|
HC POUCH UROSTOMY 1 PIECE CUT FIT
|
Facility
|
IP
|
$13.04
|
|
|
Service Code
|
CPT A4430
|
| Hospital Charge Code |
901698463
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.74 |
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: Central Health Plan Commercial |
$10.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$9.78
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
|
|
HC POUCH UROSTOMY FLEX MAXI RED
|
Facility
|
IP
|
$1.97
|
|
|
Service Code
|
CPT A5073
|
| Hospital Charge Code |
901698598
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Central Health Plan Commercial |
$1.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$1.67
|
| Rate for Payer: Global Benefits Group Commercial |
$1.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.48
|
| Rate for Payer: Networks By Design Commercial |
$1.28
|
| Rate for Payer: Prime Health Services Commercial |
$1.67
|
|
|
HC POUCH UROSTOMY FLEX MAXI RED
|
Facility
|
OP
|
$1.97
|
|
|
Service Code
|
CPT A5073
|
| Hospital Charge Code |
901698598
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$8.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Blue Distinction Transplant |
$1.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.96
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Central Health Plan Commercial |
$1.58
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.67
|
| Rate for Payer: Dignity Health Media |
$1.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$1.67
|
| Rate for Payer: Global Benefits Group Commercial |
$1.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.77
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.48
|
| Rate for Payer: Networks By Design Commercial |
$1.28
|
| Rate for Payer: Prime Health Services Commercial |
$1.67
|
| Rate for Payer: Riverside University Health System MISP |
$0.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.99
|
| Rate for Payer: United Healthcare All Other HMO |
$0.99
|
| Rate for Payer: United Healthcare HMO Rider |
$0.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.67
|
| Rate for Payer: Vantage Medical Group Senior |
$1.67
|
|
|
HC POUCH WOUND COLOPLAST MIDI
|
Facility
|
OP
|
$126.62
|
|
| Hospital Charge Code |
901605216
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.32 |
| Max. Negotiated Rate |
$113.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$76.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$107.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$69.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.81
|
| Rate for Payer: Blue Distinction Transplant |
$75.97
|
| Rate for Payer: Blue Shield of California Commercial |
$79.64
|
| Rate for Payer: Blue Shield of California EPN |
$61.92
|
| Rate for Payer: Cash Price |
$56.98
|
| Rate for Payer: Central Health Plan Commercial |
$101.30
|
| Rate for Payer: Cigna of CA HMO |
$81.04
|
| Rate for Payer: Cigna of CA PPO |
$93.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$107.63
|
| Rate for Payer: Dignity Health Media |
$107.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.65
|
| Rate for Payer: Galaxy Health WC |
$107.63
|
| Rate for Payer: Global Benefits Group Commercial |
$75.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.96
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$94.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.32
|
| Rate for Payer: Multiplan Commercial |
$94.96
|
| Rate for Payer: Networks By Design Commercial |
$82.30
|
| Rate for Payer: Prime Health Services Commercial |
$107.63
|
| Rate for Payer: Riverside University Health System MISP |
$50.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.31
|
| Rate for Payer: United Healthcare All Other HMO |
$63.31
|
| Rate for Payer: United Healthcare HMO Rider |
$63.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$107.63
|
| Rate for Payer: Vantage Medical Group Senior |
$107.63
|
|
|
HC POUCH WOUND COLOPLAST MIDI
|
Facility
|
IP
|
$126.62
|
|
| Hospital Charge Code |
901605216
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.32 |
| Max. Negotiated Rate |
$113.96 |
| Rate for Payer: Cash Price |
$56.98
|
| Rate for Payer: Central Health Plan Commercial |
$101.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.65
|
| Rate for Payer: Galaxy Health WC |
$107.63
|
| Rate for Payer: Global Benefits Group Commercial |
$75.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.32
|
| Rate for Payer: Multiplan Commercial |
$94.96
|
| Rate for Payer: Networks By Design Commercial |
$82.30
|
| Rate for Payer: Prime Health Services Commercial |
$107.63
|
|
|
HC POUCH WOUND FISTULA 6/9X4.3
|
Facility
|
OP
|
$32.31
|
|
|
Service Code
|
CPT A6154
|
| Hospital Charge Code |
901698171
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$37.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.09
|
| Rate for Payer: Blue Distinction Transplant |
$19.39
|
| Rate for Payer: Blue Shield of California Commercial |
$20.32
|
| Rate for Payer: Blue Shield of California EPN |
$15.80
|
| Rate for Payer: Cash Price |
$14.54
|
| Rate for Payer: Cash Price |
$14.54
|
| Rate for Payer: Central Health Plan Commercial |
$25.85
|
| Rate for Payer: Cigna of CA HMO |
$20.68
|
| Rate for Payer: Cigna of CA PPO |
$23.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.46
|
| Rate for Payer: Dignity Health Media |
$27.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.92
|
| Rate for Payer: Galaxy Health WC |
$27.46
|
| Rate for Payer: Global Benefits Group Commercial |
$19.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.08
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$24.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.46
|
| Rate for Payer: Multiplan Commercial |
$24.23
|
| Rate for Payer: Networks By Design Commercial |
$21.00
|
| Rate for Payer: Prime Health Services Commercial |
$27.46
|
| Rate for Payer: Riverside University Health System MISP |
$12.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.16
|
| Rate for Payer: United Healthcare All Other HMO |
$16.16
|
| Rate for Payer: United Healthcare HMO Rider |
$16.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.46
|
| Rate for Payer: Vantage Medical Group Senior |
$27.46
|
|
|
HC POUCH WOUND FISTULA 6/9X4.3
|
Facility
|
IP
|
$32.31
|
|
|
Service Code
|
CPT A6154
|
| Hospital Charge Code |
901698171
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$29.08 |
| Rate for Payer: Cash Price |
$14.54
|
| Rate for Payer: Central Health Plan Commercial |
$25.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.92
|
| Rate for Payer: Galaxy Health WC |
$27.46
|
| Rate for Payer: Global Benefits Group Commercial |
$19.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.46
|
| Rate for Payer: Multiplan Commercial |
$24.23
|
| Rate for Payer: Networks By Design Commercial |
$21.00
|
| Rate for Payer: Prime Health Services Commercial |
$27.46
|
|
|
HC POWDER HYPAQUE CAN
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT Q9964
|
| Hospital Charge Code |
909001018
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$192.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$124.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.52
|
| Rate for Payer: Blue Distinction Transplant |
$135.60
|
| Rate for Payer: Blue Shield of California Commercial |
$142.15
|
| Rate for Payer: Blue Shield of California EPN |
$110.51
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Central Health Plan Commercial |
$180.80
|
| Rate for Payer: Cigna of CA HMO |
$144.64
|
| Rate for Payer: Cigna of CA PPO |
$167.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$192.10
|
| Rate for Payer: Dignity Health Media |
$192.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$90.40
|
| Rate for Payer: Galaxy Health WC |
$192.10
|
| Rate for Payer: Global Benefits Group Commercial |
$135.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$203.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$169.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$79.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.20
|
| Rate for Payer: Multiplan Commercial |
$169.50
|
| Rate for Payer: Networks By Design Commercial |
$146.90
|
| Rate for Payer: Prime Health Services Commercial |
$192.10
|
| Rate for Payer: Riverside University Health System MISP |
$90.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$113.00
|
| Rate for Payer: United Healthcare HMO Rider |
$113.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.10
|
| Rate for Payer: Vantage Medical Group Senior |
$192.10
|
|
|
HC POWDER HYPAQUE CAN
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT Q9964
|
| Hospital Charge Code |
909001018
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$45.20 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Blue Shield of California Commercial |
$169.50
|
| Rate for Payer: Blue Shield of California EPN |
$120.68
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Central Health Plan Commercial |
$180.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.40
|
| Rate for Payer: Galaxy Health WC |
$192.10
|
| Rate for Payer: Global Benefits Group Commercial |
$135.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$203.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.20
|
| Rate for Payer: Multiplan Commercial |
$169.50
|
| Rate for Payer: Networks By Design Commercial |
$146.90
|
| Rate for Payer: Prime Health Services Commercial |
$192.10
|
|
|
HC PRCD DRG GT 6YR W/O CGN CRDC ANM
|
Facility
|
OP
|
$1,644.00
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
900503017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$328.80 |
| Max. Negotiated Rate |
$7,084.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,048.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,397.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$904.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$904.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$986.40
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,315.20
|
| Rate for Payer: Cigna of CA PPO |
$1,216.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,397.40
|
| Rate for Payer: Dignity Health Media |
$1,397.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,397.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$657.60
|
| Rate for Payer: Galaxy Health WC |
$1,397.40
|
| Rate for Payer: Global Benefits Group Commercial |
$986.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,479.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,233.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$575.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,096.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.80
|
| Rate for Payer: Multiplan Commercial |
$1,233.00
|
| Rate for Payer: Networks By Design Commercial |
$1,068.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,397.40
|
| Rate for Payer: Riverside University Health System MISP |
$657.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$986.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,397.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,397.40
|
|
|
HC PRCD DRG GT 6YR W/O CGN CRDC ANM
|
Facility
|
IP
|
$1,644.00
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
900503017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$328.80 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,315.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.60
|
| Rate for Payer: Galaxy Health WC |
$1,397.40
|
| Rate for Payer: Global Benefits Group Commercial |
$986.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,479.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,096.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.80
|
| Rate for Payer: Multiplan Commercial |
$1,233.00
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,397.40
|
|
|
HC PRCD DRG GT 6YR W/O CGN CRDC ANM
|
Facility
|
OP
|
$1,644.00
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
906820268
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$328.80 |
| Max. Negotiated Rate |
$7,084.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,048.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,397.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$904.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$904.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$986.40
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,315.20
|
| Rate for Payer: Cigna of CA PPO |
$1,216.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,397.40
|
| Rate for Payer: Dignity Health Media |
$1,397.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,397.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$657.60
|
| Rate for Payer: Galaxy Health WC |
$1,397.40
|
| Rate for Payer: Global Benefits Group Commercial |
$986.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,479.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,233.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$575.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,096.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.80
|
| Rate for Payer: Multiplan Commercial |
$1,233.00
|
| Rate for Payer: Networks By Design Commercial |
$1,068.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,397.40
|
| Rate for Payer: Riverside University Health System MISP |
$657.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$986.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,397.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,397.40
|
|
|
HC PRCD DRG GT 6YR W/O CGN CRDC ANM
|
Facility
|
IP
|
$1,644.00
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
906820268
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$328.80 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,315.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.60
|
| Rate for Payer: Galaxy Health WC |
$1,397.40
|
| Rate for Payer: Global Benefits Group Commercial |
$986.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,479.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,096.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.80
|
| Rate for Payer: Multiplan Commercial |
$1,233.00
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,397.40
|
|
|
HC PRCRD DRG LT 6YR/ANY AGE W/ANMLY
|
Facility
|
OP
|
$1,644.00
|
|
|
Service Code
|
CPT 33018
|
| Hospital Charge Code |
906820269
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$90.80 |
| Max. Negotiated Rate |
$7,084.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,048.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,397.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$904.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$904.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$986.40
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,315.20
|
| Rate for Payer: Cigna of CA PPO |
$1,216.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,397.40
|
| Rate for Payer: Dignity Health Media |
$1,397.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,397.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$657.60
|
| Rate for Payer: Galaxy Health WC |
$1,397.40
|
| Rate for Payer: Global Benefits Group Commercial |
$986.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,479.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,233.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$575.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,096.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.80
|
| Rate for Payer: Multiplan Commercial |
$1,233.00
|
| Rate for Payer: Networks By Design Commercial |
$1,068.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,397.40
|
| Rate for Payer: Riverside University Health System MISP |
$657.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$986.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,397.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,397.40
|
|
|
HC PRCRD DRG LT 6YR/ANY AGE W/ANMLY
|
Facility
|
IP
|
$1,644.00
|
|
|
Service Code
|
CPT 33018
|
| Hospital Charge Code |
906820269
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$328.80 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,315.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.60
|
| Rate for Payer: Galaxy Health WC |
$1,397.40
|
| Rate for Payer: Global Benefits Group Commercial |
$986.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,479.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,096.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.80
|
| Rate for Payer: Multiplan Commercial |
$1,233.00
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,397.40
|
|
|
HC PRCRD DRG LT 6YR/ANY AGE W/ANMLY
|
Facility
|
OP
|
$1,644.00
|
|
|
Service Code
|
CPT 33018
|
| Hospital Charge Code |
900503018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$90.80 |
| Max. Negotiated Rate |
$7,084.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,048.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,397.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$904.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$904.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$986.40
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,315.20
|
| Rate for Payer: Cigna of CA PPO |
$1,216.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,397.40
|
| Rate for Payer: Dignity Health Media |
$1,397.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,397.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$657.60
|
| Rate for Payer: Galaxy Health WC |
$1,397.40
|
| Rate for Payer: Global Benefits Group Commercial |
$986.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,479.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,233.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$575.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,096.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.80
|
| Rate for Payer: Multiplan Commercial |
$1,233.00
|
| Rate for Payer: Networks By Design Commercial |
$1,068.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,397.40
|
| Rate for Payer: Riverside University Health System MISP |
$657.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$986.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,397.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,397.40
|
|
|
HC PRCRD DRG LT 6YR/ANY AGE W/ANMLY
|
Facility
|
IP
|
$1,644.00
|
|
|
Service Code
|
CPT 33018
|
| Hospital Charge Code |
900503018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$328.80 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,315.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.60
|
| Rate for Payer: Galaxy Health WC |
$1,397.40
|
| Rate for Payer: Global Benefits Group Commercial |
$986.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,479.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,096.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.80
|
| Rate for Payer: Multiplan Commercial |
$1,233.00
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,397.40
|
|
|
HC PREGNANCY TEST URINE
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
910400131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.40 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Central Health Plan Commercial |
$197.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.80
|
| Rate for Payer: Galaxy Health WC |
$209.95
|
| Rate for Payer: Global Benefits Group Commercial |
$148.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$222.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.40
|
| Rate for Payer: Multiplan Commercial |
$185.25
|
| Rate for Payer: Networks By Design Commercial |
$160.55
|
| Rate for Payer: Prime Health Services Commercial |
$209.95
|
|
|
HC PREGNANCY TEST URINE
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
910400131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.92
|
| 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 |
$45.28
|
| Rate for Payer: Blue Distinction Transplant |
$148.20
|
| Rate for Payer: Blue Shield of California Commercial |
$152.65
|
| Rate for Payer: Blue Shield of California EPN |
$120.04
|
| Rate for Payer: Caremore Medicare Advantage |
$8.61
|
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Central Health Plan Commercial |
$197.60
|
| Rate for Payer: Cigna of CA HMO |
$158.08
|
| Rate for Payer: Cigna of CA PPO |
$182.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.92
|
| Rate for Payer: Dignity Health Media |
$8.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.61
|
| Rate for Payer: Galaxy Health WC |
$209.95
|
| Rate for Payer: Global Benefits Group Commercial |
$148.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$222.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$185.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.61
|
| Rate for Payer: InnovAge PACE Commercial |
$12.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.75
|
| 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 |
$49.40
|
| 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 |
$185.25
|
| Rate for Payer: Networks By Design Commercial |
$160.55
|
| Rate for Payer: Prime Health Services Commercial |
$209.95
|
| 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 |
$148.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$148.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.98
|
| Rate for Payer: United Healthcare All Other HMO |
$6.98
|
| Rate for Payer: United Healthcare HMO Rider |
$6.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.47
|
| Rate for Payer: Vantage Medical Group Senior |
$8.61
|
|
|
HC PREPARE FACE/ORAL PROSTHESIS
|
Facility
|
IP
|
$6,699.00
|
|
|
Service Code
|
CPT 21085
|
| Hospital Charge Code |
900501350
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,339.80 |
| Max. Negotiated Rate |
$6,029.10 |
| Rate for Payer: Cash Price |
$3,014.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,359.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,679.60
|
| Rate for Payer: Galaxy Health WC |
$5,694.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,019.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,029.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,552.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,339.80
|
| Rate for Payer: Multiplan Commercial |
$5,024.25
|
| Rate for Payer: Networks By Design Commercial |
$4,354.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,694.15
|
|
|
HC PREPARE FACE/ORAL PROSTHESIS
|
Facility
|
OP
|
$6,699.00
|
|
|
Service Code
|
CPT 21085
|
| Hospital Charge Code |
900501350
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$305.19 |
| Max. Negotiated Rate |
$6,029.10 |
| 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 |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,019.40
|
| Rate for Payer: Caremore Medicare Advantage |
$305.19
|
| Rate for Payer: Cash Price |
$3,014.55
|
| Rate for Payer: Cash Price |
$3,014.55
|
| Rate for Payer: Cash Price |
$3,014.55
|
| Rate for Payer: Cash Price |
$3,014.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,359.20
|
| Rate for Payer: Cigna of CA PPO |
$4,957.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Galaxy Health WC |
$5,694.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,019.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,029.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,024.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$500.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$305.19
|
| Rate for Payer: InnovAge PACE Commercial |
$457.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,552.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,339.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Multiplan Commercial |
$5,024.25
|
| Rate for Payer: Networks By Design Commercial |
$4,354.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,694.15
|
| Rate for Payer: Prime Health Services Medicare |
$323.50
|
| Rate for Payer: Riverside University Health System MISP |
$335.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,019.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,349.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,349.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,349.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,349.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC PREP/HARVEST CELL CON/MONO/BUF
|
Facility
|
IP
|
$2,126.00
|
|
|
Service Code
|
CPT 38215
|
| Hospital Charge Code |
911800311
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.40
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$810.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
|
|
HC PREP/HARVEST CELL CON/MONO/BUF
|
Facility
|
OP
|
$2,126.00
|
|
|
Service Code
|
CPT 38215
|
| Hospital Charge Code |
911800311
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$273.96 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$542.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$273.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$542.38
|
| 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 |
$1,275.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,337.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,039.61
|
| Rate for Payer: Caremore Medicare Advantage |
$542.38
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Cigna of CA HMO |
$1,360.64
|
| Rate for Payer: Cigna of CA PPO |
$1,573.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.57
|
| Rate for Payer: Dignity Health Media |
$542.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$542.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$542.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$542.38
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,594.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$889.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$894.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$542.38
|
| Rate for Payer: InnovAge PACE Commercial |
$813.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$542.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$726.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$726.79
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
| Rate for Payer: Prime Health Services Medicare |
$574.92
|
| Rate for Payer: Riverside University Health System MISP |
$596.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,275.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,275.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,063.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,063.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,063.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,063.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$542.38
|
| Rate for Payer: Vantage Medical Group Senior |
$542.38
|
|
|
HC PREP/HARVEST W PLASMA VOL DEP
|
Facility
|
OP
|
$2,126.00
|
|
|
Service Code
|
CPT 38214
|
| Hospital Charge Code |
911800310
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$236.35 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$542.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$236.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$542.38
|
| 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 |
$1,275.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,337.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,039.61
|
| Rate for Payer: Caremore Medicare Advantage |
$542.38
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Cigna of CA HMO |
$1,360.64
|
| Rate for Payer: Cigna of CA PPO |
$1,573.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.57
|
| Rate for Payer: Dignity Health Media |
$542.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$542.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$542.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$542.38
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,594.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$889.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$894.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$542.38
|
| Rate for Payer: InnovAge PACE Commercial |
$813.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$542.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$726.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$726.79
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
| Rate for Payer: Prime Health Services Medicare |
$574.92
|
| Rate for Payer: Riverside University Health System MISP |
$596.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,275.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,275.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,063.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,063.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,063.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,063.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$542.38
|
| Rate for Payer: Vantage Medical Group Senior |
$542.38
|
|
|
HC PREP/HARVEST W PLASMA VOL DEP
|
Facility
|
IP
|
$2,126.00
|
|
|
Service Code
|
CPT 38214
|
| Hospital Charge Code |
911800310
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.40
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$810.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
|
