|
HC TRANSCATH TRICUSP VALVE ANNUL
|
Facility
|
IP
|
$80,419.00
|
|
|
Service Code
|
CPT 0545T
|
| Hospital Charge Code |
906810545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$16,083.80 |
| Max. Negotiated Rate |
$68,356.15 |
| Rate for Payer: Adventist Health Commercial |
$16,083.80
|
| Rate for Payer: Cash Price |
$36,188.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56,293.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,167.60
|
| Rate for Payer: EPIC Health Plan Senior |
$32,167.60
|
| Rate for Payer: Galaxy Health WC |
$68,356.15
|
| Rate for Payer: Global Benefits Group Commercial |
$48,251.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51,066.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47,447.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,300.56
|
| Rate for Payer: Multiplan Commercial |
$64,335.20
|
| Rate for Payer: Networks By Design Commercial |
$52,272.35
|
| Rate for Payer: Prime Health Services Commercial |
$68,356.15
|
|
|
HC TRANSCATH TRICUSPVALVE IMPLANT
|
Facility
|
OP
|
$92,483.00
|
|
|
Service Code
|
CPT 0646T
|
| Hospital Charge Code |
906803799
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$594.18 |
| Max. Negotiated Rate |
$78,610.55 |
| Rate for Payer: Adventist Health Commercial |
$18,496.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$78,610.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50,865.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$69,362.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59,346.34
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Cash Price |
$41,617.35
|
| Rate for Payer: Cash Price |
$41,617.35
|
| Rate for Payer: Cigna of CA HMO |
$59,189.12
|
| Rate for Payer: Cigna of CA PPO |
$68,437.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$78,610.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$78,610.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$78,610.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$64,738.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,993.20
|
| Rate for Payer: EPIC Health Plan Senior |
$36,993.20
|
| Rate for Payer: Galaxy Health WC |
$78,610.55
|
| Rate for Payer: Global Benefits Group Commercial |
$55,489.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$58,726.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33,571.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54,564.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22,195.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64,738.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64,738.10
|
| Rate for Payer: Multiplan Commercial |
$73,986.40
|
| Rate for Payer: Networks By Design Commercial |
$60,113.95
|
| Rate for Payer: Prime Health Services Commercial |
$78,610.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55,489.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$46,241.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$78,610.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$78,610.55
|
| Rate for Payer: Vantage Medical Group Senior |
$78,610.55
|
|
|
HC TRANSCATH TRICUSPVALVE IMPLANT
|
Facility
|
IP
|
$92,483.00
|
|
|
Service Code
|
CPT 0646T
|
| Hospital Charge Code |
906803799
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$18,496.60 |
| Max. Negotiated Rate |
$78,610.55 |
| Rate for Payer: Adventist Health Commercial |
$18,496.60
|
| Rate for Payer: Cash Price |
$41,617.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$64,738.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,993.20
|
| Rate for Payer: EPIC Health Plan Senior |
$36,993.20
|
| Rate for Payer: Galaxy Health WC |
$78,610.55
|
| Rate for Payer: Global Benefits Group Commercial |
$55,489.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$58,726.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54,564.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22,195.92
|
| Rate for Payer: Multiplan Commercial |
$73,986.40
|
| Rate for Payer: Networks By Design Commercial |
$60,113.95
|
| Rate for Payer: Prime Health Services Commercial |
$78,610.55
|
|
|
HC TRANSCATH TRICUSP VALVE REPAIR
|
Facility
|
IP
|
$80,419.00
|
|
|
Service Code
|
CPT 0569T
|
| Hospital Charge Code |
906810569
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$16,083.80 |
| Max. Negotiated Rate |
$68,356.15 |
| Rate for Payer: Adventist Health Commercial |
$16,083.80
|
| Rate for Payer: Cash Price |
$36,188.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56,293.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,167.60
|
| Rate for Payer: EPIC Health Plan Senior |
$32,167.60
|
| Rate for Payer: Galaxy Health WC |
$68,356.15
|
| Rate for Payer: Global Benefits Group Commercial |
$48,251.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51,066.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47,447.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,300.56
|
| Rate for Payer: Multiplan Commercial |
$64,335.20
|
| Rate for Payer: Networks By Design Commercial |
$52,272.35
|
| Rate for Payer: Prime Health Services Commercial |
$68,356.15
|
|
|
HC TRANSCATH TRICUSP VALVE REPAIR
|
Facility
|
OP
|
$80,419.00
|
|
|
Service Code
|
CPT 0569T
|
| Hospital Charge Code |
906810569
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$594.18 |
| Max. Negotiated Rate |
$68,356.15 |
| Rate for Payer: Adventist Health Commercial |
$16,083.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68,356.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44,230.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60,314.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Cash Price |
$36,188.55
|
| Rate for Payer: Cash Price |
$36,188.55
|
| Rate for Payer: Cigna of CA HMO |
$51,468.16
|
| Rate for Payer: Cigna of CA PPO |
$59,510.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68,356.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$68,356.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68,356.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56,293.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,167.60
|
| Rate for Payer: EPIC Health Plan Senior |
$32,167.60
|
| Rate for Payer: Galaxy Health WC |
$68,356.15
|
| Rate for Payer: Global Benefits Group Commercial |
$48,251.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51,066.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29,192.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47,447.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,300.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56,293.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56,293.30
|
| Rate for Payer: Multiplan Commercial |
$64,335.20
|
| Rate for Payer: Networks By Design Commercial |
$52,272.35
|
| Rate for Payer: Prime Health Services Commercial |
$68,356.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48,251.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$40,209.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68,356.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68,356.15
|
| Rate for Payer: Vantage Medical Group Senior |
$68,356.15
|
|
|
HC TRANSCRANIAL DUPLEX/DOPPLER
|
Facility
|
OP
|
$2,543.00
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
906601143
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$2,161.55 |
| Rate for Payer: Adventist Health Commercial |
$508.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,129.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,631.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,070.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,622.43
|
| Rate for Payer: Cash Price |
$1,144.35
|
| Rate for Payer: Cash Price |
$1,144.35
|
| Rate for Payer: Cash Price |
$1,144.35
|
| Rate for Payer: Cigna of CA HMO |
$1,627.52
|
| Rate for Payer: Cigna of CA PPO |
$1,881.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,780.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$2,161.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,525.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$329.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,614.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$372.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$610.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$2,034.40
|
| Rate for Payer: Networks By Design Commercial |
$1,652.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,161.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,525.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,525.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC TRANSCRANIAL DUPLEX/DOPPLER
|
Facility
|
IP
|
$2,543.00
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
906601143
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$508.60 |
| Max. Negotiated Rate |
$2,161.55 |
| Rate for Payer: Adventist Health Commercial |
$508.60
|
| Rate for Payer: Cash Price |
$1,144.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,780.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,017.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,017.20
|
| Rate for Payer: Galaxy Health WC |
$2,161.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,525.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,614.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,500.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$610.32
|
| Rate for Payer: Multiplan Commercial |
$2,034.40
|
| Rate for Payer: Networks By Design Commercial |
$1,652.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,161.55
|
|
|
HC TRANSDUCER PED A-LINE CVP
|
Facility
|
IP
|
$242.20
|
|
| Hospital Charge Code |
901604261
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.44 |
| Max. Negotiated Rate |
$205.87 |
| Rate for Payer: Adventist Health Commercial |
$48.44
|
| Rate for Payer: Cash Price |
$108.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$169.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.88
|
| Rate for Payer: EPIC Health Plan Senior |
$96.88
|
| Rate for Payer: Galaxy Health WC |
$205.87
|
| Rate for Payer: Global Benefits Group Commercial |
$145.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$153.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$142.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.13
|
| Rate for Payer: Multiplan Commercial |
$193.76
|
| Rate for Payer: Networks By Design Commercial |
$157.43
|
| Rate for Payer: Prime Health Services Commercial |
$205.87
|
|
|
HC TRANSDUCER PED A-LINE CVP
|
Facility
|
OP
|
$242.20
|
|
| Hospital Charge Code |
901604261
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.44 |
| Max. Negotiated Rate |
$205.87 |
| Rate for Payer: Adventist Health Commercial |
$48.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$158.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$181.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.42
|
| Rate for Payer: Cash Price |
$108.99
|
| Rate for Payer: Cigna of CA HMO |
$155.01
|
| Rate for Payer: Cigna of CA PPO |
$179.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$205.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$205.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$169.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.88
|
| Rate for Payer: EPIC Health Plan Senior |
$96.88
|
| Rate for Payer: Galaxy Health WC |
$205.87
|
| Rate for Payer: Global Benefits Group Commercial |
$145.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$153.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$142.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$169.54
|
| Rate for Payer: Multiplan Commercial |
$193.76
|
| Rate for Payer: Networks By Design Commercial |
$157.43
|
| Rate for Payer: Prime Health Services Commercial |
$205.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.10
|
| Rate for Payer: United Healthcare All Other HMO |
$121.10
|
| Rate for Payer: United Healthcare HMO Rider |
$121.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.87
|
| Rate for Payer: Vantage Medical Group Senior |
$205.87
|
|
|
HC TRANSESOPHOGEAL CARDIAC OUTPUT
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
900800525
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$124.00 |
| Max. Negotiated Rate |
$527.00 |
| Rate for Payer: Adventist Health Commercial |
$124.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$434.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$248.00
|
| Rate for Payer: Galaxy Health WC |
$527.00
|
| Rate for Payer: Global Benefits Group Commercial |
$372.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$393.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$365.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.80
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: Networks By Design Commercial |
$403.00
|
| Rate for Payer: Prime Health Services Commercial |
$527.00
|
|
|
HC TRANSESOPHOGEAL CARDIAC OUTPUT
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
900800525
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$124.00 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$124.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$406.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$397.85
|
| Rate for Payer: Blue Shield of California Commercial |
$261.02
|
| Rate for Payer: Blue Shield of California Commercial |
$395.56
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cigna of CA HMO |
$396.80
|
| Rate for Payer: Cigna of CA PPO |
$458.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$434.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$527.00
|
| Rate for Payer: Global Benefits Group Commercial |
$372.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$393.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: Networks By Design Commercial |
$403.00
|
| Rate for Payer: Prime Health Services Commercial |
$527.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$372.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$372.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC TRANSFERRIN
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
900910854
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$135.64 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.04
|
| Rate for Payer: Vantage Medical Group Senior |
$12.76
|
| Rate for Payer: Vantage Medical Group Senior |
$12.76
|
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Adventist Health Commercial |
$47.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.64
|
| Rate for Payer: Blue Shield of California Commercial |
$110.18
|
| Rate for Payer: Blue Shield of California Commercial |
$49.79
|
| Rate for Payer: Blue Shield of California Commercial |
$166.58
|
| Rate for Payer: Blue Shield of California Commercial |
$75.28
|
| Rate for Payer: Cash Price |
$107.55
|
| Rate for Payer: Cash Price |
$107.55
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna of CA HMO |
$152.96
|
| Rate for Payer: Cigna of CA HMO |
$69.12
|
| Rate for Payer: Cigna of CA PPO |
$79.92
|
| Rate for Payer: Cigna of CA PPO |
$176.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$167.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.05
|
| Rate for Payer: EPIC Health Plan Senior |
$14.04
|
| Rate for Payer: EPIC Health Plan Senior |
$14.04
|
| Rate for Payer: Galaxy Health WC |
$91.80
|
| Rate for Payer: Galaxy Health WC |
$203.15
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Global Benefits Group Commercial |
$143.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$151.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.10
|
| Rate for Payer: Multiplan Commercial |
$191.20
|
| Rate for Payer: Multiplan Commercial |
$86.40
|
| Rate for Payer: Networks By Design Commercial |
$155.35
|
| Rate for Payer: Networks By Design Commercial |
$70.20
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
| Rate for Payer: Prime Health Services Commercial |
$203.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$143.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$143.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.33
|
| Rate for Payer: United Healthcare All Other HMO |
$10.33
|
| Rate for Payer: United Healthcare All Other HMO |
$10.33
|
| Rate for Payer: United Healthcare HMO Rider |
$10.33
|
| Rate for Payer: United Healthcare HMO Rider |
$10.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.33
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.76
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.14
|
|
|
HC TRANSFERRIN
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
900910854
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.80 |
| Max. Negotiated Rate |
$203.15 |
| Rate for Payer: Adventist Health Commercial |
$47.80
|
| Rate for Payer: Cash Price |
$107.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$167.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.60
|
| Rate for Payer: EPIC Health Plan Senior |
$95.60
|
| Rate for Payer: Galaxy Health WC |
$203.15
|
| Rate for Payer: Global Benefits Group Commercial |
$143.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$151.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$141.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.36
|
| Rate for Payer: Multiplan Commercial |
$191.20
|
| Rate for Payer: Networks By Design Commercial |
$155.35
|
| Rate for Payer: Prime Health Services Commercial |
$203.15
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
IP
|
$2,506.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$501.20 |
| Max. Negotiated Rate |
$2,130.10 |
| Rate for Payer: Adventist Health Commercial |
$501.20
|
| Rate for Payer: Cash Price |
$1,127.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,754.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,002.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,002.40
|
| Rate for Payer: Galaxy Health WC |
$2,130.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,503.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,591.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,478.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.44
|
| Rate for Payer: Multiplan Commercial |
$2,004.80
|
| Rate for Payer: Networks By Design Commercial |
$1,628.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,130.10
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
OP
|
$2,506.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$501.20 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$501.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,127.70
|
| Rate for Payer: Cash Price |
$1,127.70
|
| Rate for Payer: Cash Price |
$1,127.70
|
| Rate for Payer: Cigna of CA HMO |
$1,603.84
|
| Rate for Payer: Cigna of CA PPO |
$1,854.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,754.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.24
|
| Rate for Payer: EPIC Health Plan Senior |
$624.16
|
| Rate for Payer: Galaxy Health WC |
$2,130.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,503.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$930.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,591.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$909.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$609.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$714.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$760.34
|
| Rate for Payer: Multiplan Commercial |
$2,004.80
|
| Rate for Payer: Multiplan WC |
$885.06
|
| Rate for Payer: Networks By Design Commercial |
$1,628.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,130.10
|
| Rate for Payer: Prime Health Services WC |
$876.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,503.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,253.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,253.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,253.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,253.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$567.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
IP
|
$2,506.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$501.20 |
| Max. Negotiated Rate |
$2,130.10 |
| Rate for Payer: Adventist Health Commercial |
$501.20
|
| Rate for Payer: Cash Price |
$1,127.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,754.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,002.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,002.40
|
| Rate for Payer: Galaxy Health WC |
$2,130.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,503.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,591.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,478.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.44
|
| Rate for Payer: Multiplan Commercial |
$2,004.80
|
| Rate for Payer: Networks By Design Commercial |
$1,628.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,130.10
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
IP
|
$2,506.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$501.20 |
| Max. Negotiated Rate |
$2,130.10 |
| Rate for Payer: Adventist Health Commercial |
$501.20
|
| Rate for Payer: Cash Price |
$1,127.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,754.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,002.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,002.40
|
| Rate for Payer: Galaxy Health WC |
$2,130.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,503.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,591.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,478.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.44
|
| Rate for Payer: Multiplan Commercial |
$2,004.80
|
| Rate for Payer: Networks By Design Commercial |
$1,628.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,130.10
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
OP
|
$2,506.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$260.15 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,027.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$260.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,127.70
|
| Rate for Payer: Cash Price |
$1,127.70
|
| Rate for Payer: Cash Price |
$1,127.70
|
| Rate for Payer: Cigna of CA HMO |
$1,603.84
|
| Rate for Payer: Cigna of CA PPO |
$1,854.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,754.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.24
|
| Rate for Payer: EPIC Health Plan Senior |
$624.16
|
| Rate for Payer: Galaxy Health WC |
$2,130.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,503.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$930.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,591.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$909.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$609.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$714.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$760.34
|
| Rate for Payer: Multiplan Commercial |
$2,004.80
|
| Rate for Payer: Multiplan WC |
$885.06
|
| Rate for Payer: Networks By Design Commercial |
$1,628.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,130.10
|
| Rate for Payer: Prime Health Services WC |
$876.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,503.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,503.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$567.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
OP
|
$2,506.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$260.15 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$501.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$260.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,127.70
|
| Rate for Payer: Cash Price |
$1,127.70
|
| Rate for Payer: Cash Price |
$1,127.70
|
| Rate for Payer: Cash Price |
$1,127.70
|
| Rate for Payer: Cigna of CA HMO |
$1,603.84
|
| Rate for Payer: Cigna of CA PPO |
$1,854.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,754.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.24
|
| Rate for Payer: EPIC Health Plan Senior |
$624.16
|
| Rate for Payer: Galaxy Health WC |
$2,130.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,503.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$930.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,591.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$909.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$714.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$760.34
|
| Rate for Payer: Multiplan Commercial |
$2,004.80
|
| Rate for Payer: Networks By Design Commercial |
$1,628.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,130.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,503.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,503.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$567.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC TRANSFUS BLOOD OR BLOOD COMPONENT
|
Facility
|
IP
|
$2,506.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
940100115
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$501.20 |
| Max. Negotiated Rate |
$2,130.10 |
| Rate for Payer: Adventist Health Commercial |
$501.20
|
| Rate for Payer: Cash Price |
$1,127.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,754.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,002.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,002.40
|
| Rate for Payer: Galaxy Health WC |
$2,130.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,503.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,591.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,478.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.44
|
| Rate for Payer: Multiplan Commercial |
$2,004.80
|
| Rate for Payer: Networks By Design Commercial |
$1,628.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,130.10
|
|
|
HC TRANSFUS BLOOD OR BLOOD COMPONENT
|
Facility
|
OP
|
$2,506.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
940100115
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$260.15 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$501.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$260.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,127.70
|
| Rate for Payer: Cash Price |
$1,127.70
|
| Rate for Payer: Cash Price |
$1,127.70
|
| Rate for Payer: Cash Price |
$1,127.70
|
| Rate for Payer: Cigna of CA HMO |
$1,603.84
|
| Rate for Payer: Cigna of CA PPO |
$1,854.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,754.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.24
|
| Rate for Payer: EPIC Health Plan Senior |
$624.16
|
| Rate for Payer: Galaxy Health WC |
$2,130.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,503.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$930.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,591.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$909.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$714.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$760.34
|
| Rate for Payer: Multiplan Commercial |
$2,004.80
|
| Rate for Payer: Networks By Design Commercial |
$1,628.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,130.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,503.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,503.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$567.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC TRANSFUS INTRAUTERINE ADDL FETUS
|
Facility
|
IP
|
$1,489.00
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
910400022
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$297.80 |
| Max. Negotiated Rate |
$1,265.65 |
| Rate for Payer: Adventist Health Commercial |
$297.80
|
| Rate for Payer: Cash Price |
$670.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,042.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$595.60
|
| Rate for Payer: EPIC Health Plan Senior |
$595.60
|
| Rate for Payer: Galaxy Health WC |
$1,265.65
|
| Rate for Payer: Global Benefits Group Commercial |
$893.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$945.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$878.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.36
|
| Rate for Payer: Multiplan Commercial |
$1,191.20
|
| Rate for Payer: Networks By Design Commercial |
$967.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,265.65
|
|
|
HC TRANSFUS INTRAUTERINE ADDL FETUS
|
Facility
|
OP
|
$1,489.00
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
910400022
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$297.80 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$297.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,318.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$670.05
|
| Rate for Payer: Cash Price |
$670.05
|
| Rate for Payer: Cash Price |
$670.05
|
| Rate for Payer: Cash Price |
$670.05
|
| Rate for Payer: Cigna of CA HMO |
$952.96
|
| Rate for Payer: Cigna of CA PPO |
$1,101.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,042.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.24
|
| Rate for Payer: EPIC Health Plan Senior |
$624.16
|
| Rate for Payer: Galaxy Health WC |
$1,265.65
|
| Rate for Payer: Global Benefits Group Commercial |
$893.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$930.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$520.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$945.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$588.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$714.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$760.34
|
| Rate for Payer: Multiplan Commercial |
$1,191.20
|
| Rate for Payer: Networks By Design Commercial |
$967.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,265.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$893.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$893.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$567.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC TRANSFUS INTRAUTERINE FETUS
|
Facility
|
IP
|
$1,489.00
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
910400021
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$297.80 |
| Max. Negotiated Rate |
$1,265.65 |
| Rate for Payer: Adventist Health Commercial |
$297.80
|
| Rate for Payer: Cash Price |
$670.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,042.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$595.60
|
| Rate for Payer: EPIC Health Plan Senior |
$595.60
|
| Rate for Payer: Galaxy Health WC |
$1,265.65
|
| Rate for Payer: Global Benefits Group Commercial |
$893.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$945.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$878.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.36
|
| Rate for Payer: Multiplan Commercial |
$1,191.20
|
| Rate for Payer: Networks By Design Commercial |
$967.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,265.65
|
|
|
HC TRANSFUS INTRAUTERINE FETUS
|
Facility
|
OP
|
$1,489.00
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
910400021
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$297.80 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$297.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,318.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$670.05
|
| Rate for Payer: Cash Price |
$670.05
|
| Rate for Payer: Cash Price |
$670.05
|
| Rate for Payer: Cash Price |
$670.05
|
| Rate for Payer: Cigna of CA HMO |
$952.96
|
| Rate for Payer: Cigna of CA PPO |
$1,101.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,042.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.24
|
| Rate for Payer: EPIC Health Plan Senior |
$624.16
|
| Rate for Payer: Galaxy Health WC |
$1,265.65
|
| Rate for Payer: Global Benefits Group Commercial |
$893.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$930.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$520.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$945.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$588.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$714.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$760.34
|
| Rate for Payer: Multiplan Commercial |
$1,191.20
|
| Rate for Payer: Networks By Design Commercial |
$967.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,265.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$893.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$893.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$567.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
