|
HC HELMET SOFT SHELL SMALL,TAN
|
Facility
|
IP
|
$488.13
|
|
| Hospital Charge Code |
901698206
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$97.63 |
| Max. Negotiated Rate |
$439.32 |
| Rate for Payer: Cash Price |
$219.66
|
| Rate for Payer: Central Health Plan Commercial |
$390.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.25
|
| Rate for Payer: Galaxy Health WC |
$414.91
|
| Rate for Payer: Global Benefits Group Commercial |
$292.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$439.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.63
|
| Rate for Payer: Multiplan Commercial |
$366.10
|
| Rate for Payer: Networks By Design Commercial |
$317.28
|
| Rate for Payer: Prime Health Services Commercial |
$414.91
|
|
|
HC HELMET SOFT SHELL X-LRG TAN
|
Facility
|
IP
|
$663.32
|
|
| Hospital Charge Code |
901698209
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$132.66 |
| Max. Negotiated Rate |
$596.99 |
| Rate for Payer: Cash Price |
$298.49
|
| Rate for Payer: Central Health Plan Commercial |
$530.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.33
|
| Rate for Payer: Galaxy Health WC |
$563.82
|
| Rate for Payer: Global Benefits Group Commercial |
$397.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$596.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$442.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.66
|
| Rate for Payer: Multiplan Commercial |
$497.49
|
| Rate for Payer: Networks By Design Commercial |
$431.16
|
| Rate for Payer: Prime Health Services Commercial |
$563.82
|
|
|
HC HELMET SOFT SHELL X-LRG TAN
|
Facility
|
OP
|
$663.32
|
|
| Hospital Charge Code |
901698209
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$132.66 |
| Max. Negotiated Rate |
$596.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$402.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$563.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$364.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$364.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$321.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$391.89
|
| Rate for Payer: Blue Distinction Transplant |
$397.99
|
| Rate for Payer: Blue Shield of California Commercial |
$417.23
|
| Rate for Payer: Blue Shield of California EPN |
$324.36
|
| Rate for Payer: Cash Price |
$298.49
|
| Rate for Payer: Central Health Plan Commercial |
$530.66
|
| Rate for Payer: Cigna of CA HMO |
$424.52
|
| Rate for Payer: Cigna of CA PPO |
$490.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$563.82
|
| Rate for Payer: Dignity Health Media |
$563.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$563.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$265.33
|
| Rate for Payer: Galaxy Health WC |
$563.82
|
| Rate for Payer: Global Benefits Group Commercial |
$397.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$596.99
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$497.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$232.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$442.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.66
|
| Rate for Payer: Multiplan Commercial |
$497.49
|
| Rate for Payer: Networks By Design Commercial |
$431.16
|
| Rate for Payer: Prime Health Services Commercial |
$563.82
|
| Rate for Payer: Riverside University Health System MISP |
$265.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$397.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$397.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$331.66
|
| Rate for Payer: United Healthcare All Other HMO |
$331.66
|
| Rate for Payer: United Healthcare HMO Rider |
$331.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$331.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$563.82
|
| Rate for Payer: Vantage Medical Group Senior |
$563.82
|
|
|
HC HELMET SOFT SHELL X-SMALL TAN
|
Facility
|
IP
|
$488.13
|
|
| Hospital Charge Code |
901698205
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$97.63 |
| Max. Negotiated Rate |
$439.32 |
| Rate for Payer: Cash Price |
$219.66
|
| Rate for Payer: Central Health Plan Commercial |
$390.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.25
|
| Rate for Payer: Galaxy Health WC |
$414.91
|
| Rate for Payer: Global Benefits Group Commercial |
$292.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$439.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.63
|
| Rate for Payer: Multiplan Commercial |
$366.10
|
| Rate for Payer: Networks By Design Commercial |
$317.28
|
| Rate for Payer: Prime Health Services Commercial |
$414.91
|
|
|
HC HELMET SOFT SHELL X-SMALL TAN
|
Facility
|
OP
|
$488.13
|
|
| Hospital Charge Code |
901698205
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$97.63 |
| Max. Negotiated Rate |
$439.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$296.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$414.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$268.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$268.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$236.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$288.39
|
| Rate for Payer: Blue Distinction Transplant |
$292.88
|
| Rate for Payer: Blue Shield of California Commercial |
$307.03
|
| Rate for Payer: Blue Shield of California EPN |
$238.70
|
| Rate for Payer: Cash Price |
$219.66
|
| Rate for Payer: Central Health Plan Commercial |
$390.50
|
| Rate for Payer: Cigna of CA HMO |
$312.40
|
| Rate for Payer: Cigna of CA PPO |
$361.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$414.91
|
| Rate for Payer: Dignity Health Media |
$414.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$414.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.25
|
| Rate for Payer: Galaxy Health WC |
$414.91
|
| Rate for Payer: Global Benefits Group Commercial |
$292.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$439.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$366.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.63
|
| Rate for Payer: Multiplan Commercial |
$366.10
|
| Rate for Payer: Networks By Design Commercial |
$317.28
|
| Rate for Payer: Prime Health Services Commercial |
$414.91
|
| Rate for Payer: Riverside University Health System MISP |
$195.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$292.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$292.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$244.06
|
| Rate for Payer: United Healthcare All Other HMO |
$244.06
|
| Rate for Payer: United Healthcare HMO Rider |
$244.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$244.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$414.91
|
| Rate for Payer: Vantage Medical Group Senior |
$414.91
|
|
|
HC HELMET SOFT SHELL XXLG
|
Facility
|
IP
|
$393.99
|
|
| Hospital Charge Code |
901692013
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$78.80 |
| Max. Negotiated Rate |
$354.59 |
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Central Health Plan Commercial |
$315.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.60
|
| Rate for Payer: Galaxy Health WC |
$334.89
|
| Rate for Payer: Global Benefits Group Commercial |
$236.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$354.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$262.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.80
|
| Rate for Payer: Multiplan Commercial |
$295.49
|
| Rate for Payer: Networks By Design Commercial |
$256.09
|
| Rate for Payer: Prime Health Services Commercial |
$334.89
|
|
|
HC HELMET SOFT SHELL XXLG
|
Facility
|
OP
|
$393.99
|
|
| Hospital Charge Code |
901692013
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$78.80 |
| Max. Negotiated Rate |
$354.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$239.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$334.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$216.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$216.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$190.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.77
|
| Rate for Payer: Blue Distinction Transplant |
$236.39
|
| Rate for Payer: Blue Shield of California Commercial |
$247.82
|
| Rate for Payer: Blue Shield of California EPN |
$192.66
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Central Health Plan Commercial |
$315.19
|
| Rate for Payer: Cigna of CA HMO |
$252.15
|
| Rate for Payer: Cigna of CA PPO |
$291.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$334.89
|
| Rate for Payer: Dignity Health Media |
$334.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$334.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$157.60
|
| Rate for Payer: Galaxy Health WC |
$334.89
|
| Rate for Payer: Global Benefits Group Commercial |
$236.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$354.59
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$295.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$137.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$262.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.80
|
| Rate for Payer: Multiplan Commercial |
$295.49
|
| Rate for Payer: Networks By Design Commercial |
$256.09
|
| Rate for Payer: Prime Health Services Commercial |
$334.89
|
| Rate for Payer: Riverside University Health System MISP |
$157.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$236.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$236.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.00
|
| Rate for Payer: United Healthcare All Other HMO |
$197.00
|
| Rate for Payer: United Healthcare HMO Rider |
$197.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$197.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$334.89
|
| Rate for Payer: Vantage Medical Group Senior |
$334.89
|
|
|
HC HEMATOCRIT HCT POC
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
900912115
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.97
|
| Rate for Payer: Blue Distinction Transplant |
$84.00
|
| Rate for Payer: Blue Shield of California Commercial |
$86.52
|
| Rate for Payer: Blue Shield of California EPN |
$68.04
|
| Rate for Payer: Caremore Medicare Advantage |
$2.37
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Central Health Plan Commercial |
$112.00
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$103.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.56
|
| Rate for Payer: Dignity Health Media |
$2.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.20
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.37
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$105.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.37
|
| Rate for Payer: InnovAge PACE Commercial |
$3.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.18
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
| Rate for Payer: Prime Health Services Medicare |
$2.51
|
| Rate for Payer: Riverside University Health System MISP |
$2.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1.92
|
| Rate for Payer: United Healthcare HMO Rider |
$1.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.61
|
| Rate for Payer: Vantage Medical Group Senior |
$2.37
|
|
|
HC HEMATOCRIT HCT POC
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
900912115
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Central Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.00
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
|
|
HC HEMATOPOIETIC PROGENITOR CELLS
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900912029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$90.20 |
| Max. Negotiated Rate |
$405.90 |
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Central Health Plan Commercial |
$360.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.40
|
| Rate for Payer: Galaxy Health WC |
$383.35
|
| Rate for Payer: Global Benefits Group Commercial |
$270.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$405.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$300.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.20
|
| Rate for Payer: Multiplan Commercial |
$338.25
|
| Rate for Payer: Networks By Design Commercial |
$293.15
|
| Rate for Payer: Prime Health Services Commercial |
$383.35
|
|
|
HC HEMATOPOIETIC PROGENITOR CELLS
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900912029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$80.14 |
| Max. Negotiated Rate |
$741.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$449.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$470.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$449.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$283.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$346.13
|
| Rate for Payer: Blue Distinction Transplant |
$270.60
|
| Rate for Payer: Blue Shield of California Commercial |
$278.72
|
| Rate for Payer: Blue Shield of California EPN |
$219.19
|
| Rate for Payer: Caremore Medicare Advantage |
$449.11
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Central Health Plan Commercial |
$360.80
|
| Rate for Payer: Cigna of CA HMO |
$288.64
|
| Rate for Payer: Cigna of CA PPO |
$333.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.66
|
| Rate for Payer: Dignity Health Media |
$449.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$494.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$449.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$449.11
|
| Rate for Payer: Galaxy Health WC |
$383.35
|
| Rate for Payer: Global Benefits Group Commercial |
$270.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$405.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$338.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$736.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$741.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$449.11
|
| Rate for Payer: InnovAge PACE Commercial |
$673.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$300.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$449.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$601.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.81
|
| Rate for Payer: Multiplan Commercial |
$338.25
|
| Rate for Payer: Networks By Design Commercial |
$293.15
|
| Rate for Payer: Prime Health Services Commercial |
$383.35
|
| Rate for Payer: Prime Health Services Medicare |
$476.06
|
| Rate for Payer: Riverside University Health System MISP |
$494.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$270.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$270.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Vantage Medical Group Senior |
$449.11
|
|
|
HC HEMECH-EPINEPHRINE
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900910197
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$161.96 |
| Rate for Payer: Adventist Health Medi-Cal |
$24.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.96
|
| Rate for Payer: Blue Distinction Transplant |
$49.20
|
| Rate for Payer: Blue Shield of California Commercial |
$50.68
|
| Rate for Payer: Blue Shield of California EPN |
$39.85
|
| Rate for Payer: Caremore Medicare Advantage |
$24.91
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.36
|
| Rate for Payer: Dignity Health Media |
$24.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.91
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$61.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$40.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.91
|
| Rate for Payer: InnovAge PACE Commercial |
$37.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.38
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Prime Health Services Medicare |
$26.40
|
| Rate for Payer: Riverside University Health System MISP |
$27.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.18
|
| Rate for Payer: United Healthcare All Other HMO |
$20.18
|
| Rate for Payer: United Healthcare HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Senior |
$24.91
|
|
|
HC HEMECH-EPINEPHRINE
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900910197
|
|
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 HEMECH SCRN-ARACHEDONIC ACID A
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$77.80 |
| Max. Negotiated Rate |
$350.10 |
| Rate for Payer: Cash Price |
$175.05
|
| Rate for Payer: Central Health Plan Commercial |
$311.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.60
|
| Rate for Payer: Galaxy Health WC |
$330.65
|
| Rate for Payer: Global Benefits Group Commercial |
$233.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$350.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$259.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.80
|
| Rate for Payer: Multiplan Commercial |
$291.75
|
| Rate for Payer: Networks By Design Commercial |
$252.85
|
| Rate for Payer: Prime Health Services Commercial |
$330.65
|
|
|
HC HEMECH SCRN-ARACHEDONIC ACID A
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$161.96 |
| Rate for Payer: Adventist Health Medi-Cal |
$24.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.96
|
| Rate for Payer: Blue Distinction Transplant |
$49.20
|
| Rate for Payer: Blue Shield of California Commercial |
$50.68
|
| Rate for Payer: Blue Shield of California EPN |
$39.85
|
| Rate for Payer: Caremore Medicare Advantage |
$24.91
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.36
|
| Rate for Payer: Dignity Health Media |
$24.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.91
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$61.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$40.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.91
|
| Rate for Payer: InnovAge PACE Commercial |
$37.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.38
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Prime Health Services Medicare |
$26.40
|
| Rate for Payer: Riverside University Health System MISP |
$27.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.18
|
| Rate for Payer: United Healthcare All Other HMO |
$20.18
|
| Rate for Payer: United Healthcare HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Senior |
$24.91
|
|
|
HC HEMIC/LYMPHATIC SYSTM PROCEDURE
|
Facility
|
OP
|
$1,478.00
|
|
|
Service Code
|
CPT 38999
|
| Hospital Charge Code |
909008999
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$295.60 |
| Max. Negotiated Rate |
$3,079.84 |
| Rate for Payer: Adventist Health Medi-Cal |
$542.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$542.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$715.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$873.20
|
| Rate for Payer: Blue Distinction Transplant |
$886.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$542.38
|
| Rate for Payer: Cash Price |
$665.10
|
| Rate for Payer: Cash Price |
$665.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,182.40
|
| Rate for Payer: Cigna of CA PPO |
$1,093.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.57
|
| Rate for Payer: Dignity Health Media |
$542.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$542.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$542.38
|
| Rate for Payer: Galaxy Health WC |
$1,256.30
|
| Rate for Payer: Global Benefits Group Commercial |
$886.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,330.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,108.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$889.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$894.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$542.38
|
| Rate for Payer: InnovAge PACE Commercial |
$813.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$985.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$542.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$726.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$726.79
|
| Rate for Payer: Multiplan Commercial |
$1,108.50
|
| Rate for Payer: Networks By Design Commercial |
$960.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,256.30
|
| Rate for Payer: Prime Health Services Medicare |
$574.92
|
| Rate for Payer: Riverside University Health System MISP |
$596.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$886.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Vantage Medical Group Senior |
$542.38
|
|
|
HC HEMIC/LYMPHATIC SYSTM PROCEDURE
|
Facility
|
IP
|
$1,478.00
|
|
|
Service Code
|
CPT 38999
|
| Hospital Charge Code |
909008999
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$295.60 |
| Max. Negotiated Rate |
$1,330.20 |
| Rate for Payer: Cash Price |
$665.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,182.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$591.20
|
| Rate for Payer: Galaxy Health WC |
$1,256.30
|
| Rate for Payer: Global Benefits Group Commercial |
$886.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,330.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$985.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$563.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.60
|
| Rate for Payer: Multiplan Commercial |
$1,108.50
|
| Rate for Payer: Networks By Design Commercial |
$960.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,256.30
|
|
|
HC HEMODIALYSIS KIT 2LUMEN 12FR
|
Facility
|
IP
|
$701.45
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.29 |
| Max. Negotiated Rate |
$631.30 |
| Rate for Payer: Blue Shield of California EPN |
$374.57
|
| Rate for Payer: Cash Price |
$315.65
|
| Rate for Payer: Central Health Plan Commercial |
$561.16
|
| Rate for Payer: Cigna of CA HMO |
$491.02
|
| Rate for Payer: Cigna of CA PPO |
$491.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$280.58
|
| Rate for Payer: Galaxy Health WC |
$596.23
|
| Rate for Payer: Global Benefits Group Commercial |
$420.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$467.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.29
|
| Rate for Payer: Multiplan Commercial |
$526.09
|
| Rate for Payer: Prime Health Services Commercial |
$596.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.87
|
| Rate for Payer: United Healthcare All Other HMO |
$258.69
|
| Rate for Payer: United Healthcare HMO Rider |
$253.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$231.48
|
|
|
HC HEMODIALYSIS KIT 2LUMEN 12FR
|
Facility
|
OP
|
$701.45
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.29 |
| Max. Negotiated Rate |
$631.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$596.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$385.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$385.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$320.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$390.71
|
| Rate for Payer: Blue Distinction Transplant |
$420.87
|
| Rate for Payer: Blue Shield of California Commercial |
$526.09
|
| Rate for Payer: Blue Shield of California EPN |
$381.59
|
| Rate for Payer: Cash Price |
$315.65
|
| Rate for Payer: Central Health Plan Commercial |
$561.16
|
| Rate for Payer: Cigna of CA HMO |
$491.02
|
| Rate for Payer: Cigna of CA PPO |
$491.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$596.23
|
| Rate for Payer: Dignity Health Media |
$596.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$280.58
|
| Rate for Payer: Galaxy Health WC |
$596.23
|
| Rate for Payer: Global Benefits Group Commercial |
$420.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$526.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$245.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$467.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.29
|
| Rate for Payer: Multiplan Commercial |
$526.09
|
| Rate for Payer: Networks By Design Commercial |
$350.72
|
| Rate for Payer: Prime Health Services Commercial |
$596.23
|
| Rate for Payer: Riverside University Health System MISP |
$280.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$420.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$420.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$350.72
|
| Rate for Payer: United Healthcare All Other HMO |
$350.72
|
| Rate for Payer: United Healthcare HMO Rider |
$350.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$350.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.23
|
| Rate for Payer: Vantage Medical Group Senior |
$596.23
|
|
|
HC HEMODIALYSIS, ONE EVALUATION
|
Facility
|
IP
|
$2,024.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
900501419
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$404.80 |
| Max. Negotiated Rate |
$1,821.60 |
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,619.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$809.60
|
| Rate for Payer: Galaxy Health WC |
$1,720.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,214.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,821.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$771.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.80
|
| Rate for Payer: Multiplan Commercial |
$1,518.00
|
| Rate for Payer: Networks By Design Commercial |
$1,315.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,720.40
|
|
|
HC HEMODIALYSIS, ONE EVALUATION
|
Facility
|
OP
|
$2,024.00
|
|
|
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 Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,309.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$960.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$873.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,214.40
|
| Rate for Payer: Caremore Medicare Advantage |
$873.10
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,619.20
|
| Rate for Payer: Cigna of CA PPO |
$1,497.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,309.65
|
| Rate for Payer: Dignity Health Media |
$873.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$960.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,178.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$873.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$873.10
|
| Rate for Payer: Galaxy Health WC |
$1,720.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,214.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,821.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,518.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,431.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$873.10
|
| Rate for Payer: InnovAge PACE Commercial |
$1,309.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$873.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,169.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,169.95
|
| Rate for Payer: Multiplan Commercial |
$1,518.00
|
| Rate for Payer: Networks By Design Commercial |
$1,315.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,720.40
|
| Rate for Payer: Prime Health Services Medicare |
$925.49
|
| Rate for Payer: Riverside University Health System MISP |
$960.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,214.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,012.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,012.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,012.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,012.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,309.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$960.41
|
| Rate for Payer: Vantage Medical Group Senior |
$873.10
|
|
|
HC HEMODIALYSIS TREATMENT OUTPT
|
Facility
|
IP
|
$2,024.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
941000105
|
|
Hospital Revenue Code
|
821
|
| Min. Negotiated Rate |
$404.80 |
| Max. Negotiated Rate |
$1,821.60 |
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,619.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$809.60
|
| Rate for Payer: Galaxy Health WC |
$1,720.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,214.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,821.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$771.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.80
|
| Rate for Payer: Multiplan Commercial |
$1,518.00
|
| Rate for Payer: Networks By Design Commercial |
$1,315.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,720.40
|
|
|
HC HEMODIALYSIS TREATMENT OUTPT
|
Facility
|
OP
|
$2,024.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
941000105
|
|
Hospital Revenue Code
|
821
|
| Min. Negotiated Rate |
$107.54 |
| Max. Negotiated Rate |
$1,821.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$873.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$429.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,309.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$960.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$873.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$980.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,195.78
|
| Rate for Payer: Blue Distinction Transplant |
$1,214.40
|
| Rate for Payer: Caremore Medicare Advantage |
$873.10
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,619.20
|
| Rate for Payer: Cigna of CA HMO |
$1,295.36
|
| Rate for Payer: Cigna of CA PPO |
$1,497.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,309.65
|
| Rate for Payer: Dignity Health Media |
$873.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$960.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,178.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$873.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$873.10
|
| Rate for Payer: Galaxy Health WC |
$1,720.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,214.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,821.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,518.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,431.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,440.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$873.10
|
| Rate for Payer: InnovAge PACE Commercial |
$1,309.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$873.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,169.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,169.95
|
| Rate for Payer: Multiplan Commercial |
$1,518.00
|
| Rate for Payer: Networks By Design Commercial |
$1,315.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,720.40
|
| Rate for Payer: Prime Health Services Medicare |
$925.49
|
| Rate for Payer: Riverside University Health System MISP |
$960.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,214.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,214.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,490.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,533.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,114.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,019.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,309.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$960.41
|
| Rate for Payer: Vantage Medical Group Senior |
$873.10
|
|
|
HC HEMODIALYSIS TREATMENT OUTPT/PEDS
|
Facility
|
IP
|
$2,024.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
949000105
|
|
Hospital Revenue Code
|
821
|
| Min. Negotiated Rate |
$404.80 |
| Max. Negotiated Rate |
$1,821.60 |
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,619.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$809.60
|
| Rate for Payer: Galaxy Health WC |
$1,720.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,214.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,821.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$771.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.80
|
| Rate for Payer: Multiplan Commercial |
$1,518.00
|
| Rate for Payer: Networks By Design Commercial |
$1,315.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,720.40
|
|
|
HC HEMODIALYSIS TREATMENT OUTPT/PEDS
|
Facility
|
OP
|
$2,024.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
949000105
|
|
Hospital Revenue Code
|
821
|
| Min. Negotiated Rate |
$107.54 |
| Max. Negotiated Rate |
$1,821.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$873.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$429.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,309.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$960.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$873.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$980.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,195.78
|
| Rate for Payer: Blue Distinction Transplant |
$1,214.40
|
| Rate for Payer: Caremore Medicare Advantage |
$873.10
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,619.20
|
| Rate for Payer: Cigna of CA HMO |
$1,295.36
|
| Rate for Payer: Cigna of CA PPO |
$1,497.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,309.65
|
| Rate for Payer: Dignity Health Media |
$873.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$960.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,178.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$873.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$873.10
|
| Rate for Payer: Galaxy Health WC |
$1,720.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,214.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,821.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,518.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,431.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,440.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$873.10
|
| Rate for Payer: InnovAge PACE Commercial |
$1,309.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$873.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,169.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,169.95
|
| Rate for Payer: Multiplan Commercial |
$1,518.00
|
| Rate for Payer: Networks By Design Commercial |
$1,315.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,720.40
|
| Rate for Payer: Prime Health Services Medicare |
$925.49
|
| Rate for Payer: Riverside University Health System MISP |
$960.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,214.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,214.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,490.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,533.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,114.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,019.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,309.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$960.41
|
| Rate for Payer: Vantage Medical Group Senior |
$873.10
|
|
