|
HC AORTOGRAM/SUPRAVALVULAR
|
Facility
|
IP
|
$2,473.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
906811416
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$494.60 |
| Max. Negotiated Rate |
$2,102.05 |
| Rate for Payer: Adventist Health Commercial |
$494.60
|
| Rate for Payer: Cash Price |
$1,112.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,731.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$989.20
|
| Rate for Payer: EPIC Health Plan Senior |
$989.20
|
| Rate for Payer: Galaxy Health WC |
$2,102.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,483.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,570.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,459.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$593.52
|
| Rate for Payer: Multiplan Commercial |
$1,978.40
|
| Rate for Payer: Networks By Design Commercial |
$1,607.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,102.05
|
|
|
HC AORTOGRAPH ABDOMINAL
|
Facility
|
IP
|
$11,040.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
909081602
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,208.00 |
| Max. Negotiated Rate |
$9,384.00 |
| Rate for Payer: Adventist Health Commercial |
$2,208.00
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,728.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,416.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,416.00
|
| Rate for Payer: Galaxy Health WC |
$9,384.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,624.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,010.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,513.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,649.60
|
| Rate for Payer: Multiplan Commercial |
$8,832.00
|
| Rate for Payer: Networks By Design Commercial |
$7,176.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,384.00
|
|
|
HC AORTOGRAPH ABDOMINAL
|
Facility
|
OP
|
$11,040.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
909081602
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$193.17 |
| Max. Negotiated Rate |
$9,384.00 |
| Rate for Payer: Adventist Health Commercial |
$2,208.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,138.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,700.64
|
| Rate for Payer: Blue Shield of California Commercial |
$4,647.84
|
| Rate for Payer: Blue Shield of California Commercial |
$7,043.52
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Cigna of CA HMO |
$7,065.60
|
| Rate for Payer: Cigna of CA PPO |
$8,169.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,728.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$9,384.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,624.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$193.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,010.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$218.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,649.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$8,832.00
|
| Rate for Payer: Networks By Design Commercial |
$7,176.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,384.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,624.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,624.00
|
| 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 |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
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 |
$1,164.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,819.76
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| 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: 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 |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,530.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| 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/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$238.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,738.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$270.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,924.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| 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 |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,530.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7,738.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,189.74
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,530.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7,738.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,189.74
|
| 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
|
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 |
$1,164.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,856.85
|
| Rate for Payer: Blue Shield of California Commercial |
$5,130.31
|
| Rate for Payer: Blue Shield of California Commercial |
$7,774.67
|
| 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 |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,530.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| 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/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$238.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,738.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$270.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,924.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| 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 |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,969.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6,322.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,874.04
|
| 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 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 |
$11,808.82 |
| Rate for Payer: Adventist Health Commercial |
$1,991.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,135.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,700.64
|
| Rate for Payer: Blue Shield of California Commercial |
$4,191.48
|
| Rate for Payer: Blue Shield of California Commercial |
$6,351.93
|
| 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 |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,969.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,808.82
|
| Rate for Payer: EPIC Health Plan Senior |
$7,872.55
|
| 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/Senior |
$11,737.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$185.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,322.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,019.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,389.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,017.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,590.19
|
| 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 |
$7,156.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$166.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$581.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$527.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$212.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$489.70
|
| 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 |
$415.00
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$581.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$527.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$489.70
|
| 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 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 |
$611.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,203.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,003.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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: 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 |
$3,004.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,203.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,003.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,803.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,305.13
|
| Rate for Payer: EPIC Health Plan Senior |
$2,203.42
|
| 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/Senior |
$3,285.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,641.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,003.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,799.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,856.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,804.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,703.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,523.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,684.17
|
| 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 |
$2,003.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,203.42
|
| Rate for Payer: Vantage Medical Group Senior |
$2,003.11
|
|
|
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 |
$611.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,203.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,003.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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: 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 |
$3,004.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,203.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,003.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,803.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,305.13
|
| Rate for Payer: EPIC Health Plan Senior |
$2,203.42
|
| 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/Senior |
$3,285.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,641.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,003.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,799.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,856.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,804.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,703.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,523.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,684.17
|
| 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 |
$2,003.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,203.42
|
| Rate for Payer: Vantage Medical Group Senior |
$2,003.11
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,803.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9,799.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,105.47
|
| 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 |
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,803.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9,799.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,105.47
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,803.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9,799.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,105.47
|
| 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 |
$611.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,203.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,003.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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: 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 |
$3,004.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,203.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,003.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,803.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,305.13
|
| Rate for Payer: EPIC Health Plan Senior |
$2,203.42
|
| 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/Senior |
$3,285.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,641.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,003.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,799.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,856.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,804.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,703.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,523.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,684.17
|
| 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 |
$2,003.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,203.42
|
| Rate for Payer: Vantage Medical Group Senior |
$2,003.11
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,970.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$8,137.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,560.85
|
| 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,563.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| 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 |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,970.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.24
|
| Rate for Payer: EPIC Health Plan Senior |
$624.16
|
| 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/Senior |
$930.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$503.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,137.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$569.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,075.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$714.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$760.34
|
| Rate for Payer: Multiplan Commercial |
$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 |
$6,407.50
|
| 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 |
$567.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,970.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$8,137.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,560.85
|
| 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 |
945000102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$503.50 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,563.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| 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 |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,970.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.24
|
| Rate for Payer: EPIC Health Plan Senior |
$624.16
|
| 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/Senior |
$930.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$503.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,137.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$569.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,075.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$714.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$760.34
|
| Rate for Payer: Multiplan Commercial |
$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 |
$6,407.50
|
| 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 |
$567.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC APHERESIS RBC
|
Facility
|
IP
|
$13,218.00
|
|
|
Service Code
|
CPT 36512
|
| Hospital Charge Code |
946100101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,643.60 |
| Max. Negotiated Rate |
$11,235.30 |
| Rate for Payer: Adventist Health Commercial |
$2,643.60
|
| Rate for Payer: Cash Price |
$5,948.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,252.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,287.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,287.20
|
| Rate for Payer: Galaxy Health WC |
$11,235.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,930.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,393.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,798.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,172.32
|
| Rate for Payer: Multiplan Commercial |
$10,574.40
|
| Rate for Payer: Networks By Design Commercial |
$8,591.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,235.30
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,643.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,203.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,003.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| 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 |
$3,004.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,203.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,003.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,252.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,305.13
|
| Rate for Payer: EPIC Health Plan Senior |
$2,203.42
|
| 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/Senior |
$3,285.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,641.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,003.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,393.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,856.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,804.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,172.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,523.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,684.17
|
| 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 |
$6,609.00
|
| 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 |
$2,003.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,203.42
|
| Rate for Payer: Vantage Medical Group Senior |
$2,003.11
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,643.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,203.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,003.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| 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 |
$3,004.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,203.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,003.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,252.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,305.13
|
| Rate for Payer: EPIC Health Plan Senior |
$2,203.42
|
| 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/Senior |
$3,285.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,641.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,003.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,393.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,856.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,804.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,172.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,523.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,684.17
|
| 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 |
$6,609.00
|
| 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 |
$2,003.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,203.42
|
| Rate for Payer: Vantage Medical Group Senior |
$2,003.11
|
|
|
HC APHERESIS RBC
|
Facility
|
IP
|
$13,218.00
|
|
|
Service Code
|
CPT 36512
|
| Hospital Charge Code |
945000101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,643.60 |
| Max. Negotiated Rate |
$11,235.30 |
| Rate for Payer: Adventist Health Commercial |
$2,643.60
|
| Rate for Payer: Cash Price |
$5,948.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,252.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,287.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,287.20
|
| Rate for Payer: Galaxy Health WC |
$11,235.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,930.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,393.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,798.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,172.32
|
| Rate for Payer: Multiplan Commercial |
$10,574.40
|
| Rate for Payer: Networks By Design Commercial |
$8,591.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,235.30
|
|
