|
HC OS HYDROGEL WOUND 4X4 X-THIN
|
Facility
|
OP
|
$12.38
|
|
|
Service Code
|
CPT A4362
|
| Hospital Charge Code |
901604412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$11.14 |
| Rate for Payer: Adventist Health Commercial |
$2.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7.85
|
| Rate for Payer: Blue Shield of California EPN |
$4.94
|
| Rate for Payer: Cash Price |
$5.57
|
| Rate for Payer: Cash Price |
$5.57
|
| Rate for Payer: Central Health Plan Commercial |
$9.90
|
| Rate for Payer: Cigna of CA HMO |
$7.92
|
| Rate for Payer: Cigna of CA PPO |
$9.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.95
|
| Rate for Payer: EPIC Health Plan Senior |
$4.95
|
| Rate for Payer: Galaxy Health WC |
$10.52
|
| Rate for Payer: Global Benefits Group Commercial |
$7.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$9.29
|
| Rate for Payer: Networks By Design Commercial |
$8.05
|
| Rate for Payer: Prime Health Services Commercial |
$10.52
|
| Rate for Payer: Riverside University Health System MISP |
$4.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.19
|
| Rate for Payer: United Healthcare All Other HMO |
$6.19
|
| Rate for Payer: United Healthcare HMO Rider |
$6.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.52
|
| Rate for Payer: Vantage Medical Group Senior |
$10.52
|
|
|
HC OS HYDROGEL WOUND 4X4 X-THIN
|
Facility
|
IP
|
$12.38
|
|
|
Service Code
|
CPT A4362
|
| Hospital Charge Code |
901604412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$11.14 |
| Rate for Payer: Adventist Health Commercial |
$2.48
|
| Rate for Payer: Cash Price |
$5.57
|
| Rate for Payer: Central Health Plan Commercial |
$9.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.95
|
| Rate for Payer: EPIC Health Plan Senior |
$4.95
|
| Rate for Payer: Galaxy Health WC |
$10.52
|
| Rate for Payer: Global Benefits Group Commercial |
$7.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.48
|
| Rate for Payer: Multiplan Commercial |
$9.29
|
| Rate for Payer: Networks By Design Commercial |
$8.05
|
| Rate for Payer: Prime Health Services Commercial |
$10.52
|
|
|
HC OS HYDROGEL WOUND 4X5
|
Facility
|
OP
|
$30.26
|
|
| Hospital Charge Code |
901603226
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$27.23 |
| Rate for Payer: Adventist Health Commercial |
$6.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.60
|
| Rate for Payer: Blue Shield of California Commercial |
$19.18
|
| Rate for Payer: Blue Shield of California EPN |
$12.07
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Central Health Plan Commercial |
$24.21
|
| Rate for Payer: Cigna of CA HMO |
$19.37
|
| Rate for Payer: Cigna of CA PPO |
$22.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.10
|
| Rate for Payer: EPIC Health Plan Senior |
$12.10
|
| Rate for Payer: Galaxy Health WC |
$25.72
|
| Rate for Payer: Global Benefits Group Commercial |
$18.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.18
|
| Rate for Payer: Multiplan Commercial |
$22.70
|
| Rate for Payer: Networks By Design Commercial |
$19.67
|
| Rate for Payer: Prime Health Services Commercial |
$25.72
|
| Rate for Payer: Riverside University Health System MISP |
$12.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.13
|
| Rate for Payer: United Healthcare All Other HMO |
$15.13
|
| Rate for Payer: United Healthcare HMO Rider |
$15.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.72
|
| Rate for Payer: Vantage Medical Group Senior |
$25.72
|
|
|
HC OS HYDROGEL WOUND 4X5
|
Facility
|
IP
|
$30.26
|
|
| Hospital Charge Code |
901603226
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$27.23 |
| Rate for Payer: Adventist Health Commercial |
$6.05
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Central Health Plan Commercial |
$24.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.10
|
| Rate for Payer: EPIC Health Plan Senior |
$12.10
|
| Rate for Payer: Galaxy Health WC |
$25.72
|
| Rate for Payer: Global Benefits Group Commercial |
$18.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.05
|
| Rate for Payer: Multiplan Commercial |
$22.70
|
| Rate for Payer: Networks By Design Commercial |
$19.67
|
| Rate for Payer: Prime Health Services Commercial |
$25.72
|
|
|
HC OS LID POUCH COLOPLAST MIDI
|
Facility
|
IP
|
$12.79
|
|
| Hospital Charge Code |
901605217
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$11.51 |
| Rate for Payer: Adventist Health Commercial |
$2.56
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Central Health Plan Commercial |
$10.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.12
|
| Rate for Payer: EPIC Health Plan Senior |
$5.12
|
| Rate for Payer: Galaxy Health WC |
$10.87
|
| Rate for Payer: Global Benefits Group Commercial |
$7.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.56
|
| Rate for Payer: Multiplan Commercial |
$9.59
|
| Rate for Payer: Networks By Design Commercial |
$8.31
|
| Rate for Payer: Prime Health Services Commercial |
$10.87
|
|
|
HC OS LID POUCH COLOPLAST MIDI
|
Facility
|
OP
|
$12.79
|
|
| Hospital Charge Code |
901605217
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$11.51 |
| Rate for Payer: Adventist Health Commercial |
$2.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.44
|
| Rate for Payer: Blue Shield of California Commercial |
$8.11
|
| Rate for Payer: Blue Shield of California EPN |
$5.10
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Central Health Plan Commercial |
$10.23
|
| Rate for Payer: Cigna of CA HMO |
$8.19
|
| Rate for Payer: Cigna of CA PPO |
$9.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.12
|
| Rate for Payer: EPIC Health Plan Senior |
$5.12
|
| Rate for Payer: Galaxy Health WC |
$10.87
|
| Rate for Payer: Global Benefits Group Commercial |
$7.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.95
|
| Rate for Payer: Multiplan Commercial |
$9.59
|
| Rate for Payer: Networks By Design Commercial |
$8.31
|
| Rate for Payer: Prime Health Services Commercial |
$10.87
|
| Rate for Payer: Riverside University Health System MISP |
$5.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.39
|
| Rate for Payer: United Healthcare All Other HMO |
$6.39
|
| Rate for Payer: United Healthcare HMO Rider |
$6.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.87
|
| Rate for Payer: Vantage Medical Group Senior |
$10.87
|
|
|
HC OS LID POUCH COLOPLAST MINI
|
Facility
|
IP
|
$94.77
|
|
| Hospital Charge Code |
901605199
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$85.29 |
| Rate for Payer: Adventist Health Commercial |
$18.95
|
| Rate for Payer: Cash Price |
$42.65
|
| Rate for Payer: Central Health Plan Commercial |
$75.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$66.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.91
|
| Rate for Payer: EPIC Health Plan Senior |
$37.91
|
| Rate for Payer: Galaxy Health WC |
$80.55
|
| Rate for Payer: Global Benefits Group Commercial |
$56.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$85.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.95
|
| Rate for Payer: Multiplan Commercial |
$71.08
|
| Rate for Payer: Networks By Design Commercial |
$61.60
|
| Rate for Payer: Prime Health Services Commercial |
$80.55
|
|
|
HC OS LID POUCH COLOPLAST MINI
|
Facility
|
OP
|
$94.77
|
|
| Hospital Charge Code |
901605199
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$85.29 |
| Rate for Payer: Adventist Health Commercial |
$18.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$80.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.13
|
| Rate for Payer: Blue Shield of California Commercial |
$60.08
|
| Rate for Payer: Blue Shield of California EPN |
$37.81
|
| Rate for Payer: Cash Price |
$42.65
|
| Rate for Payer: Central Health Plan Commercial |
$75.82
|
| Rate for Payer: Cigna of CA HMO |
$60.65
|
| Rate for Payer: Cigna of CA PPO |
$70.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$80.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$80.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$66.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.91
|
| Rate for Payer: EPIC Health Plan Senior |
$37.91
|
| Rate for Payer: Galaxy Health WC |
$80.55
|
| Rate for Payer: Global Benefits Group Commercial |
$56.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$85.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$66.34
|
| Rate for Payer: Multiplan Commercial |
$71.08
|
| Rate for Payer: Networks By Design Commercial |
$61.60
|
| Rate for Payer: Prime Health Services Commercial |
$80.55
|
| Rate for Payer: Riverside University Health System MISP |
$37.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.38
|
| Rate for Payer: United Healthcare All Other HMO |
$47.38
|
| Rate for Payer: United Healthcare HMO Rider |
$47.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$80.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.55
|
| Rate for Payer: Vantage Medical Group Senior |
$80.55
|
|
|
HC OS LID POUCH MINI WO FILTER
|
Facility
|
IP
|
$12.87
|
|
| Hospital Charge Code |
901605915
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$11.58 |
| Rate for Payer: Adventist Health Commercial |
$2.57
|
| Rate for Payer: Cash Price |
$5.79
|
| Rate for Payer: Central Health Plan Commercial |
$10.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.15
|
| Rate for Payer: EPIC Health Plan Senior |
$5.15
|
| Rate for Payer: Galaxy Health WC |
$10.94
|
| Rate for Payer: Global Benefits Group Commercial |
$7.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.57
|
| Rate for Payer: Multiplan Commercial |
$9.65
|
| Rate for Payer: Networks By Design Commercial |
$8.37
|
| Rate for Payer: Prime Health Services Commercial |
$10.94
|
|
|
HC OS LID POUCH MINI WO FILTER
|
Facility
|
OP
|
$12.87
|
|
| Hospital Charge Code |
901605915
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$11.58 |
| Rate for Payer: Adventist Health Commercial |
$2.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.49
|
| Rate for Payer: Blue Shield of California Commercial |
$8.16
|
| Rate for Payer: Blue Shield of California EPN |
$5.14
|
| Rate for Payer: Cash Price |
$5.79
|
| Rate for Payer: Central Health Plan Commercial |
$10.30
|
| Rate for Payer: Cigna of CA HMO |
$8.24
|
| Rate for Payer: Cigna of CA PPO |
$9.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.15
|
| Rate for Payer: EPIC Health Plan Senior |
$5.15
|
| Rate for Payer: Galaxy Health WC |
$10.94
|
| Rate for Payer: Global Benefits Group Commercial |
$7.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.01
|
| Rate for Payer: Multiplan Commercial |
$9.65
|
| Rate for Payer: Networks By Design Commercial |
$8.37
|
| Rate for Payer: Prime Health Services Commercial |
$10.94
|
| Rate for Payer: Riverside University Health System MISP |
$5.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.43
|
| Rate for Payer: United Healthcare All Other HMO |
$6.43
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.94
|
| Rate for Payer: Vantage Medical Group Senior |
$10.94
|
|
|
HC OS LIQUID ADHESIVE MASTISOL
|
Facility
|
OP
|
$13.04
|
|
| Hospital Charge Code |
901603030
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.74 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.59
|
| Rate for Payer: Blue Shield of California Commercial |
$8.27
|
| Rate for Payer: Blue Shield of California EPN |
$5.20
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: Central Health Plan Commercial |
$10.43
|
| Rate for Payer: Cigna of CA HMO |
$8.35
|
| Rate for Payer: Cigna of CA PPO |
$9.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.13
|
| Rate for Payer: Multiplan Commercial |
$9.78
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
| Rate for Payer: Riverside University Health System MISP |
$5.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.52
|
| Rate for Payer: United Healthcare All Other HMO |
$6.52
|
| Rate for Payer: United Healthcare HMO Rider |
$6.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.08
|
| Rate for Payer: Vantage Medical Group Senior |
$11.08
|
|
|
HC OS LIQUID ADHESIVE MASTISOL
|
Facility
|
IP
|
$13.04
|
|
| Hospital Charge Code |
901603030
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.74 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: Central Health Plan Commercial |
$10.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$9.78
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
|
|
HC OSMOLALITY SERUM
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
CPT 83930
|
| Hospital Charge Code |
900910264
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$223.20 |
| Rate for Payer: Adventist Health Commercial |
$49.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.04
|
| Rate for Payer: Blue Shield of California Commercial |
$156.24
|
| Rate for Payer: Blue Shield of California EPN |
$98.46
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Central Health Plan Commercial |
$198.40
|
| Rate for Payer: Cigna of CA HMO |
$158.72
|
| Rate for Payer: Cigna of CA PPO |
$183.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$173.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Senior |
$7.27
|
| Rate for Payer: Galaxy Health WC |
$210.80
|
| Rate for Payer: Global Benefits Group Commercial |
$148.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$223.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$157.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.86
|
| Rate for Payer: Multiplan Commercial |
$186.00
|
| Rate for Payer: Networks By Design Commercial |
$161.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.61
|
| Rate for Payer: Prime Health Services Commercial |
$210.80
|
| Rate for Payer: Prime Health Services Medicare |
$7.01
|
| Rate for Payer: Riverside University Health System MISP |
$7.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$148.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$148.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.36
|
| Rate for Payer: United Healthcare All Other HMO |
$5.36
|
| Rate for Payer: United Healthcare HMO Rider |
$5.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.27
|
| Rate for Payer: Vantage Medical Group Senior |
$6.61
|
|
|
HC OSMOLALITY SERUM
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
CPT 83930
|
| Hospital Charge Code |
900910264
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.60 |
| Max. Negotiated Rate |
$223.20 |
| Rate for Payer: Adventist Health Commercial |
$49.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Central Health Plan Commercial |
$198.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$173.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.20
|
| Rate for Payer: EPIC Health Plan Senior |
$99.20
|
| Rate for Payer: Galaxy Health WC |
$210.80
|
| Rate for Payer: Global Benefits Group Commercial |
$148.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$223.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$157.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.60
|
| Rate for Payer: Multiplan Commercial |
$186.00
|
| Rate for Payer: Networks By Design Commercial |
$161.20
|
| Rate for Payer: Prime Health Services Commercial |
$210.80
|
|
|
HC OSMOLALITY STOOL
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
900910358
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$258.30 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.98
|
| Rate for Payer: Blue Shield of California Commercial |
$45.36
|
| Rate for Payer: Blue Shield of California Commercial |
$180.81
|
| Rate for Payer: Blue Shield of California EPN |
$28.58
|
| Rate for Payer: Blue Shield of California EPN |
$113.94
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Central Health Plan Commercial |
$229.60
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA HMO |
$183.68
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Cigna of CA PPO |
$212.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$200.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.25
|
| Rate for Payer: EPIC Health Plan Senior |
$7.50
|
| Rate for Payer: EPIC Health Plan Senior |
$7.50
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$258.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$182.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.14
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$215.25
|
| Rate for Payer: Networks By Design Commercial |
$186.55
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.82
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.82
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
| Rate for Payer: Prime Health Services Medicare |
$7.23
|
| Rate for Payer: Prime Health Services Medicare |
$7.23
|
| Rate for Payer: Riverside University Health System MISP |
$7.50
|
| Rate for Payer: Riverside University Health System MISP |
$7.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.53
|
| Rate for Payer: United Healthcare All Other HMO |
$5.53
|
| Rate for Payer: United Healthcare All Other HMO |
$5.53
|
| Rate for Payer: United Healthcare HMO Rider |
$5.53
|
| Rate for Payer: United Healthcare HMO Rider |
$5.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
|
|
HC OSMOLALITY STOOL
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
900910358
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$258.30 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Central Health Plan Commercial |
$229.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$200.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$258.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$182.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$169.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$215.25
|
| Rate for Payer: Networks By Design Commercial |
$186.55
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
|
|
HC OSMOLALITY URINE
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
900910214
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$234.90 |
| Rate for Payer: Adventist Health Commercial |
$52.20
|
| Rate for Payer: Cash Price |
$117.45
|
| Rate for Payer: Central Health Plan Commercial |
$208.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$182.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.40
|
| Rate for Payer: EPIC Health Plan Senior |
$104.40
|
| Rate for Payer: Galaxy Health WC |
$221.85
|
| Rate for Payer: Global Benefits Group Commercial |
$156.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$234.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$165.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$153.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.20
|
| Rate for Payer: Multiplan Commercial |
$195.75
|
| Rate for Payer: Networks By Design Commercial |
$169.65
|
| Rate for Payer: Prime Health Services Commercial |
$221.85
|
|
|
HC OSMOLALITY URINE
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
900910214
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$234.90 |
| Rate for Payer: Adventist Health Commercial |
$52.20
|
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.98
|
| Rate for Payer: Blue Shield of California Commercial |
$45.36
|
| Rate for Payer: Blue Shield of California Commercial |
$164.43
|
| Rate for Payer: Blue Shield of California EPN |
$28.58
|
| Rate for Payer: Blue Shield of California EPN |
$103.62
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$117.45
|
| Rate for Payer: Cash Price |
$117.45
|
| Rate for Payer: Central Health Plan Commercial |
$208.80
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA HMO |
$167.04
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Cigna of CA PPO |
$193.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$182.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.25
|
| Rate for Payer: EPIC Health Plan Senior |
$7.50
|
| Rate for Payer: EPIC Health Plan Senior |
$7.50
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$221.85
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Global Benefits Group Commercial |
$156.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$234.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$165.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.14
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$195.75
|
| Rate for Payer: Networks By Design Commercial |
$169.65
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.82
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.82
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Prime Health Services Commercial |
$221.85
|
| Rate for Payer: Prime Health Services Medicare |
$7.23
|
| Rate for Payer: Prime Health Services Medicare |
$7.23
|
| Rate for Payer: Riverside University Health System MISP |
$7.50
|
| Rate for Payer: Riverside University Health System MISP |
$7.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$156.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$156.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.53
|
| Rate for Payer: United Healthcare All Other HMO |
$5.53
|
| Rate for Payer: United Healthcare All Other HMO |
$5.53
|
| Rate for Payer: United Healthcare HMO Rider |
$5.53
|
| Rate for Payer: United Healthcare HMO Rider |
$5.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
|
|
HC OSMOLALITY URINE 24 HOURS
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
900912213
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$234.90 |
| Rate for Payer: Adventist Health Commercial |
$52.20
|
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.98
|
| Rate for Payer: Blue Shield of California Commercial |
$45.36
|
| Rate for Payer: Blue Shield of California Commercial |
$164.43
|
| Rate for Payer: Blue Shield of California EPN |
$28.58
|
| Rate for Payer: Blue Shield of California EPN |
$103.62
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$117.45
|
| Rate for Payer: Cash Price |
$117.45
|
| Rate for Payer: Central Health Plan Commercial |
$208.80
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA HMO |
$167.04
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Cigna of CA PPO |
$193.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$182.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.25
|
| Rate for Payer: EPIC Health Plan Senior |
$7.50
|
| Rate for Payer: EPIC Health Plan Senior |
$7.50
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$221.85
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Global Benefits Group Commercial |
$156.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$234.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$165.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.14
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$195.75
|
| Rate for Payer: Networks By Design Commercial |
$169.65
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.82
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.82
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Prime Health Services Commercial |
$221.85
|
| Rate for Payer: Prime Health Services Medicare |
$7.23
|
| Rate for Payer: Prime Health Services Medicare |
$7.23
|
| Rate for Payer: Riverside University Health System MISP |
$7.50
|
| Rate for Payer: Riverside University Health System MISP |
$7.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$156.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$156.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.53
|
| Rate for Payer: United Healthcare All Other HMO |
$5.53
|
| Rate for Payer: United Healthcare All Other HMO |
$5.53
|
| Rate for Payer: United Healthcare HMO Rider |
$5.53
|
| Rate for Payer: United Healthcare HMO Rider |
$5.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
|
|
HC OSMOLALITY URINE 24 HOURS
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
900912213
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$234.90 |
| Rate for Payer: Adventist Health Commercial |
$52.20
|
| Rate for Payer: Cash Price |
$117.45
|
| Rate for Payer: Central Health Plan Commercial |
$208.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$182.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.40
|
| Rate for Payer: EPIC Health Plan Senior |
$104.40
|
| Rate for Payer: Galaxy Health WC |
$221.85
|
| Rate for Payer: Global Benefits Group Commercial |
$156.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$234.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$165.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$153.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.20
|
| Rate for Payer: Multiplan Commercial |
$195.75
|
| Rate for Payer: Networks By Design Commercial |
$169.65
|
| Rate for Payer: Prime Health Services Commercial |
$221.85
|
|
|
HC OSMOLALITY URINE RANDOM
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
900912212
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$234.90 |
| Rate for Payer: Adventist Health Commercial |
$52.20
|
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.98
|
| Rate for Payer: Blue Shield of California Commercial |
$45.36
|
| Rate for Payer: Blue Shield of California Commercial |
$164.43
|
| Rate for Payer: Blue Shield of California EPN |
$28.58
|
| Rate for Payer: Blue Shield of California EPN |
$103.62
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$117.45
|
| Rate for Payer: Cash Price |
$117.45
|
| Rate for Payer: Central Health Plan Commercial |
$208.80
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA HMO |
$167.04
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Cigna of CA PPO |
$193.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$182.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.25
|
| Rate for Payer: EPIC Health Plan Senior |
$7.50
|
| Rate for Payer: EPIC Health Plan Senior |
$7.50
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$221.85
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Global Benefits Group Commercial |
$156.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$234.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$165.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.14
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$195.75
|
| Rate for Payer: Networks By Design Commercial |
$169.65
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.82
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.82
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Prime Health Services Commercial |
$221.85
|
| Rate for Payer: Prime Health Services Medicare |
$7.23
|
| Rate for Payer: Prime Health Services Medicare |
$7.23
|
| Rate for Payer: Riverside University Health System MISP |
$7.50
|
| Rate for Payer: Riverside University Health System MISP |
$7.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$156.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$156.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.53
|
| Rate for Payer: United Healthcare All Other HMO |
$5.53
|
| Rate for Payer: United Healthcare All Other HMO |
$5.53
|
| Rate for Payer: United Healthcare HMO Rider |
$5.53
|
| Rate for Payer: United Healthcare HMO Rider |
$5.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
|
|
HC OSMOLALITY URINE RANDOM
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
900912212
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$234.90 |
| Rate for Payer: Adventist Health Commercial |
$52.20
|
| Rate for Payer: Cash Price |
$117.45
|
| Rate for Payer: Central Health Plan Commercial |
$208.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$182.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.40
|
| Rate for Payer: EPIC Health Plan Senior |
$104.40
|
| Rate for Payer: Galaxy Health WC |
$221.85
|
| Rate for Payer: Global Benefits Group Commercial |
$156.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$234.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$165.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$153.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.20
|
| Rate for Payer: Multiplan Commercial |
$195.75
|
| Rate for Payer: Networks By Design Commercial |
$169.65
|
| Rate for Payer: Prime Health Services Commercial |
$221.85
|
|
|
HC OSMOTIC FRAGILITY
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 85555
|
| Hospital Charge Code |
900910039
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.47
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.61
|
| Rate for Payer: Blue Shield of California Commercial |
$32.13
|
| Rate for Payer: Blue Shield of California Commercial |
$88.83
|
| Rate for Payer: Blue Shield of California EPN |
$20.25
|
| Rate for Payer: Blue Shield of California EPN |
$55.98
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Central Health Plan Commercial |
$112.80
|
| Rate for Payer: Central Health Plan Commercial |
$40.80
|
| Rate for Payer: Cigna of CA HMO |
$32.64
|
| Rate for Payer: Cigna of CA HMO |
$90.24
|
| Rate for Payer: Cigna of CA PPO |
$37.74
|
| Rate for Payer: Cigna of CA PPO |
$104.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.33
|
| Rate for Payer: EPIC Health Plan Senior |
$8.22
|
| Rate for Payer: EPIC Health Plan Senior |
$8.22
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Galaxy Health WC |
$119.85
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$84.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$89.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.01
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
| Rate for Payer: Networks By Design Commercial |
$91.65
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.47
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.47
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
| Rate for Payer: Prime Health Services Commercial |
$119.85
|
| Rate for Payer: Prime Health Services Medicare |
$7.92
|
| Rate for Payer: Prime Health Services Medicare |
$7.92
|
| Rate for Payer: Riverside University Health System MISP |
$8.22
|
| Rate for Payer: Riverside University Health System MISP |
$8.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.05
|
| Rate for Payer: United Healthcare All Other HMO |
$6.05
|
| Rate for Payer: United Healthcare All Other HMO |
$6.05
|
| Rate for Payer: United Healthcare HMO Rider |
$6.05
|
| Rate for Payer: United Healthcare HMO Rider |
$6.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.22
|
| Rate for Payer: Vantage Medical Group Senior |
$7.47
|
| Rate for Payer: Vantage Medical Group Senior |
$7.47
|
|
|
HC OSMOTIC FRAGILITY
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 85555
|
| Hospital Charge Code |
900910039
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Central Health Plan Commercial |
$112.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.40
|
| Rate for Payer: EPIC Health Plan Senior |
$56.40
|
| Rate for Payer: Galaxy Health WC |
$119.85
|
| Rate for Payer: Global Benefits Group Commercial |
$84.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$89.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.20
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
| Rate for Payer: Networks By Design Commercial |
$91.65
|
| Rate for Payer: Prime Health Services Commercial |
$119.85
|
|
|
HC OSMOTIC FRAGILITY (INC)
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
CPT 85557
|
| Hospital Charge Code |
900910077
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$340.20 |
| Rate for Payer: Adventist Health Commercial |
$75.60
|
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.36
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$97.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$97.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.09
|
| Rate for Payer: Blue Shield of California Commercial |
$30.87
|
| Rate for Payer: Blue Shield of California Commercial |
$238.14
|
| Rate for Payer: Blue Shield of California EPN |
$19.45
|
| Rate for Payer: Blue Shield of California EPN |
$150.07
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Central Health Plan Commercial |
$302.40
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA HMO |
$241.92
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Cigna of CA PPO |
$279.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$264.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.04
|
| Rate for Payer: EPIC Health Plan Senior |
$14.70
|
| Rate for Payer: EPIC Health Plan Senior |
$14.70
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Galaxy Health WC |
$321.30
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Global Benefits Group Commercial |
$226.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$340.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$240.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.90
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Multiplan Commercial |
$283.50
|
| Rate for Payer: Networks By Design Commercial |
$245.70
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.36
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.36
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Prime Health Services Commercial |
$321.30
|
| Rate for Payer: Prime Health Services Medicare |
$14.16
|
| Rate for Payer: Prime Health Services Medicare |
$14.16
|
| Rate for Payer: Riverside University Health System MISP |
$14.70
|
| Rate for Payer: Riverside University Health System MISP |
$14.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.82
|
| Rate for Payer: United Healthcare All Other HMO |
$10.82
|
| Rate for Payer: United Healthcare All Other HMO |
$10.82
|
| Rate for Payer: United Healthcare HMO Rider |
$10.82
|
| Rate for Payer: United Healthcare HMO Rider |
$10.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.70
|
| Rate for Payer: Vantage Medical Group Senior |
$13.36
|
| Rate for Payer: Vantage Medical Group Senior |
$13.36
|
|
