|
HC HEMECH SCRN-ARACHEDONIC ACID A
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
|
|
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 |
$1,075.25
|
| Rate for Payer: Cash Price |
$1,075.25
|
| Rate for Payer: Cash Price |
$1,075.25
|
| 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 |
$1,075.25
|
| 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
|
$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 |
$467.04
|
| 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
|
$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 |
$467.04
|
| 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
|
$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 |
$380.08
|
| 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
|
$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 |
$380.08
|
| 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
|
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 |
$1,411.85
|
| 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, 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 |
$1,411.85
|
| Rate for Payer: Cash Price |
$1,411.85
|
| Rate for Payer: Cash Price |
$1,411.85
|
| Rate for Payer: Cash Price |
$1,411.85
|
| 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 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 |
$1,411.85
|
| 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 |
$1,411.85
|
| Rate for Payer: Cash Price |
$1,411.85
|
| Rate for Payer: Cash Price |
$1,411.85
|
| 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/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 |
$1,411.85
|
| 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 |
$1,411.85
|
| Rate for Payer: Cash Price |
$1,411.85
|
| Rate for Payer: Cash Price |
$1,411.85
|
| 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
|
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 |
$44.99
|
| Rate for Payer: Cash Price |
$44.99
|
| 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
|
Facility
|
IP
|
$81.80
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
900912128
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$73.62 |
| Rate for Payer: Adventist Health Commercial |
$16.36
|
| Rate for Payer: Cash Price |
$44.99
|
| Rate for Payer: Central Health Plan Commercial |
$65.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.72
|
| Rate for Payer: EPIC Health Plan Senior |
$32.72
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$54.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.36
|
| Rate for Payer: Multiplan Commercial |
$61.35
|
| Rate for Payer: Networks By Design Commercial |
$53.17
|
| Rate for Payer: Prime Health Services Commercial |
$69.53
|
|
|
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 |
$129.25
|
| 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 |
$129.25
|
| Rate for Payer: Cash Price |
$129.25
|
| 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
|
$67.99
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900910898
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$61.19 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Cash Price |
$37.39
|
| Rate for Payer: Central Health Plan Commercial |
$54.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Senior |
$27.20
|
| Rate for Payer: Galaxy Health WC |
$57.79
|
| Rate for Payer: Global Benefits Group Commercial |
$40.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.60
|
| Rate for Payer: Multiplan Commercial |
$50.99
|
| Rate for Payer: Networks By Design Commercial |
$44.19
|
| Rate for Payer: Prime Health Services Commercial |
$57.79
|
|
|
HC HEMOGLOBIN CITRATE
|
Facility
|
OP
|
$67.99
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900910898
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$79.54 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.29
|
| 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 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 HMO/PPO |
$16.14
|
| Rate for Payer: Blue Shield of California Commercial |
$41.27
|
| Rate for Payer: Blue Shield of California EPN |
$26.99
|
| Rate for Payer: Cash Price |
$37.39
|
| Rate for Payer: Cash Price |
$37.39
|
| Rate for Payer: Central Health Plan Commercial |
$54.39
|
| Rate for Payer: Cigna of CA HMO |
$43.51
|
| Rate for Payer: Cigna of CA PPO |
$50.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.37
|
| Rate for Payer: EPIC Health Plan Senior |
$12.87
|
| Rate for Payer: Galaxy Health WC |
$57.79
|
| Rate for Payer: Global Benefits Group Commercial |
$40.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.19
|
| 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) Medicare Advantage |
$12.87
|
| Rate for Payer: InnovAge PACE Commercial |
$19.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$50.99
|
| Rate for Payer: Networks By Design Commercial |
$44.19
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.87
|
| Rate for Payer: Prime Health Services Commercial |
$57.79
|
| Rate for Payer: Prime Health Services Medicare |
$13.64
|
| Rate for Payer: Riverside University Health System MISP |
$14.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.79
|
| 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 HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| 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 Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS
|
Facility
|
OP
|
$67.99
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900910897
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$79.54 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.29
|
| 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 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 HMO/PPO |
$16.14
|
| Rate for Payer: Blue Shield of California Commercial |
$41.27
|
| Rate for Payer: Blue Shield of California EPN |
$26.99
|
| Rate for Payer: Cash Price |
$37.39
|
| Rate for Payer: Cash Price |
$37.39
|
| Rate for Payer: Central Health Plan Commercial |
$54.39
|
| Rate for Payer: Cigna of CA HMO |
$43.51
|
| Rate for Payer: Cigna of CA PPO |
$50.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.37
|
| Rate for Payer: EPIC Health Plan Senior |
$12.87
|
| Rate for Payer: Galaxy Health WC |
$57.79
|
| Rate for Payer: Global Benefits Group Commercial |
$40.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.19
|
| 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) Medicare Advantage |
$12.87
|
| Rate for Payer: InnovAge PACE Commercial |
$19.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$50.99
|
| Rate for Payer: Networks By Design Commercial |
$44.19
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.87
|
| Rate for Payer: Prime Health Services Commercial |
$57.79
|
| Rate for Payer: Prime Health Services Medicare |
$13.64
|
| Rate for Payer: Riverside University Health System MISP |
$14.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.79
|
| 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 HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| 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 Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS
|
Facility
|
IP
|
$67.99
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900910897
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$61.19 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Cash Price |
$37.39
|
| Rate for Payer: Central Health Plan Commercial |
$54.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Senior |
$27.20
|
| Rate for Payer: Galaxy Health WC |
$57.79
|
| Rate for Payer: Global Benefits Group Commercial |
$40.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.60
|
| Rate for Payer: Multiplan Commercial |
$50.99
|
| Rate for Payer: Networks By Design Commercial |
$44.19
|
| Rate for Payer: Prime Health Services Commercial |
$57.79
|
|
|
HC HEMOGLOBIN FETAL, STAIN
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 85460
|
| Hospital Charge Code |
900910133
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11.20
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
|
|
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 |
$56.27 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.00
|
| 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 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 HMO/PPO |
$11.42
|
| Rate for Payer: Blue Shield of California Commercial |
$17.00
|
| Rate for Payer: Blue Shield of California EPN |
$11.12
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.44
|
| Rate for Payer: EPIC Health Plan Senior |
$7.73
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| 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) Medicare Advantage |
$7.73
|
| Rate for Payer: InnovAge PACE Commercial |
$11.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.36
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.73
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Prime Health Services Medicare |
$8.19
|
| Rate for Payer: Riverside University Health System MISP |
$8.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| 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 HMO |
$6.26
|
| Rate for Payer: United Healthcare HMO Rider |
$6.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.26
|
| 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 Medi-Cal |
$8.50
|
| Rate for Payer: Vantage Medical Group Senior |
$7.73
|
|
|
HC HEMOGLOBIN PLASMA
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
900912162
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
|
|
HC HEMOGLOBIN PLASMA
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
900912162
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$53.14 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.86
|
| 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 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 HMO/PPO |
$10.78
|
| Rate for Payer: Blue Shield of California Commercial |
$21.85
|
| Rate for Payer: Blue Shield of California EPN |
$14.29
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7.31
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| 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) Medicare Advantage |
$7.31
|
| Rate for Payer: InnovAge PACE Commercial |
$10.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| 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 Medicare |
$7.75
|
| Rate for Payer: Riverside University Health System MISP |
$8.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| 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 HMO Rider |
$5.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.92
|
| 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 Medi-Cal |
$8.04
|
| Rate for Payer: Vantage Medical Group Senior |
$7.31
|
|
