|
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: 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 |
$11.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.82
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.36
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Cash Price |
$9.00
|
| 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 Media |
$17.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.00
|
| 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: 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
|
| 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 Medi-Cal |
$17.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.00
|
|
|
HC PHARM-POTASSIUM IV SOLUTION
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
900912106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
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: 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 |
$11.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.82
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.36
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Cash Price |
$9.00
|
| 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 Media |
$17.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.00
|
| 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: 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
|
| 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 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: 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 |
$11.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.82
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.36
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Cash Price |
$9.00
|
| 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 Media |
$17.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.00
|
| 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: 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
|
| 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 Medi-Cal |
$17.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.00
|
|
|
HC PHARM-SODIUM IV SOLUTION
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
900912105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC PHASE I CONDITIONING SINGLE SE
|
Facility
|
IP
|
$39.00
|
|
| Hospital Charge Code |
905103080
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
|
|
HC PHASE I CONDITIONING SINGLE SE
|
Facility
|
OP
|
$39.00
|
|
| Hospital Charge Code |
905103080
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.15
|
| Rate for Payer: Dignity Health Media |
$33.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.99
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Riverside University Health System MISP |
$15.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.15
|
| Rate for Payer: Vantage Medical Group Senior |
$33.15
|
|
|
HC PHASE I GRP CONDITIONING
|
Facility
|
IP
|
$509.00
|
|
| Hospital Charge Code |
905103070
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$101.80 |
| Max. Negotiated Rate |
$458.10 |
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Central Health Plan Commercial |
$407.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.60
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$458.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.80
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
| Rate for Payer: Networks By Design Commercial |
$330.85
|
| Rate for Payer: Prime Health Services Commercial |
$432.65
|
|
|
HC PHASE I GRP CONDITIONING
|
Facility
|
OP
|
$509.00
|
|
| Hospital Charge Code |
905103070
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$178.15 |
| Max. Negotiated Rate |
$458.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$309.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$432.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$279.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$279.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$305.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Central Health Plan Commercial |
$407.20
|
| Rate for Payer: Cigna of CA HMO |
$325.76
|
| Rate for Payer: Cigna of CA PPO |
$376.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$432.65
|
| Rate for Payer: Dignity Health Media |
$432.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$432.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$203.60
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$458.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$381.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$178.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.69
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
| Rate for Payer: Networks By Design Commercial |
$330.85
|
| Rate for Payer: Prime Health Services Commercial |
$432.65
|
| Rate for Payer: Riverside University Health System MISP |
$203.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$305.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$305.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$432.65
|
| Rate for Payer: Vantage Medical Group Senior |
$432.65
|
|
|
HC PHASE II CONDITIONING SINGLE S
|
Facility
|
OP
|
$33.00
|
|
| Hospital Charge Code |
905103081
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$19.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Central Health Plan Commercial |
$26.40
|
| Rate for Payer: Cigna of CA HMO |
$21.12
|
| Rate for Payer: Cigna of CA PPO |
$24.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.05
|
| Rate for Payer: Dignity Health Media |
$28.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.20
|
| Rate for Payer: Galaxy Health WC |
$28.05
|
| Rate for Payer: Global Benefits Group Commercial |
$19.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$24.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.53
|
| Rate for Payer: Multiplan Commercial |
$24.75
|
| Rate for Payer: Networks By Design Commercial |
$21.45
|
| Rate for Payer: Prime Health Services Commercial |
$28.05
|
| Rate for Payer: Riverside University Health System MISP |
$13.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.05
|
| Rate for Payer: Vantage Medical Group Senior |
$28.05
|
|
|
HC PHASE II CONDITIONING SINGLE S
|
Facility
|
IP
|
$33.00
|
|
| Hospital Charge Code |
905103081
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Central Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.20
|
| Rate for Payer: Galaxy Health WC |
$28.05
|
| Rate for Payer: Global Benefits Group Commercial |
$19.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.60
|
| Rate for Payer: Multiplan Commercial |
$24.75
|
| Rate for Payer: Networks By Design Commercial |
$21.45
|
| Rate for Payer: Prime Health Services Commercial |
$28.05
|
|
|
HC PHASE II GRP CONDITIONING
|
Facility
|
IP
|
$379.00
|
|
| Hospital Charge Code |
905103071
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$75.80 |
| Max. Negotiated Rate |
$341.10 |
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Central Health Plan Commercial |
$303.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.60
|
| Rate for Payer: Galaxy Health WC |
$322.15
|
| Rate for Payer: Global Benefits Group Commercial |
$227.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$341.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.80
|
| Rate for Payer: Multiplan Commercial |
$284.25
|
| Rate for Payer: Networks By Design Commercial |
$246.35
|
| Rate for Payer: Prime Health Services Commercial |
$322.15
|
|
|
HC PHASE II GRP CONDITIONING
|
Facility
|
OP
|
$379.00
|
|
| Hospital Charge Code |
905103071
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$132.65 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$230.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$322.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$208.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$208.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$227.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Central Health Plan Commercial |
$303.20
|
| Rate for Payer: Cigna of CA HMO |
$242.56
|
| Rate for Payer: Cigna of CA PPO |
$280.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$322.15
|
| Rate for Payer: Dignity Health Media |
$322.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$322.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$151.60
|
| Rate for Payer: Galaxy Health WC |
$322.15
|
| Rate for Payer: Global Benefits Group Commercial |
$227.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$341.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$284.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$132.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.39
|
| Rate for Payer: Multiplan Commercial |
$284.25
|
| Rate for Payer: Networks By Design Commercial |
$246.35
|
| Rate for Payer: Prime Health Services Commercial |
$322.15
|
| Rate for Payer: Riverside University Health System MISP |
$151.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$227.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$227.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$322.15
|
| Rate for Payer: Vantage Medical Group Senior |
$322.15
|
|
|
HC PH BODY FLUID
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
900910261
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
|
HC PH BODY FLUID
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
900910261
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$31.72 |
| Rate for Payer: Adventist Health Medi-Cal |
$3.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.72
|
| Rate for Payer: Blue Distinction Transplant |
$7.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8.03
|
| Rate for Payer: Blue Shield of California EPN |
$6.32
|
| Rate for Payer: Caremore Medicare Advantage |
$3.58
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Central Health Plan Commercial |
$10.40
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$9.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.37
|
| Rate for Payer: Dignity Health Media |
$3.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.58
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.58
|
| Rate for Payer: InnovAge PACE Commercial |
$5.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Medicare |
$3.79
|
| Rate for Payer: Riverside University Health System MISP |
$3.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.90
|
| Rate for Payer: United Healthcare All Other HMO |
$2.90
|
| Rate for Payer: United Healthcare HMO Rider |
$2.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.94
|
| Rate for Payer: Vantage Medical Group Senior |
$3.58
|
|
|
HC PHENCYCLIDINE CONF
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900910517
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.20 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Central Health Plan Commercial |
$216.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.40
|
| Rate for Payer: Galaxy Health WC |
$230.35
|
| Rate for Payer: Global Benefits Group Commercial |
$162.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.20
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
| Rate for Payer: Networks By Design Commercial |
$176.15
|
| Rate for Payer: Prime Health Services Commercial |
$230.35
|
|
|
HC PHENCYCLIDINE CONF
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900910517
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.52
|
| Rate for Payer: Blue Distinction Transplant |
$135.00
|
| Rate for Payer: Blue Shield of California Commercial |
$139.05
|
| Rate for Payer: Blue Shield of California EPN |
$109.35
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Central Health Plan Commercial |
$180.00
|
| Rate for Payer: Cigna of CA HMO |
$144.00
|
| Rate for Payer: Cigna of CA PPO |
$166.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.25
|
| Rate for Payer: Dignity Health Media |
$191.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$90.00
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$168.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: Networks By Design Commercial |
$146.25
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
| Rate for Payer: Riverside University Health System MISP |
$90.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.27
|
| Rate for Payer: United Healthcare All Other HMO |
$30.27
|
| Rate for Payer: United Healthcare HMO Rider |
$30.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.25
|
| Rate for Payer: Vantage Medical Group Senior |
$191.25
|
|
|
HC PHENOBARBITAL (LUMINAL)
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
900910409
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Central Health Plan Commercial |
$152.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.00
|
| Rate for Payer: Galaxy Health WC |
$161.50
|
| Rate for Payer: Global Benefits Group Commercial |
$114.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Multiplan Commercial |
$142.50
|
| Rate for Payer: Networks By Design Commercial |
$123.50
|
| Rate for Payer: Prime Health Services Commercial |
$161.50
|
|
|
HC PHENOBARBITAL (LUMINAL)
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
900910409
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$101.44 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$83.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.44
|
| Rate for Payer: Blue Distinction Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$30.90
|
| Rate for Payer: Blue Shield of California EPN |
$24.30
|
| Rate for Payer: Caremore Medicare Advantage |
$15.30
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.95
|
| Rate for Payer: Dignity Health Media |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.66
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.30
|
| Rate for Payer: InnovAge PACE Commercial |
$22.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$16.22
|
| Rate for Payer: Riverside University Health System MISP |
$16.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.39
|
| Rate for Payer: United Healthcare All Other HMO |
$12.39
|
| Rate for Payer: United Healthcare HMO Rider |
$12.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
HC PHENYTOIN (DILANTN)
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
900910400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$117.63 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$96.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.63
|
| Rate for Payer: Blue Distinction Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$30.90
|
| Rate for Payer: Blue Shield of California EPN |
$24.30
|
| Rate for Payer: Caremore Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.88
|
| Rate for Payer: Dignity Health Media |
$13.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.25
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.25
|
| Rate for Payer: InnovAge PACE Commercial |
$19.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.76
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$14.04
|
| Rate for Payer: Riverside University Health System MISP |
$14.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.74
|
| Rate for Payer: United Healthcare All Other HMO |
$10.74
|
| Rate for Payer: United Healthcare HMO Rider |
$10.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.58
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
|
HC PHENYTOIN (DILANTN)
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
900910400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$208.80 |
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Central Health Plan Commercial |
$185.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.80
|
| Rate for Payer: Galaxy Health WC |
$197.20
|
| Rate for Payer: Global Benefits Group Commercial |
$139.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$208.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.40
|
| Rate for Payer: Multiplan Commercial |
$174.00
|
| Rate for Payer: Networks By Design Commercial |
$150.80
|
| Rate for Payer: Prime Health Services Commercial |
$197.20
|
|
|
HC PHERESFLOW TRIPLE LUMEN CATH
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081725
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.40 |
| Max. Negotiated Rate |
$1,117.80 |
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: Central Health Plan Commercial |
$993.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$496.80
|
| Rate for Payer: Galaxy Health WC |
$1,055.70
|
| Rate for Payer: Global Benefits Group Commercial |
$745.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,117.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$828.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.40
|
| Rate for Payer: Multiplan Commercial |
$931.50
|
| Rate for Payer: Networks By Design Commercial |
$807.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,055.70
|
|
|
HC PHERESFLOW TRIPLE LUMEN CATH
|
Facility
|
OP
|
$1,242.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081725
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.40 |
| Max. Negotiated Rate |
$2,565.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,565.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,055.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$683.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$601.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$733.77
|
| Rate for Payer: Blue Distinction Transplant |
$745.20
|
| Rate for Payer: Blue Shield of California Commercial |
$781.22
|
| Rate for Payer: Blue Shield of California EPN |
$607.34
|
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: Central Health Plan Commercial |
$993.60
|
| Rate for Payer: Cigna of CA HMO |
$794.88
|
| Rate for Payer: Cigna of CA PPO |
$919.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,055.70
|
| Rate for Payer: Dignity Health Media |
$1,055.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,055.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$496.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$496.80
|
| Rate for Payer: Galaxy Health WC |
$1,055.70
|
| Rate for Payer: Global Benefits Group Commercial |
$745.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,117.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$931.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$434.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$828.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.40
|
| Rate for Payer: Multiplan Commercial |
$931.50
|
| Rate for Payer: Networks By Design Commercial |
$807.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,055.70
|
| Rate for Payer: Riverside University Health System MISP |
$496.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$745.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$745.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$621.00
|
| Rate for Payer: United Healthcare All Other HMO |
$621.00
|
| Rate for Payer: United Healthcare HMO Rider |
$621.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$621.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,055.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,055.70
|
|
|
HC PHLEBOTOMY THERAPEUTIC
|
Facility
|
OP
|
$559.00
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
901200030
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$111.80 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$520.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$335.40
|
| Rate for Payer: Blue Shield of California Commercial |
$351.61
|
| Rate for Payer: Blue Shield of California EPN |
$273.35
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Central Health Plan Commercial |
$447.20
|
| Rate for Payer: Cigna of CA HMO |
$357.76
|
| Rate for Payer: Cigna of CA PPO |
$413.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$475.15
|
| Rate for Payer: Global Benefits Group Commercial |
$335.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$503.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$419.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$263.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: InnovAge PACE Commercial |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$419.25
|
| Rate for Payer: Networks By Design Commercial |
$363.35
|
| Rate for Payer: Prime Health Services Commercial |
$475.15
|
| Rate for Payer: Prime Health Services Medicare |
$169.18
|
| Rate for Payer: Riverside University Health System MISP |
$175.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$335.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$335.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC PHLEBOTOMY THERAPEUTIC
|
Facility
|
IP
|
$559.00
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
901200030
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$111.80 |
| Max. Negotiated Rate |
$503.10 |
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Central Health Plan Commercial |
$447.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.60
|
| Rate for Payer: Galaxy Health WC |
$475.15
|
| Rate for Payer: Global Benefits Group Commercial |
$335.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$503.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.80
|
| Rate for Payer: Multiplan Commercial |
$419.25
|
| Rate for Payer: Networks By Design Commercial |
$363.35
|
| Rate for Payer: Prime Health Services Commercial |
$475.15
|
|
