|
HC PRCD DRG GT 6YR W/O CGN CRDC ANM
|
Facility
|
IP
|
$1,562.00
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
906820268
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$312.40 |
| Max. Negotiated Rate |
$1,405.80 |
| Rate for Payer: Adventist Health Commercial |
$312.40
|
| Rate for Payer: Cash Price |
$859.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,249.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.80
|
| Rate for Payer: EPIC Health Plan Senior |
$624.80
|
| Rate for Payer: Galaxy Health WC |
$1,327.70
|
| Rate for Payer: Global Benefits Group Commercial |
$937.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,405.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,041.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$966.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.40
|
| Rate for Payer: Multiplan Commercial |
$1,171.50
|
| Rate for Payer: Networks By Design Commercial |
$1,015.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,327.70
|
|
|
HC PRCD DRG GT 6YR W/O CGN CRDC ANM
|
Facility
|
IP
|
$1,328.00
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
900503017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$265.60 |
| Max. Negotiated Rate |
$1,195.20 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,062.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$531.20
|
| Rate for Payer: EPIC Health Plan Senior |
$531.20
|
| Rate for Payer: Galaxy Health WC |
$1,128.80
|
| Rate for Payer: Global Benefits Group Commercial |
$796.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,195.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$885.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$505.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$822.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.60
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: Networks By Design Commercial |
$863.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,128.80
|
|
|
HC PRCD DRG GT 6YR W/O CGN CRDC ANM
|
Facility
|
OP
|
$1,328.00
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
900503017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$265.60 |
| Max. Negotiated Rate |
$4,460.00 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$730.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$996.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$643.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$779.93
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,062.40
|
| Rate for Payer: Cigna of CA HMO |
$849.92
|
| Rate for Payer: Cigna of CA PPO |
$982.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,128.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$531.20
|
| Rate for Payer: EPIC Health Plan Senior |
$531.20
|
| Rate for Payer: Galaxy Health WC |
$1,128.80
|
| Rate for Payer: Global Benefits Group Commercial |
$796.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,195.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$358.60
|
| Rate for Payer: InnovAge PACE Commercial |
$664.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$885.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$822.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$929.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$929.60
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: Networks By Design Commercial |
$863.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,128.80
|
| Rate for Payer: Riverside University Health System MISP |
$531.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$796.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,128.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,128.80
|
|
|
HC PRCD DRG GT 6YR W/O CGN CRDC ANM
|
Facility
|
OP
|
$1,562.00
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
906820268
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$312.40 |
| Max. Negotiated Rate |
$4,460.00 |
| Rate for Payer: Adventist Health Commercial |
$312.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$859.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,171.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$756.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$917.36
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$859.10
|
| Rate for Payer: Cash Price |
$859.10
|
| Rate for Payer: Cash Price |
$859.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,249.60
|
| Rate for Payer: Cigna of CA HMO |
$999.68
|
| Rate for Payer: Cigna of CA PPO |
$1,155.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,327.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,327.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.80
|
| Rate for Payer: EPIC Health Plan Senior |
$624.80
|
| Rate for Payer: Galaxy Health WC |
$1,327.70
|
| Rate for Payer: Global Benefits Group Commercial |
$937.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,405.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$358.60
|
| Rate for Payer: InnovAge PACE Commercial |
$781.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,041.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$966.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,093.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,093.40
|
| Rate for Payer: Multiplan Commercial |
$1,171.50
|
| Rate for Payer: Networks By Design Commercial |
$1,015.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,327.70
|
| Rate for Payer: Riverside University Health System MISP |
$624.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$937.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,327.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,327.70
|
|
|
HC PRCRD DRG LT 6YR/ANY AGE W/ANMLY
|
Facility
|
IP
|
$1,562.00
|
|
|
Service Code
|
CPT 33018
|
| Hospital Charge Code |
906820269
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$312.40 |
| Max. Negotiated Rate |
$1,405.80 |
| Rate for Payer: Adventist Health Commercial |
$312.40
|
| Rate for Payer: Cash Price |
$859.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,249.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.80
|
| Rate for Payer: EPIC Health Plan Senior |
$624.80
|
| Rate for Payer: Galaxy Health WC |
$1,327.70
|
| Rate for Payer: Global Benefits Group Commercial |
$937.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,405.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,041.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$966.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.40
|
| Rate for Payer: Multiplan Commercial |
$1,171.50
|
| Rate for Payer: Networks By Design Commercial |
$1,015.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,327.70
|
|
|
HC PRCRD DRG LT 6YR/ANY AGE W/ANMLY
|
Facility
|
IP
|
$1,328.00
|
|
|
Service Code
|
CPT 33018
|
| Hospital Charge Code |
900503018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$265.60 |
| Max. Negotiated Rate |
$1,195.20 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,062.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$531.20
|
| Rate for Payer: EPIC Health Plan Senior |
$531.20
|
| Rate for Payer: Galaxy Health WC |
$1,128.80
|
| Rate for Payer: Global Benefits Group Commercial |
$796.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,195.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$885.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$505.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$822.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.60
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: Networks By Design Commercial |
$863.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,128.80
|
|
|
HC PRCRD DRG LT 6YR/ANY AGE W/ANMLY
|
Facility
|
OP
|
$1,328.00
|
|
|
Service Code
|
CPT 33018
|
| Hospital Charge Code |
900503018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$81.96 |
| Max. Negotiated Rate |
$4,460.00 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$730.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$996.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$643.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$779.93
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,062.40
|
| Rate for Payer: Cigna of CA HMO |
$849.92
|
| Rate for Payer: Cigna of CA PPO |
$982.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,128.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$531.20
|
| Rate for Payer: EPIC Health Plan Senior |
$531.20
|
| Rate for Payer: Galaxy Health WC |
$1,128.80
|
| Rate for Payer: Global Benefits Group Commercial |
$796.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,195.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$81.96
|
| Rate for Payer: InnovAge PACE Commercial |
$664.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$885.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$822.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$929.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$929.60
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: Networks By Design Commercial |
$863.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,128.80
|
| Rate for Payer: Riverside University Health System MISP |
$531.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$796.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,128.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,128.80
|
|
|
HC PRCRD DRG LT 6YR/ANY AGE W/ANMLY
|
Facility
|
OP
|
$1,562.00
|
|
|
Service Code
|
CPT 33018
|
| Hospital Charge Code |
906820269
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$81.96 |
| Max. Negotiated Rate |
$4,460.00 |
| Rate for Payer: Adventist Health Commercial |
$312.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$859.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,171.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$756.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$917.36
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$859.10
|
| Rate for Payer: Cash Price |
$859.10
|
| Rate for Payer: Cash Price |
$859.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,249.60
|
| Rate for Payer: Cigna of CA HMO |
$999.68
|
| Rate for Payer: Cigna of CA PPO |
$1,155.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,327.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,327.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.80
|
| Rate for Payer: EPIC Health Plan Senior |
$624.80
|
| Rate for Payer: Galaxy Health WC |
$1,327.70
|
| Rate for Payer: Global Benefits Group Commercial |
$937.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,405.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$81.96
|
| Rate for Payer: InnovAge PACE Commercial |
$781.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,041.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$966.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,093.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,093.40
|
| Rate for Payer: Multiplan Commercial |
$1,171.50
|
| Rate for Payer: Networks By Design Commercial |
$1,015.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,327.70
|
| Rate for Payer: Riverside University Health System MISP |
$624.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$937.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,327.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,327.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,327.70
|
|
|
HC PREFAB HAND FINGER ORTHOSIS
|
Facility
|
IP
|
$44.00
|
|
| Hospital Charge Code |
905353911
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Cash Price |
$24.20
|
| Rate for Payer: Central Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.60
|
| Rate for Payer: EPIC Health Plan Senior |
$17.60
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.80
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
|
|
HC PREFAB HAND FINGER ORTHOSIS
|
Facility
|
OP
|
$44.00
|
|
| Hospital Charge Code |
905353911
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.84
|
| Rate for Payer: Blue Shield of California Commercial |
$26.88
|
| Rate for Payer: Blue Shield of California EPN |
$17.56
|
| Rate for Payer: Cash Price |
$24.20
|
| Rate for Payer: Central Health Plan Commercial |
$35.20
|
| Rate for Payer: Cigna of CA HMO |
$28.16
|
| Rate for Payer: Cigna of CA PPO |
$32.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.60
|
| Rate for Payer: EPIC Health Plan Senior |
$17.60
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.60
|
| Rate for Payer: InnovAge PACE Commercial |
$22.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.80
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
| Rate for Payer: Riverside University Health System MISP |
$17.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.00
|
| Rate for Payer: United Healthcare All Other HMO |
$22.00
|
| Rate for Payer: United Healthcare HMO Rider |
$22.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.40
|
| Rate for Payer: Vantage Medical Group Senior |
$37.40
|
|
|
HC PREGNANCY TEST URINE
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
910400131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$216.90 |
| Rate for Payer: Adventist Health Commercial |
$48.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.53
|
| Rate for Payer: Blue Shield of California Commercial |
$146.29
|
| Rate for Payer: Blue Shield of California EPN |
$95.68
|
| Rate for Payer: Cash Price |
$132.55
|
| Rate for Payer: Cash Price |
$132.55
|
| Rate for Payer: Central Health Plan Commercial |
$192.80
|
| Rate for Payer: Cigna of CA HMO |
$154.24
|
| Rate for Payer: Cigna of CA PPO |
$178.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.62
|
| Rate for Payer: EPIC Health Plan Senior |
$8.61
|
| Rate for Payer: Galaxy Health WC |
$204.85
|
| Rate for Payer: Global Benefits Group Commercial |
$144.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$216.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.61
|
| Rate for Payer: InnovAge PACE Commercial |
$12.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$160.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.54
|
| Rate for Payer: Multiplan Commercial |
$180.75
|
| Rate for Payer: Networks By Design Commercial |
$156.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.61
|
| Rate for Payer: Prime Health Services Commercial |
$204.85
|
| Rate for Payer: Prime Health Services Medicare |
$9.13
|
| Rate for Payer: Riverside University Health System MISP |
$9.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$144.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$144.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.97
|
| Rate for Payer: United Healthcare All Other HMO |
$6.97
|
| Rate for Payer: United Healthcare HMO Rider |
$6.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.47
|
| Rate for Payer: Vantage Medical Group Senior |
$8.61
|
|
|
HC PREGNANCY TEST URINE
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
910400131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$216.90 |
| Rate for Payer: Adventist Health Commercial |
$48.20
|
| Rate for Payer: Cash Price |
$132.55
|
| Rate for Payer: Central Health Plan Commercial |
$192.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.40
|
| Rate for Payer: EPIC Health Plan Senior |
$96.40
|
| Rate for Payer: Galaxy Health WC |
$204.85
|
| Rate for Payer: Global Benefits Group Commercial |
$144.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$216.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$160.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.20
|
| Rate for Payer: Multiplan Commercial |
$180.75
|
| Rate for Payer: Networks By Design Commercial |
$156.65
|
| Rate for Payer: Prime Health Services Commercial |
$204.85
|
|
|
HC PREPARE FACE/ORAL PROSTHESIS
|
Facility
|
OP
|
$7,319.00
|
|
|
Service Code
|
CPT 21085
|
| Hospital Charge Code |
900501350
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.06 |
| Max. Negotiated Rate |
$6,587.10 |
| Rate for Payer: Adventist Health Commercial |
$1,463.80
|
| 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 |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$470.13
|
| Rate for Payer: Cash Price |
$4,025.45
|
| Rate for Payer: Cash Price |
$4,025.45
|
| Rate for Payer: Cash Price |
$4,025.45
|
| Rate for Payer: Cash Price |
$4,025.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,855.20
|
| Rate for Payer: Cigna of CA HMO |
$4,684.16
|
| Rate for Payer: Cigna of CA PPO |
$5,416.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$6,221.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,391.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,587.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: InnovAge PACE Commercial |
$442.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,881.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,788.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,463.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$395.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$5,489.25
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$4,757.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$295.06
|
| Rate for Payer: Preferred Health Network WC |
$479.72
|
| Rate for Payer: Prime Health Services Commercial |
$6,221.15
|
| Rate for Payer: Prime Health Services Medicare |
$312.76
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Riverside University Health System MISP |
$324.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,391.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,659.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,659.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,659.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,659.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC PREPARE FACE/ORAL PROSTHESIS
|
Facility
|
IP
|
$7,319.00
|
|
|
Service Code
|
CPT 21085
|
| Hospital Charge Code |
900501350
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,463.80 |
| Max. Negotiated Rate |
$6,587.10 |
| Rate for Payer: Adventist Health Commercial |
$1,463.80
|
| Rate for Payer: Cash Price |
$4,025.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,855.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,927.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,927.60
|
| Rate for Payer: Galaxy Health WC |
$6,221.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,391.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,587.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,881.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,788.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,530.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,463.80
|
| Rate for Payer: Multiplan Commercial |
$5,489.25
|
| Rate for Payer: Networks By Design Commercial |
$4,757.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,221.15
|
|
|
HC PREP/HARVEST CELL CON/MONO/BUF
|
Facility
|
IP
|
$2,078.00
|
|
|
Service Code
|
CPT 38215
|
| Hospital Charge Code |
911800311
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$415.60 |
| Max. Negotiated Rate |
$1,870.20 |
| Rate for Payer: Adventist Health Commercial |
$415.60
|
| Rate for Payer: Cash Price |
$1,142.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,662.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$831.20
|
| Rate for Payer: EPIC Health Plan Senior |
$831.20
|
| Rate for Payer: Galaxy Health WC |
$1,766.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,870.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,386.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$791.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,286.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.60
|
| Rate for Payer: Multiplan Commercial |
$1,558.50
|
| Rate for Payer: Networks By Design Commercial |
$1,350.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,766.30
|
|
|
HC PREP/HARVEST CELL CON/MONO/BUF
|
Facility
|
OP
|
$2,078.00
|
|
|
Service Code
|
CPT 38215
|
| Hospital Charge Code |
911800311
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$415.60 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$415.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$555.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,261.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$885.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,269.66
|
| Rate for Payer: Blue Shield of California EPN |
$829.12
|
| Rate for Payer: Cash Price |
$1,142.90
|
| Rate for Payer: Cash Price |
$1,142.90
|
| Rate for Payer: Cash Price |
$1,142.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,662.40
|
| Rate for Payer: Cigna of CA HMO |
$1,329.92
|
| Rate for Payer: Cigna of CA PPO |
$1,537.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$555.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| Rate for Payer: Galaxy Health WC |
$1,766.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,870.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: InnovAge PACE Commercial |
$833.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,386.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$744.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| Rate for Payer: Multiplan Commercial |
$1,558.50
|
| Rate for Payer: Multiplan WC |
$885.06
|
| Rate for Payer: Networks By Design Commercial |
$1,350.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$555.48
|
| Rate for Payer: Preferred Health Network WC |
$903.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,766.30
|
| Rate for Payer: Prime Health Services Medicare |
$588.81
|
| Rate for Payer: Prime Health Services WC |
$876.03
|
| Rate for Payer: Riverside University Health System MISP |
$611.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,246.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,246.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,039.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,039.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,039.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$555.48
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC PREP/HARVEST W PLASMA VOL DEP
|
Facility
|
OP
|
$2,078.00
|
|
|
Service Code
|
CPT 38214
|
| Hospital Charge Code |
911800310
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$415.60 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$415.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$555.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,261.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$885.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,269.66
|
| Rate for Payer: Blue Shield of California EPN |
$829.12
|
| Rate for Payer: Cash Price |
$1,142.90
|
| Rate for Payer: Cash Price |
$1,142.90
|
| Rate for Payer: Cash Price |
$1,142.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,662.40
|
| Rate for Payer: Cigna of CA HMO |
$1,329.92
|
| Rate for Payer: Cigna of CA PPO |
$1,537.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$555.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| Rate for Payer: Galaxy Health WC |
$1,766.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,870.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: InnovAge PACE Commercial |
$833.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,386.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$744.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| Rate for Payer: Multiplan Commercial |
$1,558.50
|
| Rate for Payer: Multiplan WC |
$885.06
|
| Rate for Payer: Networks By Design Commercial |
$1,350.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$555.48
|
| Rate for Payer: Preferred Health Network WC |
$903.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,766.30
|
| Rate for Payer: Prime Health Services Medicare |
$588.81
|
| Rate for Payer: Prime Health Services WC |
$876.03
|
| Rate for Payer: Riverside University Health System MISP |
$611.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,246.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,246.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,039.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,039.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,039.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$555.48
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC PREP/HARVEST W PLASMA VOL DEP
|
Facility
|
IP
|
$2,078.00
|
|
|
Service Code
|
CPT 38214
|
| Hospital Charge Code |
911800310
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$415.60 |
| Max. Negotiated Rate |
$1,870.20 |
| Rate for Payer: Adventist Health Commercial |
$415.60
|
| Rate for Payer: Cash Price |
$1,142.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,662.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$831.20
|
| Rate for Payer: EPIC Health Plan Senior |
$831.20
|
| Rate for Payer: Galaxy Health WC |
$1,766.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,870.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,386.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$791.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,286.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.60
|
| Rate for Payer: Multiplan Commercial |
$1,558.50
|
| Rate for Payer: Networks By Design Commercial |
$1,350.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,766.30
|
|
|
HC PREP/HARVEST W PLATELET DEPLET
|
Facility
|
OP
|
$2,078.00
|
|
|
Service Code
|
CPT 38213
|
| Hospital Charge Code |
911800309
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$415.60 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$415.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$555.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,261.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$885.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,269.66
|
| Rate for Payer: Blue Shield of California EPN |
$829.12
|
| Rate for Payer: Cash Price |
$1,142.90
|
| Rate for Payer: Cash Price |
$1,142.90
|
| Rate for Payer: Cash Price |
$1,142.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,662.40
|
| Rate for Payer: Cigna of CA HMO |
$1,329.92
|
| Rate for Payer: Cigna of CA PPO |
$1,537.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$555.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| Rate for Payer: Galaxy Health WC |
$1,766.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,870.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: InnovAge PACE Commercial |
$833.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,386.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$744.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| Rate for Payer: Multiplan Commercial |
$1,558.50
|
| Rate for Payer: Multiplan WC |
$885.06
|
| Rate for Payer: Networks By Design Commercial |
$1,350.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$555.48
|
| Rate for Payer: Preferred Health Network WC |
$903.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,766.30
|
| Rate for Payer: Prime Health Services Medicare |
$588.81
|
| Rate for Payer: Prime Health Services WC |
$876.03
|
| Rate for Payer: Riverside University Health System MISP |
$611.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,246.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,246.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,039.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,039.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,039.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$555.48
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC PREP/HARVEST W PLATELET DEPLET
|
Facility
|
IP
|
$2,078.00
|
|
|
Service Code
|
CPT 38213
|
| Hospital Charge Code |
911800309
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$415.60 |
| Max. Negotiated Rate |
$1,870.20 |
| Rate for Payer: Adventist Health Commercial |
$415.60
|
| Rate for Payer: Cash Price |
$1,142.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,662.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$831.20
|
| Rate for Payer: EPIC Health Plan Senior |
$831.20
|
| Rate for Payer: Galaxy Health WC |
$1,766.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,870.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,386.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$791.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,286.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.60
|
| Rate for Payer: Multiplan Commercial |
$1,558.50
|
| Rate for Payer: Networks By Design Commercial |
$1,350.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,766.30
|
|
|
HC PREP/HARVEST W RBC REMOVAL
|
Facility
|
IP
|
$2,078.00
|
|
|
Service Code
|
CPT 38212
|
| Hospital Charge Code |
911800308
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$415.60 |
| Max. Negotiated Rate |
$1,870.20 |
| Rate for Payer: Adventist Health Commercial |
$415.60
|
| Rate for Payer: Cash Price |
$1,142.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,662.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$831.20
|
| Rate for Payer: EPIC Health Plan Senior |
$831.20
|
| Rate for Payer: Galaxy Health WC |
$1,766.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,870.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,386.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$791.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,286.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.60
|
| Rate for Payer: Multiplan Commercial |
$1,558.50
|
| Rate for Payer: Networks By Design Commercial |
$1,350.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,766.30
|
|
|
HC PREP/HARVEST W RBC REMOVAL
|
Facility
|
OP
|
$2,078.00
|
|
|
Service Code
|
CPT 38212
|
| Hospital Charge Code |
911800308
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$415.60 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$415.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$555.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,261.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$885.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,269.66
|
| Rate for Payer: Blue Shield of California EPN |
$829.12
|
| Rate for Payer: Cash Price |
$1,142.90
|
| Rate for Payer: Cash Price |
$1,142.90
|
| Rate for Payer: Cash Price |
$1,142.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,662.40
|
| Rate for Payer: Cigna of CA HMO |
$1,329.92
|
| Rate for Payer: Cigna of CA PPO |
$1,537.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$555.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| Rate for Payer: Galaxy Health WC |
$1,766.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,870.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: InnovAge PACE Commercial |
$833.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,386.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$744.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| Rate for Payer: Multiplan Commercial |
$1,558.50
|
| Rate for Payer: Multiplan WC |
$885.06
|
| Rate for Payer: Networks By Design Commercial |
$1,350.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$555.48
|
| Rate for Payer: Preferred Health Network WC |
$903.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,766.30
|
| Rate for Payer: Prime Health Services Medicare |
$588.81
|
| Rate for Payer: Prime Health Services WC |
$876.03
|
| Rate for Payer: Riverside University Health System MISP |
$611.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,246.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,246.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,039.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,039.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,039.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$555.48
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC PREP/HARVEST W T-CELL DEPLETIO
|
Facility
|
IP
|
$2,078.00
|
|
|
Service Code
|
CPT 38210
|
| Hospital Charge Code |
911800306
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$415.60 |
| Max. Negotiated Rate |
$1,870.20 |
| Rate for Payer: Adventist Health Commercial |
$415.60
|
| Rate for Payer: Cash Price |
$1,142.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,662.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$831.20
|
| Rate for Payer: EPIC Health Plan Senior |
$831.20
|
| Rate for Payer: Galaxy Health WC |
$1,766.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,870.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,386.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$791.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,286.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.60
|
| Rate for Payer: Multiplan Commercial |
$1,558.50
|
| Rate for Payer: Networks By Design Commercial |
$1,350.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,766.30
|
|
|
HC PREP/HARVEST W T-CELL DEPLETIO
|
Facility
|
OP
|
$2,078.00
|
|
|
Service Code
|
CPT 38210
|
| Hospital Charge Code |
911800306
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$415.60 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$415.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$555.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,261.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$885.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,269.66
|
| Rate for Payer: Blue Shield of California EPN |
$829.12
|
| Rate for Payer: Cash Price |
$1,142.90
|
| Rate for Payer: Cash Price |
$1,142.90
|
| Rate for Payer: Cash Price |
$1,142.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,662.40
|
| Rate for Payer: Cigna of CA HMO |
$1,329.92
|
| Rate for Payer: Cigna of CA PPO |
$1,537.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$555.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| Rate for Payer: Galaxy Health WC |
$1,766.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,870.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: InnovAge PACE Commercial |
$833.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,386.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$744.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| Rate for Payer: Multiplan Commercial |
$1,558.50
|
| Rate for Payer: Multiplan WC |
$885.06
|
| Rate for Payer: Networks By Design Commercial |
$1,350.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$555.48
|
| Rate for Payer: Preferred Health Network WC |
$903.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,766.30
|
| Rate for Payer: Prime Health Services Medicare |
$588.81
|
| Rate for Payer: Prime Health Services WC |
$876.03
|
| Rate for Payer: Riverside University Health System MISP |
$611.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,246.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,246.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,039.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,039.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,039.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$555.48
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC PREP/HARVEST W TUMOR CELL DEP
|
Facility
|
IP
|
$2,078.00
|
|
|
Service Code
|
CPT 38211
|
| Hospital Charge Code |
911800307
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$415.60 |
| Max. Negotiated Rate |
$1,870.20 |
| Rate for Payer: Adventist Health Commercial |
$415.60
|
| Rate for Payer: Cash Price |
$1,142.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,662.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$831.20
|
| Rate for Payer: EPIC Health Plan Senior |
$831.20
|
| Rate for Payer: Galaxy Health WC |
$1,766.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,870.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,386.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$791.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,286.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.60
|
| Rate for Payer: Multiplan Commercial |
$1,558.50
|
| Rate for Payer: Networks By Design Commercial |
$1,350.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,766.30
|
|
