|
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 |
$80.77
|
| 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 |
$3.49
|
| Rate for Payer: Blue Shield of California Commercial |
$80.73
|
| 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: EPIC Health Plan Commercial |
$3.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2.37
|
| 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: InnovAge PACE Commercial |
$3.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.18
|
| Rate for Payer: Molina Healthcare of CA 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 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: 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 Permanente of CA Commercial/Self Funded |
$88.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.33
|
| 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 HEMATOPOIETIC PROGENITOR CELLS
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900912029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$57.59 |
| Max. Negotiated Rate |
$749.58 |
| Rate for Payer: Adventist Health Commercial |
$88.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$457.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$267.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$283.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.59
|
| Rate for Payer: Blue Shield of California Commercial |
$267.69
|
| 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 |
$685.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$457.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.03
|
| Rate for Payer: EPIC Health Plan Senior |
$457.06
|
| 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 |
$749.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$457.06
|
| Rate for Payer: InnovAge PACE Commercial |
$685.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$457.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$612.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.46
|
| 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 |
$457.06
|
| Rate for Payer: Prime Health Services Commercial |
$374.85
|
| Rate for Payer: Prime Health Services Medicare |
$484.48
|
| Rate for Payer: Riverside University Health System MISP |
$502.77
|
| 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 |
$457.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Vantage Medical Group Senior |
$457.06
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$294.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$272.98
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$296.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$275.45
|
| 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 |
$140.40 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.74
|
| 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 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 HMO/PPO |
$26.95
|
| Rate for Payer: Blue Shield of California Commercial |
$94.69
|
| Rate for Payer: Blue Shield of California EPN |
$61.93
|
| 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: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.63
|
| Rate for Payer: EPIC Health Plan Senior |
$24.91
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| 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) Medicare Advantage |
$24.91
|
| Rate for Payer: InnovAge PACE Commercial |
$37.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.38
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.91
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Medicare |
$26.40
|
| Rate for Payer: Riverside University Health System MISP |
$27.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| 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 HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| 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 Medi-Cal |
$27.40
|
| 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 |
$140.40 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.74
|
| 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 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 HMO/PPO |
$26.95
|
| Rate for Payer: Blue Shield of California Commercial |
$94.69
|
| Rate for Payer: Blue Shield of California EPN |
$61.93
|
| 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: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.63
|
| Rate for Payer: EPIC Health Plan Senior |
$24.91
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| 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) Medicare Advantage |
$24.91
|
| Rate for Payer: InnovAge PACE Commercial |
$37.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.38
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.91
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Medicare |
$26.40
|
| Rate for Payer: Riverside University Health System MISP |
$27.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| 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 HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| 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 Medi-Cal |
$27.40
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$246.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.03
|
| 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
|
OP
|
$1,955.00
|
|
|
Service Code
|
CPT 38999
|
| Hospital Charge Code |
909008999
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$391.00 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$391.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$555.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$885.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| 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 |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| 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 |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: InnovAge PACE Commercial |
$833.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,303.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$744.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| 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 |
$555.48
|
| 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 |
$588.81
|
| Rate for Payer: Prime Health Services WC |
$876.03
|
| Rate for Payer: Riverside University Health System MISP |
$611.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,173.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| 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 |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$1,303.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$744.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,210.14
|
| 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 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 |
$534.19
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$460.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$427.77
|
| 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 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 |
$470.18
|
| Rate for Payer: Blue Shield of California Commercial |
$656.40
|
| 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: 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: InnovAge PACE Commercial |
$424.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$566.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$323.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$525.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$594.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$594.41
|
| Rate for Payer: Multiplan Commercial |
$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
|
$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 |
$656.40
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$566.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$323.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$525.63
|
| 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 |
$382.64
|
| Rate for Payer: Blue Shield of California Commercial |
$534.19
|
| 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: 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: InnovAge PACE Commercial |
$345.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$460.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$427.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$483.74
|
| Rate for Payer: Molina Healthcare of CA 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, 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 |
$1,333.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$977.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$889.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| 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 |
$1,333.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$977.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$889.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,200.23
|
| Rate for Payer: EPIC Health Plan Senior |
$889.06
|
| 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 |
$1,458.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$889.06
|
| Rate for Payer: InnovAge PACE Commercial |
$1,333.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,712.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$889.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,191.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,191.34
|
| 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 |
$889.06
|
| 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 |
$942.40
|
| Rate for Payer: Prime Health Services WC |
$1,402.11
|
| Rate for Payer: Riverside University Health System MISP |
$977.97
|
| 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 |
$889.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$977.97
|
| Rate for Payer: Vantage Medical Group Senior |
$889.06
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$1,712.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$978.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,588.97
|
| 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
|
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 |
$889.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,558.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$977.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$889.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,242.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,507.60
|
| 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 |
$1,333.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$977.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$889.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,200.23
|
| Rate for Payer: EPIC Health Plan Senior |
$889.06
|
| 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 |
$1,458.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$889.06
|
| Rate for Payer: InnovAge PACE Commercial |
$1,333.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,712.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$889.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,191.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,191.34
|
| 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 |
$889.06
|
| Rate for Payer: Prime Health Services Commercial |
$2,181.95
|
| Rate for Payer: Prime Health Services Medicare |
$942.40
|
| Rate for Payer: Riverside University Health System MISP |
$977.97
|
| 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 |
$889.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$977.97
|
| Rate for Payer: Vantage Medical Group Senior |
$889.06
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$1,712.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$978.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,588.97
|
| 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: 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: 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 Permanente of CA Commercial/Self Funded |
$1,712.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$978.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,588.97
|
| 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
|
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 |
$889.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,558.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$977.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$889.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,242.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,507.60
|
| 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 |
$1,333.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$977.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$889.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,200.23
|
| Rate for Payer: EPIC Health Plan Senior |
$889.06
|
| 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 |
$1,458.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$889.06
|
| Rate for Payer: InnovAge PACE Commercial |
$1,333.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,712.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$889.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,191.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,191.34
|
| 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 |
$889.06
|
| Rate for Payer: Prime Health Services Commercial |
$2,181.95
|
| Rate for Payer: Prime Health Services Medicare |
$942.40
|
| Rate for Payer: Riverside University Health System MISP |
$977.97
|
| 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 |
$889.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$977.97
|
| Rate for Payer: Vantage Medical Group Senior |
$889.06
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$156.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.47
|
| 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
|
Facility
|
OP
|
$81.80
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
900912128
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$73.62 |
| Rate for Payer: Adventist Health Commercial |
$16.36
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.68
|
| 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 |
$14.33
|
| Rate for Payer: Blue Shield of California Commercial |
$49.65
|
| Rate for Payer: Blue Shield of California EPN |
$32.47
|
| Rate for Payer: Cash Price |
$36.81
|
| Rate for Payer: Cash Price |
$36.81
|
| Rate for Payer: Central Health Plan Commercial |
$65.44
|
| Rate for Payer: Cigna of CA HMO |
$52.35
|
| Rate for Payer: Cigna of CA PPO |
$60.53
|
| 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: EPIC Health Plan Commercial |
$13.11
|
| Rate for Payer: EPIC Health Plan Senior |
$9.71
|
| Rate for Payer: Galaxy Health WC |
$69.53
|
| Rate for Payer: Global Benefits Group Commercial |
$49.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.62
|
| 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: InnovAge PACE Commercial |
$14.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.01
|
| Rate for Payer: Multiplan Commercial |
$61.35
|
| Rate for Payer: Networks By Design Commercial |
$53.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.71
|
| Rate for Payer: Prime Health Services Commercial |
$69.53
|
| 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 |
$49.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.87
|
| Rate for Payer: United Healthcare All Other HMO |
$7.87
|
| Rate for Payer: United Healthcare HMO Rider |
$7.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Vantage Medical Group Senior |
$9.71
|
|
|
HC HEMOGLOBIN A1C (POC)
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
900912157
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$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: 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 Permanente of CA Commercial/Self Funded |
$156.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.47
|
| 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 |
$142.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$70.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.33
|
| Rate for Payer: Blue Shield of California Commercial |
$142.65
|
| 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: EPIC Health Plan Commercial |
$13.11
|
| Rate for Payer: EPIC Health Plan Senior |
$9.71
|
| 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: InnovAge PACE Commercial |
$14.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.01
|
| Rate for Payer: Molina Healthcare of CA 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: 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 Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.33
|
| 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
|
|
