|
HC FACIAL BONES LIMITED
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
909001102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.36 |
| Max. Negotiated Rate |
$918.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$128.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.18
|
| Rate for Payer: Blue Distinction Transplant |
$612.00
|
| Rate for Payer: Blue Shield of California Commercial |
$630.36
|
| Rate for Payer: Blue Shield of California EPN |
$495.72
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Central Health Plan Commercial |
$816.00
|
| Rate for Payer: Cigna of CA HMO |
$652.80
|
| Rate for Payer: Cigna of CA PPO |
$754.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$867.00
|
| Rate for Payer: Global Benefits Group Commercial |
$612.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$918.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$765.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$680.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$765.00
|
| Rate for Payer: Networks By Design Commercial |
$663.00
|
| Rate for Payer: Prime Health Services Commercial |
$867.00
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$612.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$612.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC FACTOR II (2) ASSAY
|
Facility
|
IP
|
$1,090.00
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
900910075
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$218.00 |
| Max. Negotiated Rate |
$981.00 |
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Central Health Plan Commercial |
$872.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$436.00
|
| Rate for Payer: Galaxy Health WC |
$926.50
|
| Rate for Payer: Global Benefits Group Commercial |
$654.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$981.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$727.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.00
|
| Rate for Payer: Multiplan Commercial |
$817.50
|
| Rate for Payer: Networks By Design Commercial |
$708.50
|
| Rate for Payer: Prime Health Services Commercial |
$926.50
|
|
|
HC FACTOR II (2) ASSAY
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
900910075
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$115.24 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.24
|
| Rate for Payer: Blue Distinction Transplant |
$29.40
|
| Rate for Payer: Blue Shield of California Commercial |
$30.28
|
| Rate for Payer: Blue Shield of California EPN |
$23.81
|
| Rate for Payer: Caremore Medicare Advantage |
$12.98
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.47
|
| Rate for Payer: Dignity Health Media |
$12.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.98
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$36.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.98
|
| Rate for Payer: InnovAge PACE Commercial |
$19.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.39
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Prime Health Services Medicare |
$13.76
|
| Rate for Payer: Riverside University Health System MISP |
$14.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.51
|
| Rate for Payer: United Healthcare All Other HMO |
$10.51
|
| Rate for Payer: United Healthcare HMO Rider |
$10.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Vantage Medical Group Senior |
$12.98
|
|
|
HC FACTOR IX PTC
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
900910029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$168.94 |
| Rate for Payer: Adventist Health Medi-Cal |
$19.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$138.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.94
|
| Rate for Payer: Blue Distinction Transplant |
$43.80
|
| Rate for Payer: Blue Shield of California Commercial |
$45.11
|
| Rate for Payer: Blue Shield of California EPN |
$35.48
|
| Rate for Payer: Caremore Medicare Advantage |
$19.04
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Central Health Plan Commercial |
$58.40
|
| Rate for Payer: Cigna of CA HMO |
$46.72
|
| Rate for Payer: Cigna of CA PPO |
$54.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Media |
$19.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$19.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$19.04
|
| Rate for Payer: Galaxy Health WC |
$62.05
|
| Rate for Payer: Global Benefits Group Commercial |
$43.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$65.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$54.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.04
|
| Rate for Payer: InnovAge PACE Commercial |
$28.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.51
|
| Rate for Payer: Multiplan Commercial |
$54.75
|
| Rate for Payer: Networks By Design Commercial |
$47.45
|
| Rate for Payer: Prime Health Services Commercial |
$62.05
|
| Rate for Payer: Prime Health Services Medicare |
$20.18
|
| Rate for Payer: Riverside University Health System MISP |
$20.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.43
|
| Rate for Payer: United Healthcare All Other HMO |
$15.43
|
| Rate for Payer: United Healthcare HMO Rider |
$15.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.94
|
| Rate for Payer: Vantage Medical Group Senior |
$19.04
|
|
|
HC FACTOR IX PTC
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
900910029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$454.50 |
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Central Health Plan Commercial |
$404.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$454.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.00
|
| Rate for Payer: Multiplan Commercial |
$378.75
|
| Rate for Payer: Networks By Design Commercial |
$328.25
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
|
|
HC FACTOR V, ACG
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 85220
|
| Hospital Charge Code |
900910060
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$156.64 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$129.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$128.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.64
|
| Rate for Payer: Blue Distinction Transplant |
$40.20
|
| Rate for Payer: Blue Shield of California Commercial |
$41.41
|
| Rate for Payer: Blue Shield of California EPN |
$32.56
|
| Rate for Payer: Caremore Medicare Advantage |
$17.65
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Central Health Plan Commercial |
$53.60
|
| Rate for Payer: Cigna of CA HMO |
$42.88
|
| Rate for Payer: Cigna of CA PPO |
$49.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.48
|
| Rate for Payer: Dignity Health Media |
$17.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.65
|
| Rate for Payer: Galaxy Health WC |
$56.95
|
| Rate for Payer: Global Benefits Group Commercial |
$40.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$50.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.65
|
| Rate for Payer: InnovAge PACE Commercial |
$26.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.65
|
| Rate for Payer: Multiplan Commercial |
$50.25
|
| Rate for Payer: Networks By Design Commercial |
$43.55
|
| Rate for Payer: Prime Health Services Commercial |
$56.95
|
| Rate for Payer: Prime Health Services Medicare |
$18.71
|
| Rate for Payer: Riverside University Health System MISP |
$19.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.30
|
| Rate for Payer: United Healthcare All Other HMO |
$14.30
|
| Rate for Payer: United Healthcare HMO Rider |
$14.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.42
|
| Rate for Payer: Vantage Medical Group Senior |
$17.65
|
|
|
HC FACTOR V, ACG
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
CPT 85220
|
| Hospital Charge Code |
900910060
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$104.60 |
| Max. Negotiated Rate |
$470.70 |
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Central Health Plan Commercial |
$418.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$209.20
|
| Rate for Payer: Galaxy Health WC |
$444.55
|
| Rate for Payer: Global Benefits Group Commercial |
$313.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$470.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.60
|
| Rate for Payer: Multiplan Commercial |
$392.25
|
| Rate for Payer: Networks By Design Commercial |
$339.95
|
| Rate for Payer: Prime Health Services Commercial |
$444.55
|
|
|
HC FACTOR VIII AHG
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
900910028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$421.20 |
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Central Health Plan Commercial |
$374.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.20
|
| Rate for Payer: Galaxy Health WC |
$397.80
|
| Rate for Payer: Global Benefits Group Commercial |
$280.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$421.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$312.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.60
|
| Rate for Payer: Multiplan Commercial |
$351.00
|
| Rate for Payer: Networks By Design Commercial |
$304.20
|
| Rate for Payer: Prime Health Services Commercial |
$397.80
|
|
|
HC FACTOR VIII AHG
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
900910028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$158.91 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.91
|
| Rate for Payer: Blue Distinction Transplant |
$40.80
|
| Rate for Payer: Blue Shield of California Commercial |
$42.02
|
| Rate for Payer: Blue Shield of California EPN |
$33.05
|
| Rate for Payer: Caremore Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Central Health Plan Commercial |
$54.40
|
| Rate for Payer: Cigna of CA HMO |
$43.52
|
| Rate for Payer: Cigna of CA PPO |
$50.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Media |
$17.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.90
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$51.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.90
|
| Rate for Payer: InnovAge PACE Commercial |
$26.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.99
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
| Rate for Payer: Networks By Design Commercial |
$44.20
|
| Rate for Payer: Prime Health Services Commercial |
$57.80
|
| Rate for Payer: Prime Health Services Medicare |
$18.97
|
| Rate for Payer: Riverside University Health System MISP |
$19.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO |
$14.50
|
| Rate for Payer: United Healthcare HMO Rider |
$14.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
|
|
HC FACTOR VII, (PROCONVERTIN)
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
900910027
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$158.91 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.91
|
| Rate for Payer: Blue Distinction Transplant |
$40.80
|
| Rate for Payer: Blue Shield of California Commercial |
$42.02
|
| Rate for Payer: Blue Shield of California EPN |
$33.05
|
| Rate for Payer: Caremore Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Central Health Plan Commercial |
$54.40
|
| Rate for Payer: Cigna of CA HMO |
$43.52
|
| Rate for Payer: Cigna of CA PPO |
$50.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Media |
$17.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.90
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$51.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.90
|
| Rate for Payer: InnovAge PACE Commercial |
$26.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.99
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
| Rate for Payer: Networks By Design Commercial |
$44.20
|
| Rate for Payer: Prime Health Services Commercial |
$57.80
|
| Rate for Payer: Prime Health Services Medicare |
$18.97
|
| Rate for Payer: Riverside University Health System MISP |
$19.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO |
$14.50
|
| Rate for Payer: United Healthcare HMO Rider |
$14.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
|
|
HC FACTOR VII, (PROCONVERTIN)
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
900910027
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$421.20 |
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Central Health Plan Commercial |
$374.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.20
|
| Rate for Payer: Galaxy Health WC |
$397.80
|
| Rate for Payer: Global Benefits Group Commercial |
$280.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$421.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$312.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.60
|
| Rate for Payer: Multiplan Commercial |
$351.00
|
| Rate for Payer: Networks By Design Commercial |
$304.20
|
| Rate for Payer: Prime Health Services Commercial |
$397.80
|
|
|
HC FACTOR V LEIDEN MUTATION
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
900912323
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$357.54 |
| Rate for Payer: Adventist Health Medi-Cal |
$73.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$110.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$293.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$357.54
|
| Rate for Payer: Blue Distinction Transplant |
$100.80
|
| Rate for Payer: Blue Shield of California Commercial |
$103.82
|
| Rate for Payer: Blue Shield of California EPN |
$81.65
|
| Rate for Payer: Caremore Medicare Advantage |
$73.37
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Central Health Plan Commercial |
$134.40
|
| Rate for Payer: Cigna of CA HMO |
$107.52
|
| Rate for Payer: Cigna of CA PPO |
$124.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.06
|
| Rate for Payer: Dignity Health Media |
$73.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$73.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$73.37
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$126.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$120.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$121.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73.37
|
| Rate for Payer: InnovAge PACE Commercial |
$110.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.32
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: Prime Health Services Medicare |
$77.77
|
| Rate for Payer: Riverside University Health System MISP |
$80.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.43
|
| Rate for Payer: United Healthcare All Other HMO |
$59.43
|
| Rate for Payer: United Healthcare HMO Rider |
$59.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.71
|
| Rate for Payer: Vantage Medical Group Senior |
$73.37
|
|
|
HC FACTOR V LEIDEN MUTATION
|
Facility
|
IP
|
$632.00
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
900912323
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$568.80 |
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Central Health Plan Commercial |
$505.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.80
|
| Rate for Payer: Galaxy Health WC |
$537.20
|
| Rate for Payer: Global Benefits Group Commercial |
$379.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$568.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$421.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.40
|
| Rate for Payer: Multiplan Commercial |
$474.00
|
| Rate for Payer: Networks By Design Commercial |
$410.80
|
| Rate for Payer: Prime Health Services Commercial |
$537.20
|
|
|
HC FACTOR XII HAGEMANN
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 85280
|
| Hospital Charge Code |
900910062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$171.69 |
| Rate for Payer: Adventist Health Medi-Cal |
$19.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.69
|
| Rate for Payer: Blue Distinction Transplant |
$44.40
|
| Rate for Payer: Blue Shield of California Commercial |
$45.73
|
| Rate for Payer: Blue Shield of California EPN |
$35.96
|
| Rate for Payer: Caremore Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Central Health Plan Commercial |
$59.20
|
| Rate for Payer: Cigna of CA HMO |
$47.36
|
| Rate for Payer: Cigna of CA PPO |
$54.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Media |
$19.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$19.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$19.35
|
| Rate for Payer: Galaxy Health WC |
$62.90
|
| Rate for Payer: Global Benefits Group Commercial |
$44.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$55.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.35
|
| Rate for Payer: InnovAge PACE Commercial |
$29.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.93
|
| Rate for Payer: Multiplan Commercial |
$55.50
|
| Rate for Payer: Networks By Design Commercial |
$48.10
|
| Rate for Payer: Prime Health Services Commercial |
$62.90
|
| Rate for Payer: Prime Health Services Medicare |
$20.51
|
| Rate for Payer: Riverside University Health System MISP |
$21.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.68
|
| Rate for Payer: United Healthcare All Other HMO |
$15.68
|
| Rate for Payer: United Healthcare HMO Rider |
$15.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.28
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC FACTOR XII HAGEMANN
|
Facility
|
IP
|
$1,090.00
|
|
|
Service Code
|
CPT 85280
|
| Hospital Charge Code |
900910062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$218.00 |
| Max. Negotiated Rate |
$981.00 |
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Central Health Plan Commercial |
$872.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$436.00
|
| Rate for Payer: Galaxy Health WC |
$926.50
|
| Rate for Payer: Global Benefits Group Commercial |
$654.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$981.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$727.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.00
|
| Rate for Payer: Multiplan Commercial |
$817.50
|
| Rate for Payer: Networks By Design Commercial |
$708.50
|
| Rate for Payer: Prime Health Services Commercial |
$926.50
|
|
|
HC FACTOR XIII ANTIGEN
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900912036
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$45.76 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.76
|
| Rate for Payer: Blue Distinction Transplant |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$17.30
|
| Rate for Payer: Blue Shield of California EPN |
$13.61
|
| Rate for Payer: Caremore Medicare Advantage |
$15.48
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.22
|
| Rate for Payer: Dignity Health Media |
$15.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.90
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.48
|
| 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: Health Plan of Nevada (Sierra) Other |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.48
|
| Rate for Payer: InnovAge PACE Commercial |
$23.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.74
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$16.41
|
| Rate for Payer: Riverside University Health System MISP |
$17.03
|
| 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 |
$12.54
|
| Rate for Payer: United Healthcare All Other HMO |
$12.54
|
| Rate for Payer: United Healthcare HMO Rider |
$12.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Vantage Medical Group Senior |
$15.48
|
|
|
HC FACTOR XIII ANTIGEN
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900912036
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Central Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.40
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
|
|
HC FACTOR XIII SCREEN
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 85291
|
| Hospital Charge Code |
900910023
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$78.86 |
| Rate for Payer: Adventist Health Medi-Cal |
$9.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$64.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.86
|
| Rate for Payer: Blue Distinction Transplant |
$20.40
|
| Rate for Payer: Blue Shield of California Commercial |
$21.01
|
| Rate for Payer: Blue Shield of California EPN |
$16.52
|
| Rate for Payer: Caremore Medicare Advantage |
$9.11
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.66
|
| Rate for Payer: Dignity Health Media |
$9.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$9.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.11
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$25.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.11
|
| Rate for Payer: InnovAge PACE Commercial |
$13.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.21
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Prime Health Services Medicare |
$9.66
|
| Rate for Payer: Riverside University Health System MISP |
$10.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.38
|
| Rate for Payer: United Healthcare All Other HMO |
$7.38
|
| Rate for Payer: United Healthcare HMO Rider |
$7.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.02
|
| Rate for Payer: Vantage Medical Group Senior |
$9.11
|
|
|
HC FACTOR XIII SCREEN
|
Facility
|
IP
|
$343.00
|
|
|
Service Code
|
CPT 85291
|
| Hospital Charge Code |
900910023
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$308.70 |
| Rate for Payer: Cash Price |
$154.35
|
| Rate for Payer: Central Health Plan Commercial |
$274.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.20
|
| Rate for Payer: Galaxy Health WC |
$291.55
|
| Rate for Payer: Global Benefits Group Commercial |
$205.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$308.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$228.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.60
|
| Rate for Payer: Multiplan Commercial |
$257.25
|
| Rate for Payer: Networks By Design Commercial |
$222.95
|
| Rate for Payer: Prime Health Services Commercial |
$291.55
|
|
|
HC FACTOR XI PTA
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 85270
|
| Hospital Charge Code |
900910061
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$158.91 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.91
|
| Rate for Payer: Blue Distinction Transplant |
$40.80
|
| Rate for Payer: Blue Shield of California Commercial |
$42.02
|
| Rate for Payer: Blue Shield of California EPN |
$33.05
|
| Rate for Payer: Caremore Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Central Health Plan Commercial |
$54.40
|
| Rate for Payer: Cigna of CA HMO |
$43.52
|
| Rate for Payer: Cigna of CA PPO |
$50.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Media |
$17.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.90
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$51.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.90
|
| Rate for Payer: InnovAge PACE Commercial |
$26.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.99
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
| Rate for Payer: Networks By Design Commercial |
$44.20
|
| Rate for Payer: Prime Health Services Commercial |
$57.80
|
| Rate for Payer: Prime Health Services Medicare |
$18.97
|
| Rate for Payer: Riverside University Health System MISP |
$19.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO |
$14.50
|
| Rate for Payer: United Healthcare HMO Rider |
$14.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
|
|
HC FACTOR XI PTA
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
CPT 85270
|
| Hospital Charge Code |
900910061
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$97.00 |
| Max. Negotiated Rate |
$436.50 |
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: Central Health Plan Commercial |
$388.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.00
|
| Rate for Payer: Galaxy Health WC |
$412.25
|
| Rate for Payer: Global Benefits Group Commercial |
$291.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$436.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$323.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.00
|
| Rate for Payer: Multiplan Commercial |
$363.75
|
| Rate for Payer: Networks By Design Commercial |
$315.25
|
| Rate for Payer: Prime Health Services Commercial |
$412.25
|
|
|
HC FACTOR X STUART-PROWER
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
900910076
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$158.91 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.91
|
| Rate for Payer: Blue Distinction Transplant |
$40.80
|
| Rate for Payer: Blue Shield of California Commercial |
$42.02
|
| Rate for Payer: Blue Shield of California EPN |
$33.05
|
| Rate for Payer: Caremore Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Central Health Plan Commercial |
$54.40
|
| Rate for Payer: Cigna of CA HMO |
$43.52
|
| Rate for Payer: Cigna of CA PPO |
$50.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Media |
$17.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.90
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$51.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.90
|
| Rate for Payer: InnovAge PACE Commercial |
$26.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.99
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
| Rate for Payer: Networks By Design Commercial |
$44.20
|
| Rate for Payer: Prime Health Services Commercial |
$57.80
|
| Rate for Payer: Prime Health Services Medicare |
$18.97
|
| Rate for Payer: Riverside University Health System MISP |
$19.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO |
$14.50
|
| Rate for Payer: United Healthcare HMO Rider |
$14.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
|
|
HC FACTOR X STUART-PROWER
|
Facility
|
IP
|
$1,090.00
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
900910076
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$218.00 |
| Max. Negotiated Rate |
$981.00 |
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Central Health Plan Commercial |
$872.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$436.00
|
| Rate for Payer: Galaxy Health WC |
$926.50
|
| Rate for Payer: Global Benefits Group Commercial |
$654.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$981.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$727.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.00
|
| Rate for Payer: Multiplan Commercial |
$817.50
|
| Rate for Payer: Networks By Design Commercial |
$708.50
|
| Rate for Payer: Prime Health Services Commercial |
$926.50
|
|
|
HC FALLOPIAN TUBE CATHETERIZATION
|
Facility
|
IP
|
$1,054.00
|
|
|
Service Code
|
CPT 74742
|
| Hospital Charge Code |
909001872
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.80 |
| Max. Negotiated Rate |
$948.60 |
| Rate for Payer: Cash Price |
$474.30
|
| Rate for Payer: Central Health Plan Commercial |
$843.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.60
|
| Rate for Payer: Galaxy Health WC |
$895.90
|
| Rate for Payer: Global Benefits Group Commercial |
$632.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$948.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$703.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$401.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.80
|
| Rate for Payer: Multiplan Commercial |
$790.50
|
| Rate for Payer: Networks By Design Commercial |
$685.10
|
| Rate for Payer: Prime Health Services Commercial |
$895.90
|
|
|
HC FALLOPIAN TUBE CATHETERIZATION
|
Facility
|
OP
|
$1,054.00
|
|
|
Service Code
|
CPT 74742
|
| Hospital Charge Code |
909001872
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.80 |
| Max. Negotiated Rate |
$948.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$315.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$895.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$579.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$579.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$652.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$795.32
|
| Rate for Payer: Blue Distinction Transplant |
$632.40
|
| Rate for Payer: Blue Shield of California Commercial |
$651.37
|
| Rate for Payer: Blue Shield of California EPN |
$512.24
|
| Rate for Payer: Cash Price |
$474.30
|
| Rate for Payer: Cash Price |
$474.30
|
| Rate for Payer: Central Health Plan Commercial |
$843.20
|
| Rate for Payer: Cigna of CA HMO |
$674.56
|
| Rate for Payer: Cigna of CA PPO |
$779.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$895.90
|
| Rate for Payer: Dignity Health Media |
$895.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$895.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$421.60
|
| Rate for Payer: Galaxy Health WC |
$895.90
|
| Rate for Payer: Global Benefits Group Commercial |
$632.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$948.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$790.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$368.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$703.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$401.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.80
|
| Rate for Payer: Multiplan Commercial |
$790.50
|
| Rate for Payer: Networks By Design Commercial |
$685.10
|
| Rate for Payer: Prime Health Services Commercial |
$895.90
|
| Rate for Payer: Riverside University Health System MISP |
$421.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$632.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$632.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$527.00
|
| Rate for Payer: United Healthcare All Other HMO |
$527.00
|
| Rate for Payer: United Healthcare HMO Rider |
$527.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$527.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$895.90
|
| Rate for Payer: Vantage Medical Group Senior |
$895.90
|
|
