|
HC AORTOGRAPH ABDOMINAL AIF
|
Facility
|
OP
|
$14,336.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
909081603
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$270.22 |
| Max. Negotiated Rate |
$12,185.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,029.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,409.22
|
| Rate for Payer: Blue Distinction Transplant |
$8,601.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,472.58
|
| Rate for Payer: Blue Shield of California EPN |
$6,723.58
|
| Rate for Payer: Cash Price |
$6,451.20
|
| Rate for Payer: Cash Price |
$6,451.20
|
| Rate for Payer: Cigna of CA HMO |
$9,175.04
|
| Rate for Payer: Cigna of CA PPO |
$10,608.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$12,185.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,601.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,752.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,562.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,440.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$11,468.80
|
| Rate for Payer: Networks By Design Commercial |
$9,318.40
|
| Rate for Payer: Prime Health Services Commercial |
$12,185.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,601.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,601.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC AORTOGRAPH ABDOMINAL AIF
|
Facility
|
IP
|
$14,336.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
909081603
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$3,440.64 |
| Max. Negotiated Rate |
$12,185.60 |
| Rate for Payer: Cash Price |
$6,451.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,734.40
|
| Rate for Payer: Galaxy Health WC |
$12,185.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,601.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,562.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,462.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,440.64
|
| Rate for Payer: Multiplan Commercial |
$11,468.80
|
| Rate for Payer: Networks By Design Commercial |
$9,318.40
|
| Rate for Payer: Prime Health Services Commercial |
$12,185.60
|
|
|
HC AORTOGRAPH ABDOMINAL AIF
|
Facility
|
OP
|
$14,336.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
909081603
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$270.22 |
| Max. Negotiated Rate |
$12,185.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,029.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,541.39
|
| Rate for Payer: Blue Distinction Transplant |
$8,601.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$6,451.20
|
| Rate for Payer: Cash Price |
$6,451.20
|
| Rate for Payer: Cash Price |
$6,451.20
|
| Rate for Payer: Cigna of CA HMO |
$9,175.04
|
| Rate for Payer: Cigna of CA PPO |
$10,608.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$12,185.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,601.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,752.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,562.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,440.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$11,468.80
|
| Rate for Payer: Networks By Design Commercial |
$9,318.40
|
| Rate for Payer: Prime Health Services Commercial |
$12,185.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,601.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,601.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC AORTOGRAPH THORACIC
|
Facility
|
IP
|
$11,713.00
|
|
|
Service Code
|
CPT 75605
|
| Hospital Charge Code |
909081600
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,811.12 |
| Max. Negotiated Rate |
$9,956.05 |
| Rate for Payer: Cash Price |
$5,270.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,685.20
|
| Rate for Payer: Galaxy Health WC |
$9,956.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,027.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,812.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,462.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,811.12
|
| Rate for Payer: Multiplan Commercial |
$9,370.40
|
| Rate for Payer: Networks By Design Commercial |
$7,613.45
|
| Rate for Payer: Prime Health Services Commercial |
$9,956.05
|
|
|
HC AORTOGRAPH THORACIC
|
Facility
|
OP
|
$11,713.00
|
|
|
Service Code
|
CPT 75605
|
| Hospital Charge Code |
909081600
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$210.04 |
| Max. Negotiated Rate |
$11,260.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,003.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,271.14
|
| Rate for Payer: Blue Distinction Transplant |
$7,027.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,922.38
|
| Rate for Payer: Blue Shield of California EPN |
$5,493.40
|
| Rate for Payer: Cash Price |
$5,270.85
|
| Rate for Payer: Cash Price |
$5,270.85
|
| Rate for Payer: Cigna of CA HMO |
$7,496.32
|
| Rate for Payer: Cigna of CA PPO |
$8,667.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Media |
$6,866.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$9,956.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,027.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,784.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,260.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,260.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,123.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11,123.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,812.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,811.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$9,370.40
|
| Rate for Payer: Networks By Design Commercial |
$7,613.45
|
| Rate for Payer: Prime Health Services Commercial |
$9,956.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,027.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,027.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC AORTO TRNSLMBR NEEDL/CATH
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
CPT 36160
|
| Hospital Charge Code |
909081317
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$722.50 |
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.00
|
| Rate for Payer: Galaxy Health WC |
$722.50
|
| Rate for Payer: Global Benefits Group Commercial |
$510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$566.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$323.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.00
|
| Rate for Payer: Multiplan Commercial |
$680.00
|
| Rate for Payer: Networks By Design Commercial |
$552.50
|
| Rate for Payer: Prime Health Services Commercial |
$722.50
|
|
|
HC AORTO TRNSLMBR NEEDL/CATH
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
CPT 36160
|
| Hospital Charge Code |
909081317
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$722.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$467.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$510.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cigna of CA PPO |
$629.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$722.50
|
| Rate for Payer: Dignity Health Media |
$722.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$722.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$340.00
|
| Rate for Payer: Galaxy Health WC |
$722.50
|
| Rate for Payer: Global Benefits Group Commercial |
$510.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$637.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$566.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.00
|
| Rate for Payer: Multiplan Commercial |
$680.00
|
| Rate for Payer: Networks By Design Commercial |
$552.50
|
| Rate for Payer: Prime Health Services Commercial |
$722.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$510.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$722.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$722.50
|
| Rate for Payer: Vantage Medical Group Senior |
$722.50
|
|
|
HC APHERESIS PLASMA EXCHANGE
|
Facility
|
OP
|
$15,788.00
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
946100103
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$13,419.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,917.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,472.80
|
| Rate for Payer: Blue Shield of California Commercial |
$11,635.76
|
| Rate for Payer: Blue Shield of California EPN |
$9,220.19
|
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: Cigna of CA HMO |
$10,104.32
|
| Rate for Payer: Cigna of CA PPO |
$11,683.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Dignity Health Media |
$1,917.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,108.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,587.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,917.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,917.03
|
| Rate for Payer: Galaxy Health WC |
$13,419.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,472.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,841.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,143.93
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,143.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,105.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,105.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,917.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,530.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,856.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,917.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,789.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,415.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,568.82
|
| Rate for Payer: Multiplan Commercial |
$12,630.40
|
| Rate for Payer: Networks By Design Commercial |
$10,262.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,419.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,472.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,472.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Vantage Medical Group Senior |
$1,917.03
|
|
|
HC APHERESIS PLASMA EXCHANGE
|
Facility
|
OP
|
$15,788.00
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
946000103
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$13,419.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,917.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,472.80
|
| Rate for Payer: Blue Shield of California Commercial |
$11,635.76
|
| Rate for Payer: Blue Shield of California EPN |
$9,220.19
|
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: Cigna of CA HMO |
$10,104.32
|
| Rate for Payer: Cigna of CA PPO |
$11,683.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Dignity Health Media |
$1,917.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,108.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,587.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,917.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,917.03
|
| Rate for Payer: Galaxy Health WC |
$13,419.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,472.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,841.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,143.93
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,143.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,105.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,105.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,917.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,530.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,856.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,917.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,789.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,415.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,568.82
|
| Rate for Payer: Multiplan Commercial |
$12,630.40
|
| Rate for Payer: Networks By Design Commercial |
$10,262.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,419.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,472.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,472.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Vantage Medical Group Senior |
$1,917.03
|
|
|
HC APHERESIS PLASMA EXCHANGE
|
Facility
|
IP
|
$15,788.00
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
946000103
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$3,789.12 |
| Max. Negotiated Rate |
$13,419.80 |
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,315.20
|
| Rate for Payer: Galaxy Health WC |
$13,419.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,472.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,530.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,015.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,789.12
|
| Rate for Payer: Multiplan Commercial |
$12,630.40
|
| Rate for Payer: Networks By Design Commercial |
$10,262.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,419.80
|
|
|
HC APHERESIS PLASMA EXCHANGE
|
Facility
|
OP
|
$15,788.00
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
945000103
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$13,419.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,917.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,472.80
|
| Rate for Payer: Blue Shield of California Commercial |
$11,635.76
|
| Rate for Payer: Blue Shield of California EPN |
$9,220.19
|
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: Cigna of CA HMO |
$10,104.32
|
| Rate for Payer: Cigna of CA PPO |
$11,683.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Dignity Health Media |
$1,917.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,108.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,587.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,917.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,917.03
|
| Rate for Payer: Galaxy Health WC |
$13,419.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,472.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,841.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,143.93
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,143.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,105.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,105.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,917.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,530.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,856.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,917.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,789.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,415.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,568.82
|
| Rate for Payer: Multiplan Commercial |
$12,630.40
|
| Rate for Payer: Networks By Design Commercial |
$10,262.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,419.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,472.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,472.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Vantage Medical Group Senior |
$1,917.03
|
|
|
HC APHERESIS PLASMA EXCHANGE
|
Facility
|
IP
|
$15,788.00
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
945000103
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$3,789.12 |
| Max. Negotiated Rate |
$13,419.80 |
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,315.20
|
| Rate for Payer: Galaxy Health WC |
$13,419.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,472.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,530.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,015.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,789.12
|
| Rate for Payer: Multiplan Commercial |
$12,630.40
|
| Rate for Payer: Networks By Design Commercial |
$10,262.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,419.80
|
|
|
HC APHERESIS PLASMA EXCHANGE
|
Facility
|
IP
|
$15,788.00
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
946100103
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$3,789.12 |
| Max. Negotiated Rate |
$13,419.80 |
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,315.20
|
| Rate for Payer: Galaxy Health WC |
$13,419.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,472.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,530.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,015.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,789.12
|
| Rate for Payer: Multiplan Commercial |
$12,630.40
|
| Rate for Payer: Networks By Design Commercial |
$10,262.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,419.80
|
|
|
HC APHERESIS PLATELETS
|
Facility
|
OP
|
$13,110.00
|
|
|
Service Code
|
CPT 36513
|
| Hospital Charge Code |
945000102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$542.38 |
| Max. Negotiated Rate |
$11,143.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,866.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$5,899.50
|
| Rate for Payer: Cash Price |
$5,899.50
|
| Rate for Payer: Cigna of CA PPO |
$9,701.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.57
|
| Rate for Payer: Dignity Health Media |
$542.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.62
|
| 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 |
$11,143.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,866.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,832.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$889.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$889.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$878.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$878.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$542.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,744.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$569.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$542.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,146.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$726.79
|
| Rate for Payer: Multiplan Commercial |
$10,488.00
|
| Rate for Payer: Networks By Design Commercial |
$8,521.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,143.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,866.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Vantage Medical Group Senior |
$542.38
|
|
|
HC APHERESIS PLATELETS
|
Facility
|
IP
|
$13,110.00
|
|
|
Service Code
|
CPT 36513
|
| Hospital Charge Code |
946100102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,146.40 |
| Max. Negotiated Rate |
$11,143.50 |
| Rate for Payer: Cash Price |
$5,899.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,244.00
|
| Rate for Payer: Galaxy Health WC |
$11,143.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,866.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,744.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,994.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,146.40
|
| Rate for Payer: Multiplan Commercial |
$10,488.00
|
| Rate for Payer: Networks By Design Commercial |
$8,521.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,143.50
|
|
|
HC APHERESIS PLATELETS
|
Facility
|
IP
|
$13,110.00
|
|
|
Service Code
|
CPT 36513
|
| Hospital Charge Code |
945000102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,146.40 |
| Max. Negotiated Rate |
$11,143.50 |
| Rate for Payer: Cash Price |
$5,899.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,244.00
|
| Rate for Payer: Galaxy Health WC |
$11,143.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,866.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,744.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,994.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,146.40
|
| Rate for Payer: Multiplan Commercial |
$10,488.00
|
| Rate for Payer: Networks By Design Commercial |
$8,521.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,143.50
|
|
|
HC APHERESIS PLATELETS
|
Facility
|
OP
|
$13,110.00
|
|
|
Service Code
|
CPT 36513
|
| Hospital Charge Code |
946100102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$542.38 |
| Max. Negotiated Rate |
$11,143.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,866.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$5,899.50
|
| Rate for Payer: Cash Price |
$5,899.50
|
| Rate for Payer: Cigna of CA PPO |
$9,701.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.57
|
| Rate for Payer: Dignity Health Media |
$542.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.62
|
| 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 |
$11,143.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,866.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,832.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$889.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$889.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$878.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$878.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$542.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,744.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$569.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$542.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,146.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$726.79
|
| Rate for Payer: Multiplan Commercial |
$10,488.00
|
| Rate for Payer: Networks By Design Commercial |
$8,521.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,143.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,866.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Vantage Medical Group Senior |
$542.38
|
|
|
HC APHERESIS RBC
|
Facility
|
OP
|
$13,522.00
|
|
|
Service Code
|
CPT 36512
|
| Hospital Charge Code |
945000101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,756.86 |
| Max. Negotiated Rate |
$11,493.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,917.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,113.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$6,084.90
|
| Rate for Payer: Cash Price |
$6,084.90
|
| Rate for Payer: Cigna of CA PPO |
$10,006.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Dignity Health Media |
$1,917.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,108.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,587.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,917.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,917.03
|
| Rate for Payer: Galaxy Health WC |
$11,493.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,113.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,141.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,143.93
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,143.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,105.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,105.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,917.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,019.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,856.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,917.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,245.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,415.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,568.82
|
| Rate for Payer: Multiplan Commercial |
$10,817.60
|
| Rate for Payer: Networks By Design Commercial |
$8,789.30
|
| Rate for Payer: Prime Health Services Commercial |
$11,493.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,113.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Vantage Medical Group Senior |
$1,917.03
|
|
|
HC APHERESIS RBC
|
Facility
|
IP
|
$13,522.00
|
|
|
Service Code
|
CPT 36512
|
| Hospital Charge Code |
945000101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,245.28 |
| Max. Negotiated Rate |
$11,493.70 |
| Rate for Payer: Cash Price |
$6,084.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,408.80
|
| Rate for Payer: Galaxy Health WC |
$11,493.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,113.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,019.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,151.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,245.28
|
| Rate for Payer: Multiplan Commercial |
$10,817.60
|
| Rate for Payer: Networks By Design Commercial |
$8,789.30
|
| Rate for Payer: Prime Health Services Commercial |
$11,493.70
|
|
|
HC APHERESIS RBC
|
Facility
|
OP
|
$13,522.00
|
|
|
Service Code
|
CPT 36512
|
| Hospital Charge Code |
946100101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,756.86 |
| Max. Negotiated Rate |
$11,493.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,917.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,113.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$6,084.90
|
| Rate for Payer: Cash Price |
$6,084.90
|
| Rate for Payer: Cigna of CA PPO |
$10,006.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Dignity Health Media |
$1,917.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,108.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,587.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,917.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,917.03
|
| Rate for Payer: Galaxy Health WC |
$11,493.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,113.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,141.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,143.93
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,143.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,105.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,105.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,917.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,019.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,856.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,917.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,245.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,415.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,568.82
|
| Rate for Payer: Multiplan Commercial |
$10,817.60
|
| Rate for Payer: Networks By Design Commercial |
$8,789.30
|
| Rate for Payer: Prime Health Services Commercial |
$11,493.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,113.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Vantage Medical Group Senior |
$1,917.03
|
|
|
HC APHERESIS RBC
|
Facility
|
IP
|
$13,522.00
|
|
|
Service Code
|
CPT 36512
|
| Hospital Charge Code |
946100101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,245.28 |
| Max. Negotiated Rate |
$11,493.70 |
| Rate for Payer: Cash Price |
$6,084.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,408.80
|
| Rate for Payer: Galaxy Health WC |
$11,493.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,113.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,019.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,151.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,245.28
|
| Rate for Payer: Multiplan Commercial |
$10,817.60
|
| Rate for Payer: Networks By Design Commercial |
$8,789.30
|
| Rate for Payer: Prime Health Services Commercial |
$11,493.70
|
|
|
HC APHERESIS WBC
|
Facility
|
IP
|
$13,522.00
|
|
|
Service Code
|
CPT 36511
|
| Hospital Charge Code |
946100100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,245.28 |
| Max. Negotiated Rate |
$11,493.70 |
| Rate for Payer: Cash Price |
$6,084.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,408.80
|
| Rate for Payer: Galaxy Health WC |
$11,493.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,113.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,019.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,151.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,245.28
|
| Rate for Payer: Multiplan Commercial |
$10,817.60
|
| Rate for Payer: Networks By Design Commercial |
$8,789.30
|
| Rate for Payer: Prime Health Services Commercial |
$11,493.70
|
|
|
HC APHERESIS WBC
|
Facility
|
OP
|
$13,522.00
|
|
|
Service Code
|
CPT 36511
|
| Hospital Charge Code |
946100100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,756.86 |
| Max. Negotiated Rate |
$11,493.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,917.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,113.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$6,084.90
|
| Rate for Payer: Cash Price |
$6,084.90
|
| Rate for Payer: Cigna of CA PPO |
$10,006.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Dignity Health Media |
$1,917.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,108.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,587.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,917.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,917.03
|
| Rate for Payer: Galaxy Health WC |
$11,493.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,113.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,141.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,143.93
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,143.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,105.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,105.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,917.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,019.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,856.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,917.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,245.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,415.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,568.82
|
| Rate for Payer: Multiplan Commercial |
$10,817.60
|
| Rate for Payer: Networks By Design Commercial |
$8,789.30
|
| Rate for Payer: Prime Health Services Commercial |
$11,493.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,113.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Vantage Medical Group Senior |
$1,917.03
|
|
|
HC APHERESIS WBC
|
Facility
|
IP
|
$13,522.00
|
|
|
Service Code
|
CPT 36511
|
| Hospital Charge Code |
945000100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,245.28 |
| Max. Negotiated Rate |
$11,493.70 |
| Rate for Payer: Cash Price |
$6,084.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,408.80
|
| Rate for Payer: Galaxy Health WC |
$11,493.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,113.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,019.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,151.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,245.28
|
| Rate for Payer: Multiplan Commercial |
$10,817.60
|
| Rate for Payer: Networks By Design Commercial |
$8,789.30
|
| Rate for Payer: Prime Health Services Commercial |
$11,493.70
|
|
|
HC APHERESIS WBC
|
Facility
|
OP
|
$13,522.00
|
|
|
Service Code
|
CPT 36511
|
| Hospital Charge Code |
945000100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,756.86 |
| Max. Negotiated Rate |
$11,493.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,917.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,113.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$6,084.90
|
| Rate for Payer: Cash Price |
$6,084.90
|
| Rate for Payer: Cigna of CA PPO |
$10,006.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Dignity Health Media |
$1,917.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,108.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,587.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,917.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,917.03
|
| Rate for Payer: Galaxy Health WC |
$11,493.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,113.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,141.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,143.93
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,143.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,105.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,105.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,917.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,019.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,856.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,917.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,245.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,415.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,568.82
|
| Rate for Payer: Multiplan Commercial |
$10,817.60
|
| Rate for Payer: Networks By Design Commercial |
$8,789.30
|
| Rate for Payer: Prime Health Services Commercial |
$11,493.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,113.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Vantage Medical Group Senior |
$1,917.03
|
|
