|
HC AORTOGRAPH ABDOMINAL AIF
|
Facility
|
IP
|
$12,186.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
909081603
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,437.20 |
| Max. Negotiated Rate |
$10,358.10 |
| Rate for Payer: Adventist Health Commercial |
$2,437.20
|
| Rate for Payer: Cash Price |
$5,483.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,874.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,874.40
|
| Rate for Payer: Galaxy Health WC |
$10,358.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,311.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,128.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,642.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,543.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,924.64
|
| Rate for Payer: Multiplan Commercial |
$9,748.80
|
| Rate for Payer: Networks By Design Commercial |
$7,920.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,358.10
|
|
|
HC AORTOGRAPH ABDOMINAL AIF
|
Facility
|
IP
|
$12,186.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
909081603
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,437.20 |
| Max. Negotiated Rate |
$10,358.10 |
| Rate for Payer: Adventist Health Commercial |
$2,437.20
|
| Rate for Payer: Cash Price |
$5,483.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,874.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,874.40
|
| Rate for Payer: Galaxy Health WC |
$10,358.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,311.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,128.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,642.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,543.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,924.64
|
| Rate for Payer: Multiplan Commercial |
$9,748.80
|
| Rate for Payer: Networks By Design Commercial |
$7,920.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,358.10
|
|
|
HC AORTOGRAPH ABDOMINAL AIF
|
Facility
|
OP
|
$12,186.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
909081603
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$238.93 |
| Max. Negotiated Rate |
$10,358.10 |
| Rate for Payer: Adventist Health Commercial |
$2,437.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,992.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,483.42
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$5,483.70
|
| Rate for Payer: Cash Price |
$5,483.70
|
| Rate for Payer: Cash Price |
$5,483.70
|
| Rate for Payer: Cigna of CA HMO |
$7,799.04
|
| Rate for Payer: Cigna of CA PPO |
$9,017.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$10,358.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,311.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$238.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,128.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,924.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$9,748.80
|
| Rate for Payer: Networks By Design Commercial |
$7,920.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,358.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,311.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,311.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC AORTOGRAPH ABDOMINAL AIF
|
Facility
|
OP
|
$12,186.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
909081603
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$238.93 |
| Max. Negotiated Rate |
$10,358.10 |
| Rate for Payer: Adventist Health Commercial |
$2,437.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,992.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,690.78
|
| Rate for Payer: Blue Shield of California Commercial |
$7,457.83
|
| Rate for Payer: Blue Shield of California EPN |
$4,923.14
|
| Rate for Payer: Cash Price |
$5,483.70
|
| Rate for Payer: Cash Price |
$5,483.70
|
| Rate for Payer: Cigna of CA HMO |
$7,799.04
|
| Rate for Payer: Cigna of CA PPO |
$9,017.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$10,358.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,311.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$238.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,128.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,924.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$9,748.80
|
| Rate for Payer: Networks By Design Commercial |
$7,920.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,358.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,311.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,311.60
|
| 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: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC AORTOGRAPH ABDOMINAL AIF
|
Facility
|
IP
|
$16,486.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
906820190
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,297.20 |
| Max. Negotiated Rate |
$14,013.10 |
| Rate for Payer: Adventist Health Commercial |
$3,297.20
|
| Rate for Payer: Cash Price |
$7,418.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,594.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,594.40
|
| Rate for Payer: Galaxy Health WC |
$14,013.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,891.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,996.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,281.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,204.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,956.64
|
| Rate for Payer: Multiplan Commercial |
$13,188.80
|
| Rate for Payer: Networks By Design Commercial |
$10,715.90
|
| Rate for Payer: Prime Health Services Commercial |
$14,013.10
|
|
|
HC AORTOGRAPH THORACIC
|
Facility
|
OP
|
$13,470.00
|
|
|
Service Code
|
CPT 75605
|
| Hospital Charge Code |
906820188
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$185.72 |
| Max. Negotiated Rate |
$11,449.50 |
| Rate for Payer: Adventist Health Commercial |
$2,694.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,834.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,541.30
|
| Rate for Payer: Blue Shield of California Commercial |
$8,243.64
|
| Rate for Payer: Blue Shield of California EPN |
$5,441.88
|
| Rate for Payer: Cash Price |
$6,061.50
|
| Rate for Payer: Cash Price |
$6,061.50
|
| Rate for Payer: Cigna of CA HMO |
$8,620.80
|
| Rate for Payer: Cigna of CA PPO |
$9,967.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$11,449.50
|
| Rate for Payer: Global Benefits Group Commercial |
$8,082.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$185.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,984.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,232.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$10,776.00
|
| Rate for Payer: Networks By Design Commercial |
$8,755.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,449.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,082.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,082.00
|
| 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: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC AORTOGRAPH THORACIC
|
Facility
|
OP
|
$9,956.00
|
|
|
Service Code
|
CPT 75605
|
| Hospital Charge Code |
909081600
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$185.72 |
| Max. Negotiated Rate |
$11,264.31 |
| Rate for Payer: Adventist Health Commercial |
$1,991.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,530.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,541.30
|
| Rate for Payer: Blue Shield of California Commercial |
$6,093.07
|
| Rate for Payer: Blue Shield of California EPN |
$4,022.22
|
| Rate for Payer: Cash Price |
$4,480.20
|
| Rate for Payer: Cash Price |
$4,480.20
|
| Rate for Payer: Cigna of CA HMO |
$6,371.84
|
| Rate for Payer: Cigna of CA PPO |
$7,367.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$8,462.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,973.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$185.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,640.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,389.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$7,964.80
|
| Rate for Payer: Networks By Design Commercial |
$6,471.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,462.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,973.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,973.60
|
| 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: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC AORTOGRAPH THORACIC
|
Facility
|
IP
|
$13,470.00
|
|
|
Service Code
|
CPT 75605
|
| Hospital Charge Code |
906820188
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,694.00 |
| Max. Negotiated Rate |
$11,449.50 |
| Rate for Payer: Adventist Health Commercial |
$2,694.00
|
| Rate for Payer: Cash Price |
$6,061.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,388.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,388.00
|
| Rate for Payer: Galaxy Health WC |
$11,449.50
|
| Rate for Payer: Global Benefits Group Commercial |
$8,082.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,984.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,132.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,337.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,232.80
|
| Rate for Payer: Multiplan Commercial |
$10,776.00
|
| Rate for Payer: Networks By Design Commercial |
$8,755.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,449.50
|
|
|
HC AORTOGRAPH THORACIC
|
Facility
|
IP
|
$9,956.00
|
|
|
Service Code
|
CPT 75605
|
| Hospital Charge Code |
909081600
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,991.20 |
| Max. Negotiated Rate |
$8,462.60 |
| Rate for Payer: Adventist Health Commercial |
$1,991.20
|
| Rate for Payer: Cash Price |
$4,480.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,982.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,982.40
|
| Rate for Payer: Galaxy Health WC |
$8,462.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,973.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,640.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,793.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,162.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,389.44
|
| Rate for Payer: Multiplan Commercial |
$7,964.80
|
| Rate for Payer: Networks By Design Commercial |
$6,471.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,462.60
|
|
|
HC AORTO TRNSLMBR NEEDL/CATH
|
Facility
|
IP
|
$808.00
|
|
|
Service Code
|
CPT 36160
|
| Hospital Charge Code |
906820174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$161.60 |
| Max. Negotiated Rate |
$686.80 |
| Rate for Payer: Adventist Health Commercial |
$161.60
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.20
|
| Rate for Payer: EPIC Health Plan Senior |
$323.20
|
| Rate for Payer: Galaxy Health WC |
$686.80
|
| Rate for Payer: Global Benefits Group Commercial |
$484.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$538.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$500.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.92
|
| Rate for Payer: Multiplan Commercial |
$646.40
|
| Rate for Payer: Networks By Design Commercial |
$525.20
|
| Rate for Payer: Prime Health Services Commercial |
$686.80
|
|
|
HC AORTO TRNSLMBR NEEDL/CATH
|
Facility
|
IP
|
$830.00
|
|
|
Service Code
|
CPT 36160
|
| Hospital Charge Code |
909081317
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$166.00 |
| Max. Negotiated Rate |
$705.50 |
| Rate for Payer: Adventist Health Commercial |
$166.00
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$332.00
|
| Rate for Payer: EPIC Health Plan Senior |
$332.00
|
| Rate for Payer: Galaxy Health WC |
$705.50
|
| Rate for Payer: Global Benefits Group Commercial |
$498.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$553.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$316.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$513.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.20
|
| Rate for Payer: Multiplan Commercial |
$664.00
|
| Rate for Payer: Networks By Design Commercial |
$539.50
|
| Rate for Payer: Prime Health Services Commercial |
$705.50
|
|
|
HC AORTO TRNSLMBR NEEDL/CATH
|
Facility
|
OP
|
$808.00
|
|
|
Service Code
|
CPT 36160
|
| Hospital Charge Code |
906820174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$161.60 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$161.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$686.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$444.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$606.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna of CA HMO |
$517.12
|
| Rate for Payer: Cigna of CA PPO |
$597.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$686.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$686.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$686.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.20
|
| Rate for Payer: EPIC Health Plan Senior |
$323.20
|
| Rate for Payer: Galaxy Health WC |
$686.80
|
| Rate for Payer: Global Benefits Group Commercial |
$484.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$187.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$538.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$500.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$565.60
|
| Rate for Payer: Multiplan Commercial |
$646.40
|
| Rate for Payer: Networks By Design Commercial |
$525.20
|
| Rate for Payer: Prime Health Services Commercial |
$686.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$484.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$686.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$686.80
|
| Rate for Payer: Vantage Medical Group Senior |
$686.80
|
|
|
HC AORTO TRNSLMBR NEEDL/CATH
|
Facility
|
OP
|
$830.00
|
|
|
Service Code
|
CPT 36160
|
| Hospital Charge Code |
909081317
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$166.00 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$166.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$705.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$456.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$622.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna of CA HMO |
$531.20
|
| Rate for Payer: Cigna of CA PPO |
$614.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$705.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$705.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$705.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$332.00
|
| Rate for Payer: EPIC Health Plan Senior |
$332.00
|
| Rate for Payer: Galaxy Health WC |
$705.50
|
| Rate for Payer: Global Benefits Group Commercial |
$498.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$187.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$553.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$513.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$581.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$581.00
|
| Rate for Payer: Multiplan Commercial |
$664.00
|
| Rate for Payer: Networks By Design Commercial |
$539.50
|
| Rate for Payer: Prime Health Services Commercial |
$705.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$498.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$705.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$705.50
|
| Rate for Payer: Vantage Medical Group Senior |
$705.50
|
|
|
HC APHERESIS PLASMA EXCHANGE
|
Facility
|
IP
|
$15,433.00
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
946000103
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$3,086.60 |
| Max. Negotiated Rate |
$13,118.05 |
| Rate for Payer: Adventist Health Commercial |
$3,086.60
|
| Rate for Payer: Cash Price |
$6,944.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,173.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,173.20
|
| Rate for Payer: Galaxy Health WC |
$13,118.05
|
| Rate for Payer: Global Benefits Group Commercial |
$9,259.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,293.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,879.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,553.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,703.92
|
| Rate for Payer: Multiplan Commercial |
$12,346.40
|
| Rate for Payer: Networks By Design Commercial |
$10,031.45
|
| Rate for Payer: Prime Health Services Commercial |
$13,118.05
|
|
|
HC APHERESIS PLASMA EXCHANGE
|
Facility
|
IP
|
$15,433.00
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
945000103
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$3,086.60 |
| Max. Negotiated Rate |
$13,118.05 |
| Rate for Payer: Adventist Health Commercial |
$3,086.60
|
| Rate for Payer: Cash Price |
$6,944.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,173.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,173.20
|
| Rate for Payer: Galaxy Health WC |
$13,118.05
|
| Rate for Payer: Global Benefits Group Commercial |
$9,259.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,293.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,879.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,553.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,703.92
|
| Rate for Payer: Multiplan Commercial |
$12,346.40
|
| Rate for Payer: Networks By Design Commercial |
$10,031.45
|
| Rate for Payer: Prime Health Services Commercial |
$13,118.05
|
|
|
HC APHERESIS PLASMA EXCHANGE
|
Facility
|
IP
|
$15,433.00
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
946100103
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$3,086.60 |
| Max. Negotiated Rate |
$13,118.05 |
| Rate for Payer: Adventist Health Commercial |
$3,086.60
|
| Rate for Payer: Cash Price |
$6,944.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,173.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,173.20
|
| Rate for Payer: Galaxy Health WC |
$13,118.05
|
| Rate for Payer: Global Benefits Group Commercial |
$9,259.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,293.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,879.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,553.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,703.92
|
| Rate for Payer: Multiplan Commercial |
$12,346.40
|
| Rate for Payer: Networks By Design Commercial |
$10,031.45
|
| Rate for Payer: Prime Health Services Commercial |
$13,118.05
|
|
|
HC APHERESIS PLASMA EXCHANGE
|
Facility
|
OP
|
$15,433.00
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
946000103
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$13,118.05 |
| Rate for Payer: Adventist Health Commercial |
$3,086.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,291.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,082.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$6,944.85
|
| Rate for Payer: Cash Price |
$6,944.85
|
| Rate for Payer: Cash Price |
$6,944.85
|
| Rate for Payer: Cigna of CA HMO |
$9,877.12
|
| Rate for Payer: Cigna of CA PPO |
$11,420.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,291.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,082.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,811.87
|
| Rate for Payer: EPIC Health Plan Senior |
$2,082.87
|
| Rate for Payer: Galaxy Health WC |
$13,118.05
|
| Rate for Payer: Global Benefits Group Commercial |
$9,259.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,415.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,641.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,082.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,293.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,856.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,082.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,703.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,624.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,791.05
|
| Rate for Payer: Multiplan Commercial |
$12,346.40
|
| Rate for Payer: Networks By Design Commercial |
$10,031.45
|
| Rate for Payer: Prime Health Services Commercial |
$13,118.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,259.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,259.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,082.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,291.16
|
| Rate for Payer: Vantage Medical Group Senior |
$2,082.87
|
|
|
HC APHERESIS PLASMA EXCHANGE
|
Facility
|
OP
|
$15,433.00
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
946100103
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$13,118.05 |
| Rate for Payer: Adventist Health Commercial |
$3,086.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,291.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,082.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$6,944.85
|
| Rate for Payer: Cash Price |
$6,944.85
|
| Rate for Payer: Cash Price |
$6,944.85
|
| Rate for Payer: Cigna of CA HMO |
$9,877.12
|
| Rate for Payer: Cigna of CA PPO |
$11,420.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,291.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,082.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,811.87
|
| Rate for Payer: EPIC Health Plan Senior |
$2,082.87
|
| Rate for Payer: Galaxy Health WC |
$13,118.05
|
| Rate for Payer: Global Benefits Group Commercial |
$9,259.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,415.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,641.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,082.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,293.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,856.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,082.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,703.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,624.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,791.05
|
| Rate for Payer: Multiplan Commercial |
$12,346.40
|
| Rate for Payer: Networks By Design Commercial |
$10,031.45
|
| Rate for Payer: Prime Health Services Commercial |
$13,118.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,259.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,259.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,082.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,291.16
|
| Rate for Payer: Vantage Medical Group Senior |
$2,082.87
|
|
|
HC APHERESIS PLASMA EXCHANGE
|
Facility
|
OP
|
$15,433.00
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
945000103
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$13,118.05 |
| Rate for Payer: Adventist Health Commercial |
$3,086.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,291.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,082.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$6,944.85
|
| Rate for Payer: Cash Price |
$6,944.85
|
| Rate for Payer: Cash Price |
$6,944.85
|
| Rate for Payer: Cigna of CA HMO |
$9,877.12
|
| Rate for Payer: Cigna of CA PPO |
$11,420.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,291.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,082.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,811.87
|
| Rate for Payer: EPIC Health Plan Senior |
$2,082.87
|
| Rate for Payer: Galaxy Health WC |
$13,118.05
|
| Rate for Payer: Global Benefits Group Commercial |
$9,259.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,415.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,641.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,082.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,293.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,856.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,082.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,703.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,624.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,791.05
|
| Rate for Payer: Multiplan Commercial |
$12,346.40
|
| Rate for Payer: Networks By Design Commercial |
$10,031.45
|
| Rate for Payer: Prime Health Services Commercial |
$13,118.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,259.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,259.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,082.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,291.16
|
| Rate for Payer: Vantage Medical Group Senior |
$2,082.87
|
|
|
HC APHERESIS PLATELETS
|
Facility
|
IP
|
$12,815.00
|
|
|
Service Code
|
CPT 36513
|
| Hospital Charge Code |
946100102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,563.00 |
| Max. Negotiated Rate |
$10,892.75 |
| Rate for Payer: Adventist Health Commercial |
$2,563.00
|
| Rate for Payer: Cash Price |
$5,766.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,126.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,126.00
|
| Rate for Payer: Galaxy Health WC |
$10,892.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,689.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,547.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,882.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,932.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,075.60
|
| Rate for Payer: Multiplan Commercial |
$10,252.00
|
| Rate for Payer: Networks By Design Commercial |
$8,329.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,892.75
|
|
|
HC APHERESIS PLATELETS
|
Facility
|
IP
|
$12,815.00
|
|
|
Service Code
|
CPT 36513
|
| Hospital Charge Code |
945000102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,563.00 |
| Max. Negotiated Rate |
$10,892.75 |
| Rate for Payer: Adventist Health Commercial |
$2,563.00
|
| Rate for Payer: Cash Price |
$5,766.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,126.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,126.00
|
| Rate for Payer: Galaxy Health WC |
$10,892.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,689.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,547.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,882.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,932.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,075.60
|
| Rate for Payer: Multiplan Commercial |
$10,252.00
|
| Rate for Payer: Networks By Design Commercial |
$8,329.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,892.75
|
|
|
HC APHERESIS PLATELETS
|
Facility
|
OP
|
$12,815.00
|
|
|
Service Code
|
CPT 36513
|
| Hospital Charge Code |
946100102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$503.50 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$2,563.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$5,766.75
|
| Rate for Payer: Cash Price |
$5,766.75
|
| Rate for Payer: Cash Price |
$5,766.75
|
| Rate for Payer: Cigna of CA HMO |
$8,201.60
|
| Rate for Payer: Cigna of CA PPO |
$9,483.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| Rate for Payer: Galaxy Health WC |
$10,892.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,689.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$503.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,547.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$569.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,075.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$699.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| Rate for Payer: Multiplan Commercial |
$10,252.00
|
| Rate for Payer: Multiplan WC |
$885.06
|
| Rate for Payer: Networks By Design Commercial |
$8,329.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,892.75
|
| Rate for Payer: Prime Health Services WC |
$876.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,689.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC APHERESIS PLATELETS
|
Facility
|
OP
|
$12,815.00
|
|
|
Service Code
|
CPT 36513
|
| Hospital Charge Code |
945000102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$503.50 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$2,563.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$5,766.75
|
| Rate for Payer: Cash Price |
$5,766.75
|
| Rate for Payer: Cash Price |
$5,766.75
|
| Rate for Payer: Cigna of CA HMO |
$8,201.60
|
| Rate for Payer: Cigna of CA PPO |
$9,483.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| Rate for Payer: Galaxy Health WC |
$10,892.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,689.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$503.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,547.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$569.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,075.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$699.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| Rate for Payer: Multiplan Commercial |
$10,252.00
|
| Rate for Payer: Multiplan WC |
$885.06
|
| Rate for Payer: Networks By Design Commercial |
$8,329.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,892.75
|
| Rate for Payer: Prime Health Services WC |
$876.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,689.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC APHERESIS RBC
|
Facility
|
OP
|
$13,218.00
|
|
|
Service Code
|
CPT 36512
|
| Hospital Charge Code |
945000101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,641.85 |
| Max. Negotiated Rate |
$11,235.30 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,291.16
|
| Rate for Payer: Vantage Medical Group Senior |
$2,082.87
|
| Rate for Payer: Adventist Health Commercial |
$2,643.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,291.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,082.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$5,948.10
|
| Rate for Payer: Cash Price |
$5,948.10
|
| Rate for Payer: Cash Price |
$5,948.10
|
| Rate for Payer: Cigna of CA HMO |
$8,459.52
|
| Rate for Payer: Cigna of CA PPO |
$9,781.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,291.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,082.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,811.87
|
| Rate for Payer: EPIC Health Plan Senior |
$2,082.87
|
| Rate for Payer: Galaxy Health WC |
$11,235.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,930.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,415.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,641.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,082.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,816.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,856.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,082.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,172.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,624.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,791.05
|
| Rate for Payer: Multiplan Commercial |
$10,574.40
|
| Rate for Payer: Multiplan WC |
$3,318.68
|
| Rate for Payer: Networks By Design Commercial |
$8,591.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,235.30
|
| Rate for Payer: Prime Health Services WC |
$3,284.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,930.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,082.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,124.30
|
|
|
HC APHERESIS RBC
|
Facility
|
OP
|
$13,218.00
|
|
|
Service Code
|
CPT 36512
|
| Hospital Charge Code |
946100101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,641.85 |
| Max. Negotiated Rate |
$11,235.30 |
| Rate for Payer: Adventist Health Commercial |
$2,643.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,291.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,082.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$5,948.10
|
| Rate for Payer: Cash Price |
$5,948.10
|
| Rate for Payer: Cash Price |
$5,948.10
|
| Rate for Payer: Cigna of CA HMO |
$8,459.52
|
| Rate for Payer: Cigna of CA PPO |
$9,781.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,291.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,082.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,811.87
|
| Rate for Payer: EPIC Health Plan Senior |
$2,082.87
|
| Rate for Payer: Galaxy Health WC |
$11,235.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,930.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,415.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,641.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,082.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,816.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,856.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,082.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,172.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,624.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,791.05
|
| Rate for Payer: Multiplan Commercial |
$10,574.40
|
| Rate for Payer: Multiplan WC |
$3,318.68
|
| Rate for Payer: Networks By Design Commercial |
$8,591.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,235.30
|
| Rate for Payer: Prime Health Services WC |
$3,284.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,930.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,082.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,291.16
|
| Rate for Payer: Vantage Medical Group Senior |
$2,082.87
|
|
