|
HC PHENCYCLIDINE CONF
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900910517
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$280.80 |
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Central Health Plan Commercial |
$249.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$218.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Senior |
$124.80
|
| Rate for Payer: Galaxy Health WC |
$265.20
|
| Rate for Payer: Global Benefits Group Commercial |
$187.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$280.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$198.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
| Rate for Payer: Networks By Design Commercial |
$202.80
|
| Rate for Payer: Prime Health Services Commercial |
$265.20
|
|
|
HC PHENOBARBITAL (LUMINAL)
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
900910409
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$166.50 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Central Health Plan Commercial |
$148.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$129.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.00
|
| Rate for Payer: EPIC Health Plan Senior |
$74.00
|
| Rate for Payer: Galaxy Health WC |
$157.25
|
| Rate for Payer: Global Benefits Group Commercial |
$111.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$166.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$117.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$109.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.00
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| Rate for Payer: Networks By Design Commercial |
$120.25
|
| Rate for Payer: Prime Health Services Commercial |
$157.25
|
|
|
HC PHENOBARBITAL (LUMINAL)
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
900910409
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$166.50 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.30
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$83.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$83.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.62
|
| Rate for Payer: Blue Shield of California Commercial |
$30.87
|
| Rate for Payer: Blue Shield of California Commercial |
$116.55
|
| Rate for Payer: Blue Shield of California EPN |
$19.45
|
| Rate for Payer: Blue Shield of California EPN |
$73.44
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Central Health Plan Commercial |
$148.00
|
| 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 |
$118.40
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Cigna of CA PPO |
$136.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$129.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.25
|
| Rate for Payer: EPIC Health Plan Senior |
$16.83
|
| Rate for Payer: EPIC Health Plan Senior |
$16.83
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Galaxy Health WC |
$157.25
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Global Benefits Group Commercial |
$111.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$166.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$117.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.50
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| Rate for Payer: Networks By Design Commercial |
$120.25
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Prime Health Services Commercial |
$157.25
|
| Rate for Payer: Prime Health Services Medicare |
$16.22
|
| Rate for Payer: Prime Health Services Medicare |
$16.22
|
| Rate for Payer: Riverside University Health System MISP |
$16.83
|
| Rate for Payer: Riverside University Health System MISP |
$16.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.00
|
| 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 |
$111.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.39
|
| Rate for Payer: United Healthcare All Other HMO |
$12.39
|
| Rate for Payer: United Healthcare All Other HMO |
$12.39
|
| Rate for Payer: United Healthcare HMO Rider |
$12.39
|
| Rate for Payer: United Healthcare HMO Rider |
$12.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.39
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
HC PHENYTOIN (DILANTN)
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
900910400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.40 |
| Max. Negotiated Rate |
$204.30 |
| Rate for Payer: Adventist Health Commercial |
$45.40
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Central Health Plan Commercial |
$181.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$158.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.80
|
| Rate for Payer: EPIC Health Plan Senior |
$90.80
|
| Rate for Payer: Galaxy Health WC |
$192.95
|
| Rate for Payer: Global Benefits Group Commercial |
$136.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$204.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$144.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$133.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.40
|
| Rate for Payer: Multiplan Commercial |
$170.25
|
| Rate for Payer: Networks By Design Commercial |
$147.55
|
| Rate for Payer: Prime Health Services Commercial |
$192.95
|
|
|
HC PHENYTOIN (DILANTN)
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
900910400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$204.30 |
| Rate for Payer: Adventist Health Commercial |
$45.40
|
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.25
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$96.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$96.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.07
|
| Rate for Payer: Blue Shield of California Commercial |
$30.87
|
| Rate for Payer: Blue Shield of California Commercial |
$143.01
|
| Rate for Payer: Blue Shield of California EPN |
$19.45
|
| Rate for Payer: Blue Shield of California EPN |
$90.12
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Central Health Plan Commercial |
$181.60
|
| 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 |
$145.28
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Cigna of CA PPO |
$167.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$158.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.86
|
| Rate for Payer: EPIC Health Plan Senior |
$14.57
|
| Rate for Payer: EPIC Health Plan Senior |
$14.57
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Galaxy Health WC |
$192.95
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Global Benefits Group Commercial |
$136.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$204.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.73
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$144.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.75
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Multiplan Commercial |
$170.25
|
| Rate for Payer: Networks By Design Commercial |
$147.55
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.25
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Prime Health Services Commercial |
$192.95
|
| Rate for Payer: Prime Health Services Medicare |
$14.04
|
| Rate for Payer: Prime Health Services Medicare |
$14.04
|
| Rate for Payer: Riverside University Health System MISP |
$14.57
|
| Rate for Payer: Riverside University Health System MISP |
$14.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.20
|
| 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 |
$136.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.74
|
| Rate for Payer: United Healthcare All Other HMO |
$10.74
|
| Rate for Payer: United Healthcare All Other HMO |
$10.74
|
| Rate for Payer: United Healthcare HMO Rider |
$10.74
|
| Rate for Payer: United Healthcare HMO Rider |
$10.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
|
HC PHERESFLOW TRIPLE LUMEN CATH
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081725
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.40 |
| Max. Negotiated Rate |
$1,117.80 |
| Rate for Payer: Adventist Health Commercial |
$248.40
|
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: Central Health Plan Commercial |
$993.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$869.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$496.80
|
| Rate for Payer: EPIC Health Plan Senior |
$496.80
|
| Rate for Payer: Galaxy Health WC |
$1,055.70
|
| Rate for Payer: Global Benefits Group Commercial |
$745.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,117.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$788.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$732.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.40
|
| Rate for Payer: Multiplan Commercial |
$931.50
|
| Rate for Payer: Networks By Design Commercial |
$807.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,055.70
|
|
|
HC PHERESFLOW TRIPLE LUMEN CATH
|
Facility
|
OP
|
$1,242.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081725
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.40 |
| Max. Negotiated Rate |
$2,565.15 |
| Rate for Payer: Adventist Health Commercial |
$248.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,565.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,055.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$683.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$931.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$601.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$722.47
|
| Rate for Payer: Blue Shield of California Commercial |
$787.43
|
| Rate for Payer: Blue Shield of California EPN |
$495.56
|
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: Central Health Plan Commercial |
$993.60
|
| Rate for Payer: Cigna of CA HMO |
$794.88
|
| Rate for Payer: Cigna of CA PPO |
$919.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,055.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,055.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,055.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$869.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$496.80
|
| Rate for Payer: EPIC Health Plan Senior |
$496.80
|
| Rate for Payer: Galaxy Health WC |
$1,055.70
|
| Rate for Payer: Global Benefits Group Commercial |
$745.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,117.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$788.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$450.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$732.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$869.40
|
| Rate for Payer: Multiplan Commercial |
$931.50
|
| Rate for Payer: Networks By Design Commercial |
$807.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,055.70
|
| Rate for Payer: Riverside University Health System MISP |
$496.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$745.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$745.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$621.00
|
| Rate for Payer: United Healthcare All Other HMO |
$621.00
|
| Rate for Payer: United Healthcare HMO Rider |
$621.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$621.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,055.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,055.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,055.70
|
|
|
HC PHLEBOTOMY THERAPEUTIC
|
Facility
|
OP
|
$739.00
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
901200030
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$147.80 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$147.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$557.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$468.53
|
| Rate for Payer: Blue Shield of California EPN |
$294.86
|
| Rate for Payer: Cash Price |
$332.55
|
| Rate for Payer: Cash Price |
$332.55
|
| Rate for Payer: Cash Price |
$332.55
|
| Rate for Payer: Cash Price |
$332.55
|
| Rate for Payer: Central Health Plan Commercial |
$591.20
|
| Rate for Payer: Cigna of CA HMO |
$472.96
|
| Rate for Payer: Cigna of CA PPO |
$546.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$517.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$628.15
|
| Rate for Payer: Global Benefits Group Commercial |
$443.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$665.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$158.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$469.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$174.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$554.25
|
| Rate for Payer: Networks By Design Commercial |
$480.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Prime Health Services Commercial |
$628.15
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$443.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$443.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC PHLEBOTOMY THERAPEUTIC
|
Facility
|
IP
|
$739.00
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
901200030
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$147.80 |
| Max. Negotiated Rate |
$665.10 |
| Rate for Payer: Adventist Health Commercial |
$147.80
|
| Rate for Payer: Cash Price |
$332.55
|
| Rate for Payer: Central Health Plan Commercial |
$591.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$517.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.60
|
| Rate for Payer: EPIC Health Plan Senior |
$295.60
|
| Rate for Payer: Galaxy Health WC |
$628.15
|
| Rate for Payer: Global Benefits Group Commercial |
$443.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$665.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$469.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$436.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.80
|
| Rate for Payer: Multiplan Commercial |
$554.25
|
| Rate for Payer: Networks By Design Commercial |
$480.35
|
| Rate for Payer: Prime Health Services Commercial |
$628.15
|
|
|
HC PHOSPHATIDYLGLYCEROL (PG)
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
900910939
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.80 |
| Max. Negotiated Rate |
$228.60 |
| Rate for Payer: Adventist Health Commercial |
$50.80
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Central Health Plan Commercial |
$203.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$177.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.60
|
| Rate for Payer: EPIC Health Plan Senior |
$101.60
|
| Rate for Payer: Galaxy Health WC |
$215.90
|
| Rate for Payer: Global Benefits Group Commercial |
$152.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$228.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$161.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$149.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.80
|
| Rate for Payer: Multiplan Commercial |
$190.50
|
| Rate for Payer: Networks By Design Commercial |
$165.10
|
| Rate for Payer: Prime Health Services Commercial |
$215.90
|
|
|
HC PHOSPHATIDYLGLYCEROL (PG)
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
900910939
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$228.60 |
| Rate for Payer: Adventist Health Commercial |
$50.80
|
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.52
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$116.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$116.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.71
|
| Rate for Payer: Blue Shield of California Commercial |
$44.10
|
| Rate for Payer: Blue Shield of California Commercial |
$160.02
|
| Rate for Payer: Blue Shield of California EPN |
$27.79
|
| Rate for Payer: Blue Shield of California EPN |
$100.84
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Central Health Plan Commercial |
$203.20
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA HMO |
$162.56
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Cigna of CA PPO |
$187.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$177.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.26
|
| Rate for Payer: EPIC Health Plan Senior |
$18.17
|
| Rate for Payer: EPIC Health Plan Senior |
$18.17
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Galaxy Health WC |
$215.90
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Global Benefits Group Commercial |
$152.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$228.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$161.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.14
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$190.50
|
| Rate for Payer: Networks By Design Commercial |
$165.10
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.52
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.52
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Prime Health Services Commercial |
$215.90
|
| Rate for Payer: Prime Health Services Medicare |
$17.51
|
| Rate for Payer: Prime Health Services Medicare |
$17.51
|
| Rate for Payer: Riverside University Health System MISP |
$18.17
|
| Rate for Payer: Riverside University Health System MISP |
$18.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$152.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$152.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.38
|
| Rate for Payer: United Healthcare All Other HMO |
$13.38
|
| Rate for Payer: United Healthcare All Other HMO |
$13.38
|
| Rate for Payer: United Healthcare HMO Rider |
$13.38
|
| Rate for Payer: United Healthcare HMO Rider |
$13.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.52
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.17
|
| Rate for Payer: Vantage Medical Group Senior |
$16.52
|
| Rate for Payer: Vantage Medical Group Senior |
$16.52
|
|
|
HC PHOSPHOROUS URINE
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
900910215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Central Health Plan Commercial |
$86.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Senior |
$43.20
|
| Rate for Payer: Galaxy Health WC |
$91.80
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$81.00
|
| Rate for Payer: Networks By Design Commercial |
$70.20
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
|
|
HC PHOSPHOROUS URINE
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
900910215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.78
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.29
|
| Rate for Payer: Blue Shield of California Commercial |
$13.86
|
| Rate for Payer: Blue Shield of California Commercial |
$68.04
|
| Rate for Payer: Blue Shield of California EPN |
$8.73
|
| Rate for Payer: Blue Shield of California EPN |
$42.88
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Central Health Plan Commercial |
$86.40
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA HMO |
$69.12
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Cigna of CA PPO |
$79.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.54
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Galaxy Health WC |
$91.80
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.48
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$81.00
|
| Rate for Payer: Networks By Design Commercial |
$70.20
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.78
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
| Rate for Payer: Prime Health Services Medicare |
$6.13
|
| Rate for Payer: Prime Health Services Medicare |
$6.13
|
| Rate for Payer: Riverside University Health System MISP |
$6.36
|
| Rate for Payer: Riverside University Health System MISP |
$6.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Other HMO |
$4.68
|
| Rate for Payer: United Healthcare All Other HMO |
$4.68
|
| Rate for Payer: United Healthcare HMO Rider |
$4.68
|
| Rate for Payer: United Healthcare HMO Rider |
$4.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
|
|
HC PHOSPHORUS
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
900910252
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.60 |
| Max. Negotiated Rate |
$155.70 |
| Rate for Payer: Adventist Health Commercial |
$34.60
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Central Health Plan Commercial |
$138.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$121.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.20
|
| Rate for Payer: EPIC Health Plan Senior |
$69.20
|
| Rate for Payer: Galaxy Health WC |
$147.05
|
| Rate for Payer: Global Benefits Group Commercial |
$103.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$155.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.60
|
| Rate for Payer: Multiplan Commercial |
$129.75
|
| Rate for Payer: Networks By Design Commercial |
$112.45
|
| Rate for Payer: Prime Health Services Commercial |
$147.05
|
|
|
HC PHOSPHORUS
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
900910252
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$155.70 |
| Rate for Payer: Adventist Health Commercial |
$34.60
|
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.74
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.87
|
| Rate for Payer: Blue Shield of California Commercial |
$19.53
|
| Rate for Payer: Blue Shield of California Commercial |
$108.99
|
| Rate for Payer: Blue Shield of California EPN |
$12.31
|
| Rate for Payer: Blue Shield of California EPN |
$68.68
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Central Health Plan Commercial |
$138.40
|
| Rate for Payer: Central Health Plan Commercial |
$24.80
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA HMO |
$110.72
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Cigna of CA PPO |
$128.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$121.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.82
|
| Rate for Payer: EPIC Health Plan Senior |
$5.21
|
| Rate for Payer: EPIC Health Plan Senior |
$5.21
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Galaxy Health WC |
$147.05
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Global Benefits Group Commercial |
$103.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$155.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.77
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.35
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: Multiplan Commercial |
$129.75
|
| Rate for Payer: Networks By Design Commercial |
$112.45
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.74
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.74
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Prime Health Services Commercial |
$147.05
|
| Rate for Payer: Prime Health Services Medicare |
$5.02
|
| Rate for Payer: Prime Health Services Medicare |
$5.02
|
| Rate for Payer: Riverside University Health System MISP |
$5.21
|
| Rate for Payer: Riverside University Health System MISP |
$5.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.84
|
| Rate for Payer: United Healthcare All Other HMO |
$3.84
|
| Rate for Payer: United Healthcare All Other HMO |
$3.84
|
| Rate for Payer: United Healthcare HMO Rider |
$3.84
|
| Rate for Payer: United Healthcare HMO Rider |
$3.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.21
|
| Rate for Payer: Vantage Medical Group Senior |
$4.74
|
| Rate for Payer: Vantage Medical Group Senior |
$4.74
|
|
|
HC PHOSPHORUS URINE 24 HOURS
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
900912215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.78
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.29
|
| Rate for Payer: Blue Shield of California Commercial |
$13.86
|
| Rate for Payer: Blue Shield of California Commercial |
$68.04
|
| Rate for Payer: Blue Shield of California EPN |
$8.73
|
| Rate for Payer: Blue Shield of California EPN |
$42.88
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Central Health Plan Commercial |
$86.40
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA HMO |
$69.12
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Cigna of CA PPO |
$79.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.54
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Galaxy Health WC |
$91.80
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.48
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$81.00
|
| Rate for Payer: Networks By Design Commercial |
$70.20
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.78
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
| Rate for Payer: Prime Health Services Medicare |
$6.13
|
| Rate for Payer: Prime Health Services Medicare |
$6.13
|
| Rate for Payer: Riverside University Health System MISP |
$6.36
|
| Rate for Payer: Riverside University Health System MISP |
$6.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Other HMO |
$4.68
|
| Rate for Payer: United Healthcare All Other HMO |
$4.68
|
| Rate for Payer: United Healthcare HMO Rider |
$4.68
|
| Rate for Payer: United Healthcare HMO Rider |
$4.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
|
|
HC PHOSPHORUS URINE 24 HOURS
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
900912215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Central Health Plan Commercial |
$86.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Senior |
$43.20
|
| Rate for Payer: Galaxy Health WC |
$91.80
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$81.00
|
| Rate for Payer: Networks By Design Commercial |
$70.20
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
|
|
HC PHOSPHORUS URINE RANDOM
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
900912214
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Central Health Plan Commercial |
$86.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Senior |
$43.20
|
| Rate for Payer: Galaxy Health WC |
$91.80
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$81.00
|
| Rate for Payer: Networks By Design Commercial |
$70.20
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
|
|
HC PHOSPHORUS URINE RANDOM
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
900912214
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.78
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.29
|
| Rate for Payer: Blue Shield of California Commercial |
$13.86
|
| Rate for Payer: Blue Shield of California Commercial |
$68.04
|
| Rate for Payer: Blue Shield of California EPN |
$8.73
|
| Rate for Payer: Blue Shield of California EPN |
$42.88
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Central Health Plan Commercial |
$86.40
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA HMO |
$69.12
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Cigna of CA PPO |
$79.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.54
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Galaxy Health WC |
$91.80
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.48
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$81.00
|
| Rate for Payer: Networks By Design Commercial |
$70.20
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.78
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
| Rate for Payer: Prime Health Services Medicare |
$6.13
|
| Rate for Payer: Prime Health Services Medicare |
$6.13
|
| Rate for Payer: Riverside University Health System MISP |
$6.36
|
| Rate for Payer: Riverside University Health System MISP |
$6.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Other HMO |
$4.68
|
| Rate for Payer: United Healthcare All Other HMO |
$4.68
|
| Rate for Payer: United Healthcare HMO Rider |
$4.68
|
| Rate for Payer: United Healthcare HMO Rider |
$4.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
|
|
HC PHOTOCOAGULATION
|
Facility
|
OP
|
$2,366.00
|
|
|
Service Code
|
CPT 67145
|
| Hospital Charge Code |
900501743
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$473.20
|
| 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 |
$1,061.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$778.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$707.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,110.63
|
| Rate for Payer: Cash Price |
$1,064.70
|
| Rate for Payer: Cash Price |
$1,064.70
|
| Rate for Payer: Cash Price |
$1,064.70
|
| Rate for Payer: Cash Price |
$1,064.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,892.80
|
| Rate for Payer: Cigna of CA HMO |
$1,514.24
|
| Rate for Payer: Cigna of CA PPO |
$1,750.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,061.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$778.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$707.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,656.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,167.19
|
| Rate for Payer: EPIC Health Plan Senior |
$778.13
|
| Rate for Payer: Galaxy Health WC |
$2,011.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,419.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,129.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,160.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$707.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,502.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$707.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$760.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$473.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$947.90
|
| Rate for Payer: Multiplan Commercial |
$1,774.50
|
| Rate for Payer: Multiplan WC |
$1,110.63
|
| Rate for Payer: Networks By Design Commercial |
$1,537.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$707.39
|
| Rate for Payer: Preferred Health Network WC |
$1,133.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,011.10
|
| Rate for Payer: Prime Health Services Medicare |
$749.83
|
| Rate for Payer: Prime Health Services WC |
$1,099.30
|
| Rate for Payer: Riverside University Health System MISP |
$778.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,419.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,183.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,183.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,183.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,183.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$707.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,061.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$778.13
|
| Rate for Payer: Vantage Medical Group Senior |
$707.39
|
|
|
HC PHOTOCOAGULATION
|
Facility
|
IP
|
$2,366.00
|
|
|
Service Code
|
CPT 67145
|
| Hospital Charge Code |
900501743
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$473.20 |
| Max. Negotiated Rate |
$2,129.40 |
| Rate for Payer: Adventist Health Commercial |
$473.20
|
| Rate for Payer: Cash Price |
$1,064.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,892.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,656.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$946.40
|
| Rate for Payer: EPIC Health Plan Senior |
$946.40
|
| Rate for Payer: Galaxy Health WC |
$2,011.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,419.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,129.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,502.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,395.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$473.20
|
| Rate for Payer: Multiplan Commercial |
$1,774.50
|
| Rate for Payer: Networks By Design Commercial |
$1,537.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,011.10
|
|
|
HC PHOTOPHERESIS
|
Facility
|
OP
|
$12,905.00
|
|
|
Service Code
|
CPT 36522
|
| Hospital Charge Code |
945100104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,581.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,581.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$5,601.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,402.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,162.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,601.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$9,485.01
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$5,807.25
|
| Rate for Payer: Cash Price |
$5,807.25
|
| Rate for Payer: Cash Price |
$5,807.25
|
| Rate for Payer: Central Health Plan Commercial |
$10,324.00
|
| Rate for Payer: Cigna of CA HMO |
$8,259.20
|
| Rate for Payer: Cigna of CA PPO |
$9,549.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,402.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,162.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,601.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,033.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,243.14
|
| Rate for Payer: EPIC Health Plan Senior |
$6,162.09
|
| Rate for Payer: Galaxy Health WC |
$10,969.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,743.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,614.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9,187.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,090.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,601.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,194.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,623.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,842.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,581.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,506.55
|
| Rate for Payer: Multiplan Commercial |
$9,678.75
|
| Rate for Payer: Multiplan WC |
$9,485.01
|
| Rate for Payer: Networks By Design Commercial |
$8,388.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5,601.90
|
| Rate for Payer: Preferred Health Network WC |
$9,678.58
|
| Rate for Payer: Prime Health Services Commercial |
$10,969.25
|
| Rate for Payer: Prime Health Services Medicare |
$5,938.01
|
| Rate for Payer: Prime Health Services WC |
$9,388.22
|
| Rate for Payer: Riverside University Health System MISP |
$6,162.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,743.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,452.50
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$5,601.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,402.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,162.09
|
| Rate for Payer: Vantage Medical Group Senior |
$5,601.90
|
|
|
HC PHOTOPHERESIS
|
Facility
|
IP
|
$12,905.00
|
|
|
Service Code
|
CPT 36522
|
| Hospital Charge Code |
945000104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,581.00 |
| Max. Negotiated Rate |
$11,614.50 |
| Rate for Payer: Networks By Design Commercial |
$8,388.25
|
| Rate for Payer: Adventist Health Commercial |
$2,581.00
|
| Rate for Payer: Cash Price |
$5,807.25
|
| Rate for Payer: Central Health Plan Commercial |
$10,324.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,033.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,162.00
|
| Rate for Payer: Galaxy Health WC |
$10,969.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,743.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,614.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,194.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,613.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,581.00
|
| Rate for Payer: Multiplan Commercial |
$9,678.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,969.25
|
|
|
HC PHOTOPHERESIS
|
Facility
|
IP
|
$12,905.00
|
|
|
Service Code
|
CPT 36522
|
| Hospital Charge Code |
946100104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,581.00 |
| Max. Negotiated Rate |
$11,614.50 |
| Rate for Payer: Adventist Health Commercial |
$2,581.00
|
| Rate for Payer: Cash Price |
$5,807.25
|
| Rate for Payer: Central Health Plan Commercial |
$10,324.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,033.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,162.00
|
| Rate for Payer: Galaxy Health WC |
$10,969.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,743.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,614.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,194.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,613.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,581.00
|
| Rate for Payer: Multiplan Commercial |
$9,678.75
|
| Rate for Payer: Networks By Design Commercial |
$8,388.25
|
| Rate for Payer: Prime Health Services Commercial |
$10,969.25
|
|
|
HC PHOTOPHERESIS
|
Facility
|
OP
|
$12,905.00
|
|
|
Service Code
|
CPT 36522
|
| Hospital Charge Code |
946100104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,581.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,581.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$5,601.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,402.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,162.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,601.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$9,485.01
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$5,807.25
|
| Rate for Payer: Cash Price |
$5,807.25
|
| Rate for Payer: Cash Price |
$5,807.25
|
| Rate for Payer: Central Health Plan Commercial |
$10,324.00
|
| Rate for Payer: Cigna of CA HMO |
$8,259.20
|
| Rate for Payer: Cigna of CA PPO |
$9,549.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,402.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,162.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,601.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,033.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,243.14
|
| Rate for Payer: EPIC Health Plan Senior |
$6,162.09
|
| Rate for Payer: Galaxy Health WC |
$10,969.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,743.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,614.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9,187.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,090.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,601.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,194.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,623.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,842.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,581.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,506.55
|
| Rate for Payer: Multiplan Commercial |
$9,678.75
|
| Rate for Payer: Multiplan WC |
$9,485.01
|
| Rate for Payer: Networks By Design Commercial |
$8,388.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5,601.90
|
| Rate for Payer: Preferred Health Network WC |
$9,678.58
|
| Rate for Payer: Prime Health Services Commercial |
$10,969.25
|
| Rate for Payer: Prime Health Services Medicare |
$5,938.01
|
| Rate for Payer: Prime Health Services WC |
$9,388.22
|
| Rate for Payer: Riverside University Health System MISP |
$6,162.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,743.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,452.50
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$5,601.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,402.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,162.09
|
| Rate for Payer: Vantage Medical Group Senior |
$5,601.90
|
|
