|
HC BLEEDING TIME TEMPLATE
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 85002
|
| Hospital Charge Code |
900910065
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$41.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.15
|
| Rate for Payer: BCBS Transplant Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.23
|
| Rate for Payer: Dignity Health Media |
$4.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.51
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.82
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.90
|
| Rate for Payer: IEHP Medi-Cal |
$7.81
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$7.81
|
| Rate for Payer: IEHP Medicare Advantage |
$4.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.46
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.91
|
| Rate for Payer: United Healthcare All Other HMO |
$3.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4.82
|
|
|
HC BLEPHAROTOMY DRAIN ABSCESS EYE
|
Facility
OP
|
$1,310.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
900501547
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$236.97 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$363.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$786.00
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna of CA PPO |
$969.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$545.97
|
| Rate for Payer: Dignity Health Media |
$363.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$491.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$363.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$363.98
|
| Rate for Payer: Galaxy Health WC |
$1,113.50
|
| Rate for Payer: Global Benefits Group Commercial |
$786.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$982.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$596.93
|
| Rate for Payer: Heritage Provider Network Transplant |
$596.93
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$363.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$873.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$458.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$487.73
|
| Rate for Payer: Multiplan Commercial |
$1,048.00
|
| Rate for Payer: Networks By Design Commercial |
$851.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,113.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$786.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$786.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$655.00
|
| Rate for Payer: United Healthcare All Other HMO |
$655.00
|
| Rate for Payer: United Healthcare HMO Rider |
$655.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$655.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Vantage Medical Group Senior |
$363.98
|
|
|
HC BLEPHAROTOMY DRAIN ABSCESS EYE
|
Facility
IP
|
$1,310.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
900501547
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$314.40 |
| Max. Negotiated Rate |
$1,113.50 |
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$524.00
|
| Rate for Payer: Galaxy Health WC |
$1,113.50
|
| Rate for Payer: Global Benefits Group Commercial |
$786.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$873.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$499.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.40
|
| Rate for Payer: Multiplan Commercial |
$1,048.00
|
| Rate for Payer: Networks By Design Commercial |
$851.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,113.50
|
|
|
HC BLLN ANGIO CNTRL DIALYSIS SEG
|
Facility
IP
|
$8,527.00
|
|
|
Service Code
|
CPT 36907
|
| Hospital Charge Code |
909036907
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,046.48 |
| Max. Negotiated Rate |
$7,247.95 |
| Rate for Payer: Cash Price |
$3,837.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,410.80
|
| Rate for Payer: Galaxy Health WC |
$7,247.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,116.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,687.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,248.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,046.48
|
| Rate for Payer: Multiplan Commercial |
$6,821.60
|
| Rate for Payer: Networks By Design Commercial |
$5,542.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,247.95
|
|
|
HC BLLN ANGIO CNTRL DIALYSIS SEG
|
Facility
OP
|
$8,527.00
|
|
|
Service Code
|
CPT 36907
|
| Hospital Charge Code |
909036907
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$8,049.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,247.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,689.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,689.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,116.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,104.87
|
| Rate for Payer: Blue Shield of California EPN |
$3,322.54
|
| Rate for Payer: Cash Price |
$3,837.15
|
| Rate for Payer: Cash Price |
$3,837.15
|
| Rate for Payer: Cigna of CA PPO |
$6,309.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,247.95
|
| Rate for Payer: Dignity Health Media |
$7,247.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,247.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,410.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,410.80
|
| Rate for Payer: Galaxy Health WC |
$7,247.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,116.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,395.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,687.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,264.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,046.48
|
| Rate for Payer: Multiplan Commercial |
$6,821.60
|
| Rate for Payer: Networks By Design Commercial |
$5,542.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,247.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,116.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,116.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,247.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,247.95
|
| Rate for Payer: Vantage Medical Group Senior |
$7,247.95
|
|
|
HC BLLN ANGIOPLASTY, PULM, ADD'L
|
Facility
OP
|
$15,314.00
|
|
|
Service Code
|
CPT 92998
|
| Hospital Charge Code |
906812072
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$539.05 |
| Max. Negotiated Rate |
$13,016.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,147.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,422.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,422.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$9,188.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,058.23
|
| Rate for Payer: Blue Shield of California EPN |
$5,244.75
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cigna of CA HMO |
$9,800.96
|
| Rate for Payer: Cigna of CA PPO |
$11,332.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Dignity Health Media |
$13,016.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,016.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11,485.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$539.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,675.36
|
| Rate for Payer: Multiplan Commercial |
$12,251.20
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9,188.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,188.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,188.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13,016.90
|
|
|
HC BLLN ANGIOPLASTY, PULM, ADD'L
|
Facility
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 92998
|
| Hospital Charge Code |
906812072
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$3,675.36 |
| Max. Negotiated Rate |
$13,016.90 |
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,834.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,675.36
|
| Rate for Payer: Multiplan Commercial |
$12,251.20
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
|
|
HC BLLN ANGIOPLASTY, PULM, INIT
|
Facility
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 92997
|
| Hospital Charge Code |
906812071
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$3,675.36 |
| Max. Negotiated Rate |
$13,016.90 |
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,834.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,675.36
|
| Rate for Payer: Multiplan Commercial |
$12,251.20
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
|
|
HC BLLN ANGIOPLASTY, PULM, INIT
|
Facility
OP
|
$15,314.00
|
|
|
Service Code
|
CPT 92997
|
| Hospital Charge Code |
906812071
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$643.00 |
| Max. Negotiated Rate |
$22,542.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,269.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: BCBS Transplant Transplant |
$9,188.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,058.23
|
| Rate for Payer: Blue Shield of California EPN |
$5,244.75
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cigna of CA HMO |
$9,800.96
|
| Rate for Payer: Cigna of CA PPO |
$11,332.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Media |
$13,745.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11,485.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,542.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$22,542.16
|
| Rate for Payer: IEHP Medi-Cal |
$22,267.26
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$22,267.26
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,035.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,675.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$12,251.20
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9,188.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,188.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,188.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC BLLN DILATION URETERAL STRCTR
|
Facility
IP
|
$4,037.00
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
909050706
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$968.88 |
| Max. Negotiated Rate |
$3,431.45 |
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,614.80
|
| Rate for Payer: Galaxy Health WC |
$3,431.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,422.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,692.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,538.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$968.88
|
| Rate for Payer: Multiplan Commercial |
$3,229.60
|
| Rate for Payer: Networks By Design Commercial |
$2,624.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,431.45
|
|
|
HC BLLN DILATION URETERAL STRCTR
|
Facility
OP
|
$4,037.00
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
909050706
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,431.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,220.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,220.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,422.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: Cigna of CA PPO |
$2,987.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,431.45
|
| Rate for Payer: Dignity Health Media |
$3,431.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,431.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,614.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,614.80
|
| Rate for Payer: Galaxy Health WC |
$3,431.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,422.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,027.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,692.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,329.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$968.88
|
| Rate for Payer: Multiplan Commercial |
$3,229.60
|
| Rate for Payer: Networks By Design Commercial |
$2,624.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,431.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,422.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,422.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,431.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,431.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,431.45
|
|
|
HC BLOOD ADMINISTRATION
|
Facility
OP
|
$2,564.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
946100364
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$542.38 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$542.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,538.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,889.67
|
| Rate for Payer: Blue Shield of California EPN |
$1,497.38
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cigna of CA HMO |
$1,640.96
|
| Rate for Payer: Cigna of CA PPO |
$1,897.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.57
|
| Rate for Payer: Dignity Health Media |
$542.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$542.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$542.38
|
| Rate for Payer: Galaxy Health WC |
$2,179.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,538.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,923.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$889.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$889.50
|
| Rate for Payer: IEHP Medi-Cal |
$878.66
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$878.66
|
| Rate for Payer: IEHP Medicare Advantage |
$542.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,710.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$976.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$542.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$615.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$726.79
|
| Rate for Payer: Multiplan Commercial |
$2,051.20
|
| Rate for Payer: Networks By Design Commercial |
$1,666.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,179.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,538.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,538.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,538.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,282.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Vantage Medical Group Senior |
$542.38
|
|
|
HC BLOOD ADMINISTRATION
|
Facility
OP
|
$2,564.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
941100364
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$542.38 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$542.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,538.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,889.67
|
| Rate for Payer: Blue Shield of California EPN |
$1,497.38
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cigna of CA HMO |
$1,640.96
|
| Rate for Payer: Cigna of CA PPO |
$1,897.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.57
|
| Rate for Payer: Dignity Health Media |
$542.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$542.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$542.38
|
| Rate for Payer: Galaxy Health WC |
$2,179.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,538.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,923.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$889.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$889.50
|
| Rate for Payer: IEHP Medi-Cal |
$878.66
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$878.66
|
| Rate for Payer: IEHP Medicare Advantage |
$542.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,710.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$976.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$542.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$615.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$726.79
|
| Rate for Payer: Multiplan Commercial |
$2,051.20
|
| Rate for Payer: Networks By Design Commercial |
$1,666.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,179.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,538.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,538.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,538.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,282.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Vantage Medical Group Senior |
$542.38
|
|
|
HC BLOOD ADMINISTRATION
|
Facility
IP
|
$2,564.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
941100364
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$615.36 |
| Max. Negotiated Rate |
$2,179.40 |
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,025.60
|
| Rate for Payer: Galaxy Health WC |
$2,179.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,538.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,710.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$976.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$615.36
|
| Rate for Payer: Multiplan Commercial |
$2,051.20
|
| Rate for Payer: Networks By Design Commercial |
$1,666.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,179.40
|
|
|
HC BLOOD ADMINISTRATION
|
Facility
IP
|
$2,564.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
946100364
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$615.36 |
| Max. Negotiated Rate |
$2,179.40 |
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,025.60
|
| Rate for Payer: Galaxy Health WC |
$2,179.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,538.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,710.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$976.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$615.36
|
| Rate for Payer: Multiplan Commercial |
$2,051.20
|
| Rate for Payer: Networks By Design Commercial |
$1,666.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,179.40
|
|
|
HC BLOOD DRAW FOR VAD
|
Facility
OP
|
$345.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
912936591
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$293.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$147.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.33
|
| Rate for Payer: BCBS Transplant Transplant |
$207.00
|
| Rate for Payer: Blue Shield of California Commercial |
$222.87
|
| Rate for Payer: Blue Shield of California EPN |
$176.64
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Cigna of CA HMO |
$220.80
|
| Rate for Payer: Cigna of CA PPO |
$255.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$293.25
|
| Rate for Payer: Global Benefits Group Commercial |
$207.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$258.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$261.74
|
| Rate for Payer: IEHP Medi-Cal |
$258.55
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$258.55
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$230.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: Networks By Design Commercial |
$224.25
|
| Rate for Payer: Prime Health Services Commercial |
$293.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$207.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$207.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$207.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$172.50
|
| Rate for Payer: United Healthcare All Other HMO |
$172.50
|
| Rate for Payer: United Healthcare HMO Rider |
$172.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$172.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC BLOOD DRAW FOR VAD
|
Facility
IP
|
$345.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
901200031
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$293.25 |
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.00
|
| Rate for Payer: Galaxy Health WC |
$293.25
|
| Rate for Payer: Global Benefits Group Commercial |
$207.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$230.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: Networks By Design Commercial |
$224.25
|
| Rate for Payer: Prime Health Services Commercial |
$293.25
|
|
|
HC BLOOD DRAW FOR VAD
|
Facility
OP
|
$345.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
901200031
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$293.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$147.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.33
|
| Rate for Payer: BCBS Transplant Transplant |
$207.00
|
| Rate for Payer: Blue Shield of California Commercial |
$222.87
|
| Rate for Payer: Blue Shield of California EPN |
$176.64
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Cigna of CA HMO |
$220.80
|
| Rate for Payer: Cigna of CA PPO |
$255.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$293.25
|
| Rate for Payer: Global Benefits Group Commercial |
$207.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$258.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$261.74
|
| Rate for Payer: IEHP Medi-Cal |
$258.55
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$258.55
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$230.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: Networks By Design Commercial |
$224.25
|
| Rate for Payer: Prime Health Services Commercial |
$293.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$207.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$207.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$207.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$172.50
|
| Rate for Payer: United Healthcare All Other HMO |
$172.50
|
| Rate for Payer: United Healthcare HMO Rider |
$172.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$172.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC BLOOD DRAW FOR VAD
|
Facility
IP
|
$345.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
912936591
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$293.25 |
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.00
|
| Rate for Payer: Galaxy Health WC |
$293.25
|
| Rate for Payer: Global Benefits Group Commercial |
$207.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$230.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: Networks By Design Commercial |
$224.25
|
| Rate for Payer: Prime Health Services Commercial |
$293.25
|
|
|
HC BLOOD DRAW LT 3YRS FEM/JUGULAR
|
Facility
IP
|
$132.00
|
|
|
Service Code
|
CPT 36400
|
| Hospital Charge Code |
900501687
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
|
|
HC BLOOD DRAW LT 3YRS FEM/JUGULAR
|
Facility
OP
|
$132.00
|
|
|
Service Code
|
CPT 36400
|
| Hospital Charge Code |
900501687
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$72.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: BCBS Transplant Transplant |
$79.20
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna of CA PPO |
$97.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Media |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$99.00
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.00
|
| Rate for Payer: United Healthcare All Other HMO |
$66.00
|
| Rate for Payer: United Healthcare HMO Rider |
$66.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC BLOOD OCCULT FECES
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
900911638
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$132.23 |
| Rate for Payer: IEHP Medi-Cal Transplant |
$25.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.91
|
| Rate for Payer: BCBS Transplant Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$32.30
|
| Rate for Payer: Blue Shield of California EPN |
$25.60
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.88
|
| Rate for Payer: Dignity Health Media |
$15.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.49
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.92
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.11
|
| Rate for Payer: Heritage Provider Network Transplant |
$26.11
|
| Rate for Payer: IEHP Medi-Cal |
$25.79
|
| Rate for Payer: IEHP Medicare Advantage |
$15.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.33
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.90
|
| Rate for Payer: United Healthcare All Other HMO |
$12.90
|
| Rate for Payer: United Healthcare HMO Rider |
$12.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.51
|
| Rate for Payer: Vantage Medical Group Senior |
$15.92
|
|
|
HC BLOOD/PLASMA VOLUME
|
Facility
IP
|
$1,708.00
|
|
|
Service Code
|
CPT 78111
|
| Hospital Charge Code |
909301331
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$409.92 |
| Max. Negotiated Rate |
$1,451.80 |
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$683.20
|
| Rate for Payer: Galaxy Health WC |
$1,451.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,024.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,139.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$650.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.92
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: Networks By Design Commercial |
$1,110.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,451.80
|
|
|
HC BLOOD/PLASMA VOLUME
|
Facility
OP
|
$1,708.00
|
|
|
Service Code
|
CPT 78111
|
| Hospital Charge Code |
909301331
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$99.58 |
| Max. Negotiated Rate |
$2,909.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$488.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,017.63
|
| Rate for Payer: BCBS Transplant Transplant |
$1,024.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,009.43
|
| Rate for Payer: Blue Shield of California EPN |
$801.05
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cigna of CA HMO |
$1,093.12
|
| Rate for Payer: Cigna of CA PPO |
$1,263.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Dignity Health Media |
$1,774.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,395.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,774.15
|
| Rate for Payer: Galaxy Health WC |
$1,451.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,024.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,281.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,909.61
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,909.61
|
| Rate for Payer: IEHP Medi-Cal |
$2,874.12
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2,874.12
|
| Rate for Payer: IEHP Medicare Advantage |
$1,774.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,139.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,774.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,235.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,377.36
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: Networks By Design Commercial |
$1,110.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,451.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,024.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,024.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,024.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,174.62
|
| Rate for Payer: United Healthcare All Other HMO |
$1,174.62
|
| Rate for Payer: United Healthcare HMO Rider |
$1,174.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,174.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
|
HC BNDG COHESIVE 1.5" COLORED
|
Facility
IP
|
$6.31
|
|
| Hospital Charge Code |
901698812
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$5.05
|
| Rate for Payer: Networks By Design Commercial |
$4.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
|
