|
HC HEMODIALYSIS TREATMENT OUTPT/PEDS
|
Facility
|
OP
|
$2,567.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
949000105
|
|
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 HEMOGLOBIN A1C
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
900912128
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.71
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$71.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$71.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$70.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$70.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.19
|
| Rate for Payer: Blue Shield of California Commercial |
$51.66
|
| Rate for Payer: Blue Shield of California Commercial |
$148.05
|
| Rate for Payer: Blue Shield of California EPN |
$32.55
|
| Rate for Payer: Blue Shield of California EPN |
$93.30
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Central Health Plan Commercial |
$188.00
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA HMO |
$150.40
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Cigna of CA PPO |
$173.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.02
|
| Rate for Payer: EPIC Health Plan Senior |
$10.68
|
| Rate for Payer: EPIC Health Plan Senior |
$10.68
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.92
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.01
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.71
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.71
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| Rate for Payer: Prime Health Services Medicare |
$10.29
|
| Rate for Payer: Prime Health Services Medicare |
$10.29
|
| Rate for Payer: Riverside University Health System MISP |
$10.68
|
| Rate for Payer: Riverside University Health System MISP |
$10.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.87
|
| Rate for Payer: United Healthcare All Other HMO |
$7.87
|
| Rate for Payer: United Healthcare All Other HMO |
$7.87
|
| Rate for Payer: United Healthcare HMO Rider |
$7.87
|
| Rate for Payer: United Healthcare HMO Rider |
$7.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Vantage Medical Group Senior |
$9.71
|
| Rate for Payer: Vantage Medical Group Senior |
$9.71
|
|
|
HC HEMOGLOBIN A1C
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
900912128
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Central Health Plan Commercial |
$188.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
|
|
HC HEMOGLOBIN A1C (POC)
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
900912157
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Central Health Plan Commercial |
$188.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
|
|
HC HEMOGLOBIN A1C (POC)
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
900912157
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$71.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$70.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.19
|
| Rate for Payer: Blue Shield of California Commercial |
$148.05
|
| Rate for Payer: Blue Shield of California EPN |
$93.30
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Central Health Plan Commercial |
$188.00
|
| Rate for Payer: Cigna of CA HMO |
$150.40
|
| Rate for Payer: Cigna of CA PPO |
$173.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.02
|
| Rate for Payer: EPIC Health Plan Senior |
$10.68
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.01
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.71
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| Rate for Payer: Prime Health Services Medicare |
$10.29
|
| Rate for Payer: Riverside University Health System MISP |
$10.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.87
|
| Rate for Payer: United Healthcare All Other HMO |
$7.87
|
| Rate for Payer: United Healthcare HMO Rider |
$7.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Vantage Medical Group Senior |
$9.71
|
|
|
HC HEMOGLOBIN CITRATE
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900910898
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Central Health Plan Commercial |
$89.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$100.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.40
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
|
|
HC HEMOGLOBIN CITRATE
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900910898
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$110.58 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.87
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.58
|
| Rate for Payer: Blue Shield of California Commercial |
$42.84
|
| Rate for Payer: Blue Shield of California Commercial |
$70.56
|
| Rate for Payer: Blue Shield of California EPN |
$27.00
|
| Rate for Payer: Blue Shield of California EPN |
$44.46
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Central Health Plan Commercial |
$89.60
|
| Rate for Payer: Central Health Plan Commercial |
$54.40
|
| Rate for Payer: Cigna of CA HMO |
$43.52
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$50.32
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.16
|
| Rate for Payer: EPIC Health Plan Senior |
$14.16
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$100.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Networks By Design Commercial |
$44.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.87
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.87
|
| Rate for Payer: Prime Health Services Commercial |
$57.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Prime Health Services Medicare |
$13.64
|
| Rate for Payer: Prime Health Services Medicare |
$13.64
|
| Rate for Payer: Riverside University Health System MISP |
$14.16
|
| Rate for Payer: Riverside University Health System MISP |
$14.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900910897
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Central Health Plan Commercial |
$89.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$100.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.40
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900910897
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$110.58 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.87
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.58
|
| Rate for Payer: Blue Shield of California Commercial |
$42.84
|
| Rate for Payer: Blue Shield of California Commercial |
$70.56
|
| Rate for Payer: Blue Shield of California EPN |
$27.00
|
| Rate for Payer: Blue Shield of California EPN |
$44.46
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Central Health Plan Commercial |
$89.60
|
| Rate for Payer: Central Health Plan Commercial |
$54.40
|
| Rate for Payer: Cigna of CA HMO |
$43.52
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$50.32
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.16
|
| Rate for Payer: EPIC Health Plan Senior |
$14.16
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$100.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Networks By Design Commercial |
$44.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.87
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.87
|
| Rate for Payer: Prime Health Services Commercial |
$57.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Prime Health Services Medicare |
$13.64
|
| Rate for Payer: Prime Health Services Medicare |
$13.64
|
| Rate for Payer: Riverside University Health System MISP |
$14.16
|
| Rate for Payer: Riverside University Health System MISP |
$14.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC HEMOGLOBIN FETAL, STAIN
|
Facility
|
IP
|
$481.00
|
|
|
Service Code
|
CPT 85460
|
| Hospital Charge Code |
900910133
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$432.90 |
| Rate for Payer: Adventist Health Commercial |
$96.20
|
| Rate for Payer: Cash Price |
$216.45
|
| Rate for Payer: Central Health Plan Commercial |
$384.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$336.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.40
|
| Rate for Payer: EPIC Health Plan Senior |
$192.40
|
| Rate for Payer: Galaxy Health WC |
$408.85
|
| Rate for Payer: Global Benefits Group Commercial |
$288.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$432.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$305.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$283.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.20
|
| Rate for Payer: Multiplan Commercial |
$360.75
|
| Rate for Payer: Networks By Design Commercial |
$312.65
|
| Rate for Payer: Prime Health Services Commercial |
$408.85
|
|
|
HC HEMOGLOBIN FETAL, STAIN
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 85460
|
| Hospital Charge Code |
900910133
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$78.24 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Adventist Health Commercial |
$96.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.73
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.24
|
| Rate for Payer: Blue Shield of California Commercial |
$303.03
|
| Rate for Payer: Blue Shield of California Commercial |
$17.64
|
| Rate for Payer: Blue Shield of California EPN |
$190.96
|
| Rate for Payer: Blue Shield of California EPN |
$11.12
|
| Rate for Payer: Cash Price |
$216.45
|
| Rate for Payer: Cash Price |
$216.45
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: Central Health Plan Commercial |
$384.80
|
| Rate for Payer: Cigna of CA HMO |
$307.84
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$355.94
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$336.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.75
|
| Rate for Payer: EPIC Health Plan Senior |
$8.50
|
| Rate for Payer: EPIC Health Plan Senior |
$8.50
|
| Rate for Payer: Galaxy Health WC |
$408.85
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$288.60
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$432.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.68
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$305.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.36
|
| Rate for Payer: Multiplan Commercial |
$360.75
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Networks By Design Commercial |
$312.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.73
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.73
|
| Rate for Payer: Prime Health Services Commercial |
$408.85
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Prime Health Services Medicare |
$8.19
|
| Rate for Payer: Prime Health Services Medicare |
$8.19
|
| Rate for Payer: Riverside University Health System MISP |
$8.50
|
| Rate for Payer: Riverside University Health System MISP |
$8.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$288.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$288.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.26
|
| Rate for Payer: United Healthcare All Other HMO |
$6.26
|
| Rate for Payer: United Healthcare All Other HMO |
$6.26
|
| Rate for Payer: United Healthcare HMO Rider |
$6.26
|
| Rate for Payer: United Healthcare HMO Rider |
$6.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.26
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.50
|
| Rate for Payer: Vantage Medical Group Senior |
$7.73
|
| Rate for Payer: Vantage Medical Group Senior |
$7.73
|
|
|
HC HEMOGLOBIN PLASMA
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
900912162
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$138.60 |
| Rate for Payer: Adventist Health Commercial |
$30.80
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Central Health Plan Commercial |
$123.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.60
|
| Rate for Payer: EPIC Health Plan Senior |
$61.60
|
| Rate for Payer: Galaxy Health WC |
$130.90
|
| Rate for Payer: Global Benefits Group Commercial |
$92.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$138.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$97.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.80
|
| Rate for Payer: Multiplan Commercial |
$115.50
|
| Rate for Payer: Networks By Design Commercial |
$100.10
|
| Rate for Payer: Prime Health Services Commercial |
$130.90
|
|
|
HC HEMOGLOBIN PLASMA
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
900912162
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$138.60 |
| Rate for Payer: Adventist Health Commercial |
$30.80
|
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.31
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$53.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$53.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.88
|
| Rate for Payer: Blue Shield of California Commercial |
$22.68
|
| Rate for Payer: Blue Shield of California Commercial |
$97.02
|
| Rate for Payer: Blue Shield of California EPN |
$14.29
|
| Rate for Payer: Blue Shield of California EPN |
$61.14
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Central Health Plan Commercial |
$123.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA HMO |
$98.56
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Cigna of CA PPO |
$113.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.06
|
| Rate for Payer: EPIC Health Plan Senior |
$8.04
|
| Rate for Payer: EPIC Health Plan Senior |
$8.04
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Galaxy Health WC |
$130.90
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Global Benefits Group Commercial |
$92.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$138.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.99
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$97.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$115.50
|
| Rate for Payer: Networks By Design Commercial |
$100.10
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.31
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.31
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Commercial |
$130.90
|
| Rate for Payer: Prime Health Services Medicare |
$7.75
|
| Rate for Payer: Prime Health Services Medicare |
$7.75
|
| Rate for Payer: Riverside University Health System MISP |
$8.04
|
| Rate for Payer: Riverside University Health System MISP |
$8.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$92.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$92.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.92
|
| Rate for Payer: United Healthcare All Other HMO |
$5.92
|
| Rate for Payer: United Healthcare All Other HMO |
$5.92
|
| Rate for Payer: United Healthcare HMO Rider |
$5.92
|
| Rate for Payer: United Healthcare HMO Rider |
$5.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.92
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.04
|
| Rate for Payer: Vantage Medical Group Senior |
$7.31
|
| Rate for Payer: Vantage Medical Group Senior |
$7.31
|
|
|
HC HEMOGLOBIN (POC)
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
900912023
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Adventist Health Commercial |
$19.00
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Central Health Plan Commercial |
$76.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$66.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.00
|
| Rate for Payer: EPIC Health Plan Senior |
$38.00
|
| Rate for Payer: Galaxy Health WC |
$80.75
|
| Rate for Payer: Global Benefits Group Commercial |
$57.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$85.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Multiplan Commercial |
$71.25
|
| Rate for Payer: Networks By Design Commercial |
$61.75
|
| Rate for Payer: Prime Health Services Commercial |
$80.75
|
|
|
HC HEMOGLOBIN (POC)
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
900912023
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Adventist Health Commercial |
$19.00
|
| 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 |
$59.85
|
| Rate for Payer: Blue Shield of California EPN |
$37.72
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Central Health Plan Commercial |
$76.00
|
| Rate for Payer: Cigna of CA HMO |
$60.80
|
| Rate for Payer: Cigna of CA PPO |
$70.30
|
| 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 |
$66.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.91
|
| Rate for Payer: EPIC Health Plan Senior |
$2.61
|
| Rate for Payer: Galaxy Health WC |
$80.75
|
| Rate for Payer: Global Benefits Group Commercial |
$57.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$85.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.18
|
| Rate for Payer: Multiplan Commercial |
$71.25
|
| Rate for Payer: Networks By Design Commercial |
$61.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2.37
|
| Rate for Payer: Prime Health Services Commercial |
$80.75
|
| 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 |
$57.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.00
|
| 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 HEMOPH INFLUENZA ADMIN
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
902890230
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$9.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.96
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Riverside University Health System MISP |
$9.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC HEMOPH INFLUENZA ADMIN
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
902890230
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC HEMOSTASIS TEST FOR QUANTRA
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
CPT 85396
|
| Hospital Charge Code |
900912041
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Adventist Health Commercial |
$47.60
|
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$130.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$178.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$116.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$116.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.19
|
| Rate for Payer: Blue Shield of California Commercial |
$107.10
|
| Rate for Payer: Blue Shield of California Commercial |
$149.94
|
| Rate for Payer: Blue Shield of California EPN |
$67.49
|
| Rate for Payer: Blue Shield of California EPN |
$94.49
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Central Health Plan Commercial |
$190.40
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$108.80
|
| Rate for Payer: Cigna of CA HMO |
$152.32
|
| Rate for Payer: Cigna of CA PPO |
$125.80
|
| Rate for Payer: Cigna of CA PPO |
$176.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$202.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$202.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$166.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$95.20
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Galaxy Health WC |
$202.30
|
| Rate for Payer: Global Benefits Group Commercial |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$214.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$151.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$140.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$166.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$119.00
|
| Rate for Payer: Multiplan Commercial |
$178.50
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$154.70
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Prime Health Services Commercial |
$202.30
|
| Rate for Payer: Riverside University Health System MISP |
$95.20
|
| Rate for Payer: Riverside University Health System MISP |
$68.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$142.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$142.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.98
|
| Rate for Payer: United Healthcare All Other HMO |
$15.98
|
| Rate for Payer: United Healthcare All Other HMO |
$15.98
|
| Rate for Payer: United Healthcare HMO Rider |
$15.98
|
| Rate for Payer: United Healthcare HMO Rider |
$15.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$202.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.50
|
| Rate for Payer: Vantage Medical Group Senior |
$144.50
|
| Rate for Payer: Vantage Medical Group Senior |
$202.30
|
|
|
HC HEMOSTASIS TEST FOR QUANTRA
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
CPT 85396
|
| Hospital Charge Code |
900912041
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Adventist Health Commercial |
$47.60
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Central Health Plan Commercial |
$190.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$166.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.20
|
| Rate for Payer: EPIC Health Plan Senior |
$95.20
|
| Rate for Payer: Galaxy Health WC |
$202.30
|
| Rate for Payer: Global Benefits Group Commercial |
$142.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$214.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$151.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$140.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.60
|
| Rate for Payer: Multiplan Commercial |
$178.50
|
| Rate for Payer: Networks By Design Commercial |
$154.70
|
| Rate for Payer: Prime Health Services Commercial |
$202.30
|
|
|
HC HEMOSTATIC FLOSEAL 10ML KIT
|
Facility
|
IP
|
$1,858.81
|
|
| Hospital Charge Code |
901698864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$371.76 |
| Max. Negotiated Rate |
$1,672.93 |
| Rate for Payer: Adventist Health Commercial |
$371.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,490.77
|
| Rate for Payer: Blue Shield of California EPN |
$936.84
|
| Rate for Payer: Cash Price |
$836.46
|
| Rate for Payer: Central Health Plan Commercial |
$1,487.05
|
| Rate for Payer: Cigna of CA HMO |
$1,301.17
|
| Rate for Payer: Cigna of CA PPO |
$1,301.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,301.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$743.52
|
| Rate for Payer: EPIC Health Plan Senior |
$743.52
|
| Rate for Payer: Galaxy Health WC |
$1,579.99
|
| Rate for Payer: Global Benefits Group Commercial |
$1,115.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,672.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,180.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,096.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.76
|
| Rate for Payer: Multiplan Commercial |
$1,394.11
|
| Rate for Payer: Networks By Design Commercial |
$929.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,579.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$697.61
|
| Rate for Payer: United Healthcare All Other HMO |
$679.02
|
| Rate for Payer: United Healthcare HMO Rider |
$664.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$608.76
|
|
|
HC HEMOSTATIC FLOSEAL 10ML KIT
|
Facility
|
OP
|
$1,858.81
|
|
| Hospital Charge Code |
901698864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$371.76 |
| Max. Negotiated Rate |
$1,672.93 |
| Rate for Payer: Adventist Health Commercial |
$371.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,579.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,022.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,394.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$848.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,019.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1,490.77
|
| Rate for Payer: Blue Shield of California EPN |
$936.84
|
| Rate for Payer: Cash Price |
$836.46
|
| Rate for Payer: Central Health Plan Commercial |
$1,487.05
|
| Rate for Payer: Cigna of CA HMO |
$1,301.17
|
| Rate for Payer: Cigna of CA PPO |
$1,301.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,579.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,579.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,579.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,301.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$743.52
|
| Rate for Payer: EPIC Health Plan Senior |
$743.52
|
| Rate for Payer: Galaxy Health WC |
$1,579.99
|
| Rate for Payer: Global Benefits Group Commercial |
$1,115.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,672.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,180.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$674.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,096.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,301.17
|
| Rate for Payer: Multiplan Commercial |
$1,394.11
|
| Rate for Payer: Networks By Design Commercial |
$929.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,579.99
|
| Rate for Payer: Riverside University Health System MISP |
$743.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,115.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,115.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$697.61
|
| Rate for Payer: United Healthcare All Other HMO |
$679.02
|
| Rate for Payer: United Healthcare HMO Rider |
$664.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$608.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,579.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,579.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1,579.99
|
|
|
HC HEMOSTATIC FLOSEAL 5ML KIT
|
Facility
|
IP
|
$1,016.00
|
|
| Hospital Charge Code |
901698863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.20 |
| Max. Negotiated Rate |
$914.40 |
| Rate for Payer: Adventist Health Commercial |
$203.20
|
| Rate for Payer: Blue Shield of California Commercial |
$814.83
|
| Rate for Payer: Blue Shield of California EPN |
$512.06
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Central Health Plan Commercial |
$812.80
|
| Rate for Payer: Cigna of CA HMO |
$711.20
|
| Rate for Payer: Cigna of CA PPO |
$711.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$711.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.40
|
| Rate for Payer: EPIC Health Plan Senior |
$406.40
|
| Rate for Payer: Galaxy Health WC |
$863.60
|
| Rate for Payer: Global Benefits Group Commercial |
$609.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$914.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$645.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$599.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.20
|
| Rate for Payer: Multiplan Commercial |
$762.00
|
| Rate for Payer: Networks By Design Commercial |
$508.00
|
| Rate for Payer: Prime Health Services Commercial |
$863.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$381.30
|
| Rate for Payer: United Healthcare All Other HMO |
$371.14
|
| Rate for Payer: United Healthcare HMO Rider |
$363.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.74
|
|
|
HC HEMOSTATIC FLOSEAL 5ML KIT
|
Facility
|
OP
|
$1,016.00
|
|
| Hospital Charge Code |
901698863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.20 |
| Max. Negotiated Rate |
$914.40 |
| Rate for Payer: Adventist Health Commercial |
$203.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$863.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$762.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$463.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$557.17
|
| Rate for Payer: Blue Shield of California Commercial |
$814.83
|
| Rate for Payer: Blue Shield of California EPN |
$512.06
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Central Health Plan Commercial |
$812.80
|
| Rate for Payer: Cigna of CA HMO |
$711.20
|
| Rate for Payer: Cigna of CA PPO |
$711.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$863.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$863.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$711.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.40
|
| Rate for Payer: EPIC Health Plan Senior |
$406.40
|
| Rate for Payer: Galaxy Health WC |
$863.60
|
| Rate for Payer: Global Benefits Group Commercial |
$609.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$914.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$645.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$368.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$599.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$711.20
|
| Rate for Payer: Multiplan Commercial |
$762.00
|
| Rate for Payer: Networks By Design Commercial |
$508.00
|
| Rate for Payer: Prime Health Services Commercial |
$863.60
|
| Rate for Payer: Riverside University Health System MISP |
$406.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$609.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$609.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$381.30
|
| Rate for Payer: United Healthcare All Other HMO |
$371.14
|
| Rate for Payer: United Healthcare HMO Rider |
$363.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$863.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.60
|
| Rate for Payer: Vantage Medical Group Senior |
$863.60
|
|
|
HC HEMOSTATIC VALVE
|
Facility
|
IP
|
$60.50
|
|
| Hospital Charge Code |
909081232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.10 |
| Max. Negotiated Rate |
$54.45 |
| Rate for Payer: Adventist Health Commercial |
$12.10
|
| Rate for Payer: Cash Price |
$27.22
|
| Rate for Payer: Central Health Plan Commercial |
$48.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.20
|
| Rate for Payer: EPIC Health Plan Senior |
$24.20
|
| Rate for Payer: Galaxy Health WC |
$51.42
|
| Rate for Payer: Global Benefits Group Commercial |
$36.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.10
|
| Rate for Payer: Multiplan Commercial |
$45.38
|
| Rate for Payer: Networks By Design Commercial |
$39.33
|
| Rate for Payer: Prime Health Services Commercial |
$51.42
|
|
|
HC HEMOSTATIC VALVE
|
Facility
|
OP
|
$60.50
|
|
| Hospital Charge Code |
909081232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.10 |
| Max. Negotiated Rate |
$54.45 |
| Rate for Payer: Adventist Health Commercial |
$12.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.19
|
| Rate for Payer: Blue Shield of California Commercial |
$38.36
|
| Rate for Payer: Blue Shield of California EPN |
$24.14
|
| Rate for Payer: Cash Price |
$27.22
|
| Rate for Payer: Central Health Plan Commercial |
$48.40
|
| Rate for Payer: Cigna of CA HMO |
$38.72
|
| Rate for Payer: Cigna of CA PPO |
$44.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.20
|
| Rate for Payer: EPIC Health Plan Senior |
$24.20
|
| Rate for Payer: Galaxy Health WC |
$51.42
|
| Rate for Payer: Global Benefits Group Commercial |
$36.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$42.35
|
| Rate for Payer: Multiplan Commercial |
$45.38
|
| Rate for Payer: Networks By Design Commercial |
$39.33
|
| Rate for Payer: Prime Health Services Commercial |
$51.42
|
| Rate for Payer: Riverside University Health System MISP |
$24.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.25
|
| Rate for Payer: United Healthcare All Other HMO |
$30.25
|
| Rate for Payer: United Healthcare HMO Rider |
$30.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.42
|
| Rate for Payer: Vantage Medical Group Senior |
$51.42
|
|
