|
HC PET SCAN SKULL BASE TO MID THIGH
|
Facility
|
IP
|
$7,638.00
|
|
|
Service Code
|
CPT 78812
|
| Hospital Charge Code |
909301481
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,527.60 |
| Max. Negotiated Rate |
$6,874.20 |
| Rate for Payer: Adventist Health Commercial |
$1,527.60
|
| Rate for Payer: Cash Price |
$4,200.90
|
| Rate for Payer: Central Health Plan Commercial |
$6,110.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,055.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,055.20
|
| Rate for Payer: Galaxy Health WC |
$6,492.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,582.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,874.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,094.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,910.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,727.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,527.60
|
| Rate for Payer: Multiplan Commercial |
$5,728.50
|
| Rate for Payer: Networks By Design Commercial |
$4,964.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,492.30
|
|
|
HC PET SCAN WHOLE BODY
|
Facility
|
IP
|
$10,105.00
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
909301482
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,021.00 |
| Max. Negotiated Rate |
$9,094.50 |
| Rate for Payer: Adventist Health Commercial |
$2,021.00
|
| Rate for Payer: Cash Price |
$5,557.75
|
| Rate for Payer: Central Health Plan Commercial |
$8,084.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,042.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,042.00
|
| Rate for Payer: Galaxy Health WC |
$8,589.25
|
| Rate for Payer: Global Benefits Group Commercial |
$6,063.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,094.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,740.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,850.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,254.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,021.00
|
| Rate for Payer: Multiplan Commercial |
$7,578.75
|
| Rate for Payer: Networks By Design Commercial |
$6,568.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,589.25
|
|
|
HC PET SCAN WHOLE BODY
|
Facility
|
OP
|
$10,105.00
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
909301482
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,853.28 |
| Max. Negotiated Rate |
$9,094.50 |
| Rate for Payer: Adventist Health Commercial |
$2,021.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,853.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,136.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,853.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,705.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,934.67
|
| Rate for Payer: Blue Shield of California Commercial |
$6,133.73
|
| Rate for Payer: Blue Shield of California EPN |
$4,011.68
|
| Rate for Payer: Cash Price |
$5,557.75
|
| Rate for Payer: Cash Price |
$5,557.75
|
| Rate for Payer: Central Health Plan Commercial |
$8,084.00
|
| Rate for Payer: Cigna of CA HMO |
$6,467.20
|
| Rate for Payer: Cigna of CA PPO |
$7,477.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,038.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,853.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,501.93
|
| Rate for Payer: EPIC Health Plan Senior |
$1,853.28
|
| Rate for Payer: Galaxy Health WC |
$8,589.25
|
| Rate for Payer: Global Benefits Group Commercial |
$6,063.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,094.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,039.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,486.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: InnovAge PACE Commercial |
$2,779.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,740.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,851.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,853.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,021.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,483.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,483.40
|
| Rate for Payer: Multiplan Commercial |
$7,578.75
|
| Rate for Payer: Networks By Design Commercial |
$6,568.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,853.28
|
| Rate for Payer: Prime Health Services Commercial |
$8,589.25
|
| Rate for Payer: Prime Health Services Medicare |
$1,964.48
|
| Rate for Payer: Riverside University Health System MISP |
$2,038.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,063.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,063.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,654.59
|
| Rate for Payer: United Healthcare All Other HMO |
$2,654.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,654.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,654.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,853.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,853.28
|
|
|
HC PET TUMOR LIMITED
|
Facility
|
IP
|
$7,638.00
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
909301480
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,527.60 |
| Max. Negotiated Rate |
$6,874.20 |
| Rate for Payer: Adventist Health Commercial |
$1,527.60
|
| Rate for Payer: Cash Price |
$4,200.90
|
| Rate for Payer: Central Health Plan Commercial |
$6,110.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,055.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,055.20
|
| Rate for Payer: Galaxy Health WC |
$6,492.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,582.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,874.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,094.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,910.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,727.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,527.60
|
| Rate for Payer: Multiplan Commercial |
$5,728.50
|
| Rate for Payer: Networks By Design Commercial |
$4,964.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,492.30
|
|
|
HC PET TUMOR LIMITED
|
Facility
|
OP
|
$7,638.00
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
909301480
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,527.60 |
| Max. Negotiated Rate |
$6,874.20 |
| Rate for Payer: Adventist Health Commercial |
$1,527.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,658.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,638.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,658.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,285.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,485.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,636.27
|
| Rate for Payer: Blue Shield of California EPN |
$3,032.29
|
| Rate for Payer: Cash Price |
$4,200.90
|
| Rate for Payer: Cash Price |
$4,200.90
|
| Rate for Payer: Central Health Plan Commercial |
$6,110.40
|
| Rate for Payer: Cigna of CA HMO |
$4,888.32
|
| Rate for Payer: Cigna of CA PPO |
$5,652.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,824.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,658.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,239.30
|
| Rate for Payer: EPIC Health Plan Senior |
$1,658.74
|
| Rate for Payer: Galaxy Health WC |
$6,492.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,582.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,874.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,720.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,486.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,658.74
|
| Rate for Payer: InnovAge PACE Commercial |
$2,488.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,094.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,851.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,658.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,527.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,222.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,222.71
|
| Rate for Payer: Multiplan Commercial |
$5,728.50
|
| Rate for Payer: Networks By Design Commercial |
$4,964.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,658.74
|
| Rate for Payer: Prime Health Services Commercial |
$6,492.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,758.26
|
| Rate for Payer: Riverside University Health System MISP |
$1,824.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,582.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,582.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,654.59
|
| Rate for Payer: United Healthcare All Other HMO |
$2,654.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,654.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,654.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,658.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,658.74
|
|
|
HC PHARMACOLOGIC AGENT ADMIN
|
Facility
|
IP
|
$2,465.00
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
906820068
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$493.00 |
| Max. Negotiated Rate |
$2,218.50 |
| Rate for Payer: Adventist Health Commercial |
$493.00
|
| Rate for Payer: Cash Price |
$1,355.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,972.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$986.00
|
| Rate for Payer: EPIC Health Plan Senior |
$986.00
|
| Rate for Payer: Galaxy Health WC |
$2,095.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,479.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,218.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,644.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$939.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,525.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$493.00
|
| Rate for Payer: Multiplan Commercial |
$1,848.75
|
| Rate for Payer: Networks By Design Commercial |
$1,602.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,095.25
|
|
|
HC PHARMACOLOGIC AGENT ADMIN
|
Facility
|
OP
|
$2,095.00
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
906811410
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$151.27 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$419.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,780.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,152.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,571.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,014.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,230.39
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,152.25
|
| Rate for Payer: Cash Price |
$1,152.25
|
| Rate for Payer: Cash Price |
$1,152.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,676.00
|
| Rate for Payer: Cigna of CA HMO |
$1,361.75
|
| Rate for Payer: Cigna of CA PPO |
$1,550.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,780.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,780.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,780.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$838.00
|
| Rate for Payer: EPIC Health Plan Senior |
$838.00
|
| Rate for Payer: Galaxy Health WC |
$1,780.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,257.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,885.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$151.27
|
| Rate for Payer: InnovAge PACE Commercial |
$1,047.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,397.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,296.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$419.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,466.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,466.50
|
| Rate for Payer: Multiplan Commercial |
$1,571.25
|
| Rate for Payer: Networks By Design Commercial |
$1,361.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,780.75
|
| Rate for Payer: Riverside University Health System MISP |
$838.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,257.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,780.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,780.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,780.75
|
|
|
HC PHARMACOLOGIC AGENT ADMIN
|
Facility
|
OP
|
$2,465.00
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
906820068
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$151.27 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$493.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,095.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,355.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,848.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,193.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,447.69
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,355.75
|
| Rate for Payer: Cash Price |
$1,355.75
|
| Rate for Payer: Cash Price |
$1,355.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,972.00
|
| Rate for Payer: Cigna of CA HMO |
$1,602.25
|
| Rate for Payer: Cigna of CA PPO |
$1,824.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,095.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,095.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$986.00
|
| Rate for Payer: EPIC Health Plan Senior |
$986.00
|
| Rate for Payer: Galaxy Health WC |
$2,095.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,479.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,218.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$151.27
|
| Rate for Payer: InnovAge PACE Commercial |
$1,232.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,644.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,525.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$493.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,725.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,725.50
|
| Rate for Payer: Multiplan Commercial |
$1,848.75
|
| Rate for Payer: Networks By Design Commercial |
$1,602.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,095.25
|
| Rate for Payer: Riverside University Health System MISP |
$986.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,479.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,095.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,095.25
|
|
|
HC PHARMACOLOGIC AGENT ADMIN
|
Facility
|
IP
|
$2,095.00
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
906811410
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$419.00 |
| Max. Negotiated Rate |
$1,885.50 |
| Rate for Payer: Adventist Health Commercial |
$419.00
|
| Rate for Payer: Cash Price |
$1,152.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,676.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$838.00
|
| Rate for Payer: EPIC Health Plan Senior |
$838.00
|
| Rate for Payer: Galaxy Health WC |
$1,780.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,257.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,885.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,397.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$798.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,296.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$419.00
|
| Rate for Payer: Multiplan Commercial |
$1,571.25
|
| Rate for Payer: Networks By Design Commercial |
$1,361.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,780.75
|
|
|
HC PHARM-CHLORIDE IV SOLUTION
|
Facility
|
OP
|
$20.00
|
|
| Hospital Charge Code |
900912107
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.75
|
| Rate for Payer: Blue Shield of California Commercial |
$12.14
|
| Rate for Payer: Blue Shield of California EPN |
$7.94
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: InnovAge PACE Commercial |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Riverside University Health System MISP |
$8.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.00
|
|
|
HC PHARM-CHLORIDE IV SOLUTION
|
Facility
|
IP
|
$20.00
|
|
| Hospital Charge Code |
900912107
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC PHARM-GLUCOSE IV SOLUTION
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
CPT 81099
|
| Hospital Charge Code |
900912109
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Central Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6.80
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
|
|
HC PHARM-GLUCOSE IV SOLUTION
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 81099
|
| Hospital Charge Code |
900912109
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.98
|
| Rate for Payer: Blue Shield of California Commercial |
$10.32
|
| Rate for Payer: Blue Shield of California EPN |
$6.75
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Central Health Plan Commercial |
$13.60
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6.80
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.30
|
| Rate for Payer: InnovAge PACE Commercial |
$8.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.90
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Riverside University Health System MISP |
$6.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.50
|
| Rate for Payer: United Healthcare All Other HMO |
$8.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.45
|
| Rate for Payer: Vantage Medical Group Senior |
$14.45
|
|
|
HC PHARM-PHOSPHORUS IV SOLUTION
|
Facility
|
OP
|
$20.00
|
|
| Hospital Charge Code |
900912108
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.75
|
| Rate for Payer: Blue Shield of California Commercial |
$12.14
|
| Rate for Payer: Blue Shield of California EPN |
$7.94
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: InnovAge PACE Commercial |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Riverside University Health System MISP |
$8.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.00
|
|
|
HC PHARM-PHOSPHORUS IV SOLUTION
|
Facility
|
IP
|
$20.00
|
|
| Hospital Charge Code |
900912108
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC PHARM-POTASSIUM IV SOLUTION
|
Facility
|
IP
|
$20.00
|
|
| Hospital Charge Code |
900912106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC PHARM-POTASSIUM IV SOLUTION
|
Facility
|
OP
|
$20.00
|
|
| Hospital Charge Code |
900912106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.75
|
| Rate for Payer: Blue Shield of California Commercial |
$12.14
|
| Rate for Payer: Blue Shield of California EPN |
$7.94
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: InnovAge PACE Commercial |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Riverside University Health System MISP |
$8.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.00
|
|
|
HC PHARM-SODIUM IV SOLUTION
|
Facility
|
OP
|
$20.00
|
|
| Hospital Charge Code |
900912105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.75
|
| Rate for Payer: Blue Shield of California Commercial |
$12.14
|
| Rate for Payer: Blue Shield of California EPN |
$7.94
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: InnovAge PACE Commercial |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Riverside University Health System MISP |
$8.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.00
|
|
|
HC PHARM-SODIUM IV SOLUTION
|
Facility
|
IP
|
$20.00
|
|
| Hospital Charge Code |
900912105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC PHASE I CONDITIONING SINGLE SE
|
Facility
|
IP
|
$41.00
|
|
| Hospital Charge Code |
905103080
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
|
|
HC PHASE I CONDITIONING SINGLE SE
|
Facility
|
OP
|
$41.00
|
|
| Hospital Charge Code |
905103080
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.62 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$16.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: Cigna of CA HMO |
$26.24
|
| Rate for Payer: Cigna of CA PPO |
$30.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: InnovAge PACE Commercial |
$20.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Riverside University Health System MISP |
$16.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.85
|
| Rate for Payer: Vantage Medical Group Senior |
$34.85
|
|
|
HC PHASE I GRP CONDITIONING
|
Facility
|
OP
|
$540.00
|
|
| Hospital Charge Code |
905103070
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$205.74 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Adventist Health Commercial |
$221.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$327.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Central Health Plan Commercial |
$432.00
|
| Rate for Payer: Cigna of CA HMO |
$345.60
|
| Rate for Payer: Cigna of CA PPO |
$399.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$459.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Senior |
$216.00
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.00
|
| Rate for Payer: InnovAge PACE Commercial |
$270.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$378.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$378.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
| Rate for Payer: Riverside University Health System MISP |
$216.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.00
|
| Rate for Payer: Vantage Medical Group Senior |
$459.00
|
|
|
HC PHASE I GRP CONDITIONING
|
Facility
|
IP
|
$540.00
|
|
| Hospital Charge Code |
905103070
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Central Health Plan Commercial |
$432.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Senior |
$216.00
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
|
|
HC PHASE II CONDITIONING SINGLE S
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
905103081
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.34 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$14.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$19.25
|
| Rate for Payer: Cash Price |
$19.25
|
| Rate for Payer: Cash Price |
$19.25
|
| Rate for Payer: Central Health Plan Commercial |
$28.00
|
| Rate for Payer: Cigna of CA HMO |
$22.40
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.50
|
| Rate for Payer: InnovAge PACE Commercial |
$17.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Riverside University Health System MISP |
$14.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.75
|
| Rate for Payer: Vantage Medical Group Senior |
$29.75
|
|
|
HC PHASE II CONDITIONING SINGLE S
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
905103081
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$19.25
|
| Rate for Payer: Central Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
|
