
| Rate for Payer: Networks By Design Commercial |
$1,668.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,181.95
|
|
|
HC HEMODIALYSIS TREATMENT OUTPT/PEDS
|
Facility
|
IP
|
$2,567.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
949000105
|
|
Hospital Revenue Code
|
821
|
| Min. Negotiated Rate |
$513.40 |
| Max. Negotiated Rate |
$2,310.30 |
| Rate for Payer: EPIC Health Plan Senior |
$1,026.80
|
| Rate for Payer: Galaxy Health WC |
$2,181.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,026.80
|
| Rate for Payer: Adventist Health Commercial |
$513.40
|
| Rate for Payer: Cash Price |
$1,155.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,053.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,796.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,540.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,310.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,630.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,514.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.40
|
| Rate for Payer: Multiplan Commercial |
$1,925.25
|
| Rate for Payer: Networks By Design Commercial |
$1,668.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,181.95
|
|
