|
HC PLACENTAL ALPHA MICROGLOB-1POC
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
900912139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.04 |
| Max. Negotiated Rate |
$535.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$535.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$147.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$98.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.96
|
| Rate for Payer: Blue Distinction Transplant |
$147.60
|
| Rate for Payer: Blue Shield of California Commercial |
$158.92
|
| Rate for Payer: Blue Shield of California EPN |
$125.95
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna of CA HMO |
$157.44
|
| Rate for Payer: Cigna of CA PPO |
$182.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.16
|
| Rate for Payer: Dignity Health Media |
$98.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$98.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$98.11
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$184.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$160.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$160.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$158.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$158.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$98.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$98.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$123.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$131.47
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.47
|
| Rate for Payer: United Healthcare All Other HMO |
$79.47
|
| Rate for Payer: United Healthcare HMO Rider |
$79.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$147.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$107.92
|
| Rate for Payer: Vantage Medical Group Senior |
$98.11
|
|
|
HC PLASMA IRON TURNOVER
|
Facility
|
IP
|
$1,071.00
|
|
| Hospital Charge Code |
909301337
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$257.04 |
| Max. Negotiated Rate |
$910.35 |
| Rate for Payer: Cash Price |
$481.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$428.40
|
| Rate for Payer: Galaxy Health WC |
$910.35
|
| Rate for Payer: Global Benefits Group Commercial |
$642.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$714.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.04
|
| Rate for Payer: Multiplan Commercial |
$856.80
|
| Rate for Payer: Networks By Design Commercial |
$696.15
|
| Rate for Payer: Prime Health Services Commercial |
$910.35
|
|
|
HC PLASMA IRON TURNOVER
|
Facility
|
OP
|
$1,071.00
|
|
| Hospital Charge Code |
909301337
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$257.04 |
| Max. Negotiated Rate |
$910.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$702.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$910.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$589.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$589.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$638.10
|
| Rate for Payer: Blue Distinction Transplant |
$642.60
|
| Rate for Payer: Blue Shield of California Commercial |
$632.96
|
| Rate for Payer: Blue Shield of California EPN |
$502.30
|
| Rate for Payer: Cash Price |
$481.95
|
| Rate for Payer: Cigna of CA HMO |
$685.44
|
| Rate for Payer: Cigna of CA PPO |
$792.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$910.35
|
| Rate for Payer: Dignity Health Media |
$910.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$910.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$428.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$428.40
|
| Rate for Payer: Galaxy Health WC |
$910.35
|
| Rate for Payer: Global Benefits Group Commercial |
$642.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$803.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$714.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.04
|
| Rate for Payer: Multiplan Commercial |
$856.80
|
| Rate for Payer: Networks By Design Commercial |
$696.15
|
| Rate for Payer: Prime Health Services Commercial |
$910.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$642.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$642.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$535.50
|
| Rate for Payer: United Healthcare All Other HMO |
$535.50
|
| Rate for Payer: United Healthcare HMO Rider |
$535.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$535.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$910.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$910.35
|
| Rate for Payer: Vantage Medical Group Senior |
$910.35
|
|
|
HC PLASTIC REPAIR OF CANALICULI
|
Facility
|
IP
|
$6,877.00
|
|
|
Service Code
|
CPT 68700
|
| Hospital Charge Code |
900501395
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,650.48 |
| Max. Negotiated Rate |
$5,845.45 |
| Rate for Payer: Cash Price |
$3,094.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,750.80
|
| Rate for Payer: Galaxy Health WC |
$5,845.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,126.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,586.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,620.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,650.48
|
| Rate for Payer: Multiplan Commercial |
$5,501.60
|
| Rate for Payer: Networks By Design Commercial |
$4,470.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,845.45
|
|
|
HC PLASTIC REPAIR OF CANALICULI
|
Facility
|
OP
|
$6,877.00
|
|
|
Service Code
|
CPT 68700
|
| Hospital Charge Code |
900501395
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,126.20
|
| Rate for Payer: Cash Price |
$3,094.65
|
| Rate for Payer: Cash Price |
$3,094.65
|
| Rate for Payer: Cash Price |
$3,094.65
|
| Rate for Payer: Cigna of CA PPO |
$5,088.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Media |
$2,919.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Galaxy Health WC |
$5,845.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,126.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,157.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,788.26
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,788.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,919.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,586.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,576.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,650.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,678.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Multiplan Commercial |
$5,501.60
|
| Rate for Payer: Networks By Design Commercial |
$4,470.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,845.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,126.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,438.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,438.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,438.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,438.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
HC PLATELET COUNT
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
900910101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$40.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.85
|
| Rate for Payer: Blue Distinction 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 |
$6.72
|
| Rate for Payer: Dignity Health Media |
$4.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.48
|
| 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) Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.00
|
| 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: 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 |
$3.63
|
| Rate for Payer: United Healthcare All Other HMO |
$3.63
|
| Rate for Payer: United Healthcare HMO Rider |
$3.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.93
|
| Rate for Payer: Vantage Medical Group Senior |
$4.48
|
|
|
HC PLATELET COUNT CITRATED
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
900912026
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$40.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.85
|
| Rate for Payer: Blue Distinction 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 |
$6.72
|
| Rate for Payer: Dignity Health Media |
$4.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.48
|
| 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) Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.00
|
| 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: 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 |
$3.63
|
| Rate for Payer: United Healthcare All Other HMO |
$3.63
|
| Rate for Payer: United Healthcare HMO Rider |
$3.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.93
|
| Rate for Payer: Vantage Medical Group Senior |
$4.48
|
|
|
HC PLATELET NEUTRALIZATION
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
900912007
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$149.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$149.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.31
|
| Rate for Payer: Blue Distinction Transplant |
$33.00
|
| Rate for Payer: Blue Shield of California Commercial |
$35.53
|
| Rate for Payer: Blue Shield of California EPN |
$28.16
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.97
|
| Rate for Payer: Dignity Health Media |
$17.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.98
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$41.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.49
|
| Rate for Payer: Heritage Provider Network Transplant |
$29.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$29.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.56
|
| Rate for Payer: United Healthcare All Other HMO |
$14.56
|
| Rate for Payer: United Healthcare HMO Rider |
$14.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.78
|
| Rate for Payer: Vantage Medical Group Senior |
$17.98
|
|
|
HC PLATELET PED PAK ALIQUOT
|
Facility
|
IP
|
$1,151.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904532
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$276.24 |
| Max. Negotiated Rate |
$978.35 |
| Rate for Payer: Cash Price |
$517.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$460.40
|
| Rate for Payer: Galaxy Health WC |
$978.35
|
| Rate for Payer: Global Benefits Group Commercial |
$690.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$767.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$438.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.24
|
| Rate for Payer: Multiplan Commercial |
$920.80
|
| Rate for Payer: Networks By Design Commercial |
$748.15
|
| Rate for Payer: Prime Health Services Commercial |
$978.35
|
|
|
HC PLATELET PED PAK ALIQUOT
|
Facility
|
OP
|
$1,151.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904532
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$195.48 |
| Max. Negotiated Rate |
$978.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$383.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$293.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$215.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$685.77
|
| Rate for Payer: Blue Distinction Transplant |
$690.60
|
| Rate for Payer: Blue Shield of California Commercial |
$848.29
|
| Rate for Payer: Blue Shield of California EPN |
$672.18
|
| Rate for Payer: Cash Price |
$517.95
|
| Rate for Payer: Cash Price |
$517.95
|
| Rate for Payer: Cash Price |
$517.95
|
| Rate for Payer: Cigna of CA HMO |
$736.64
|
| Rate for Payer: Cigna of CA PPO |
$851.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$293.22
|
| Rate for Payer: Dignity Health Media |
$195.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.90
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.48
|
| Rate for Payer: Galaxy Health WC |
$978.35
|
| Rate for Payer: Global Benefits Group Commercial |
$690.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$863.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.59
|
| Rate for Payer: Heritage Provider Network Transplant |
$320.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$316.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$316.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$767.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$246.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.94
|
| Rate for Payer: Multiplan Commercial |
$920.80
|
| Rate for Payer: Networks By Design Commercial |
$748.15
|
| Rate for Payer: Prime Health Services Commercial |
$978.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$690.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$690.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| 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 |
$293.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$215.03
|
| Rate for Payer: Vantage Medical Group Senior |
$195.48
|
|
|
HC PLATELET SURVIVAL
|
Facility
|
IP
|
$998.00
|
|
|
Service Code
|
CPT 78191
|
| Hospital Charge Code |
909301642
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$239.52 |
| Max. Negotiated Rate |
$848.30 |
| Rate for Payer: Cash Price |
$449.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$399.20
|
| Rate for Payer: Galaxy Health WC |
$848.30
|
| Rate for Payer: Global Benefits Group Commercial |
$598.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$665.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$380.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.52
|
| Rate for Payer: Multiplan Commercial |
$798.40
|
| Rate for Payer: Networks By Design Commercial |
$648.70
|
| Rate for Payer: Prime Health Services Commercial |
$848.30
|
|
|
HC PLATELET SURVIVAL
|
Facility
|
OP
|
$998.00
|
|
|
Service Code
|
CPT 78191
|
| Hospital Charge Code |
909301642
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$219.18 |
| Max. Negotiated Rate |
$930.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$930.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$594.61
|
| Rate for Payer: Blue Distinction Transplant |
$598.80
|
| Rate for Payer: Blue Shield of California Commercial |
$589.82
|
| Rate for Payer: Blue Shield of California EPN |
$468.06
|
| Rate for Payer: Cash Price |
$449.10
|
| Rate for Payer: Cash Price |
$449.10
|
| Rate for Payer: Cigna of CA HMO |
$638.72
|
| Rate for Payer: Cigna of CA PPO |
$738.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$848.30
|
| Rate for Payer: Global Benefits Group Commercial |
$598.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$748.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$665.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$798.40
|
| Rate for Payer: Networks By Design Commercial |
$648.70
|
| Rate for Payer: Prime Health Services Commercial |
$848.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$598.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$598.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$409.89
|
| Rate for Payer: United Healthcare All Other HMO |
$409.89
|
| Rate for Payer: United Healthcare HMO Rider |
$409.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$409.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC PLCMNT ACC BILIARY TREE PERCU
|
Facility
|
IP
|
$9,198.00
|
|
|
Service Code
|
CPT 47541
|
| Hospital Charge Code |
909047541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,207.52 |
| Max. Negotiated Rate |
$7,818.30 |
| Rate for Payer: Cash Price |
$4,139.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,679.20
|
| Rate for Payer: Galaxy Health WC |
$7,818.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,518.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,135.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,504.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,207.52
|
| Rate for Payer: Multiplan Commercial |
$7,358.40
|
| Rate for Payer: Networks By Design Commercial |
$5,978.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,818.30
|
|
|
HC PLCMNT ACC BILIARY TREE PERCU
|
Facility
|
OP
|
$9,198.00
|
|
|
Service Code
|
CPT 47541
|
| Hospital Charge Code |
909047541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,054.91 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,179.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,397.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,452.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,518.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$4,139.10
|
| Rate for Payer: Cash Price |
$4,139.10
|
| Rate for Payer: Cigna of CA PPO |
$6,806.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,179.02
|
| Rate for Payer: Dignity Health Media |
$9,452.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,397.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,761.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$9,452.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$9,452.68
|
| Rate for Payer: Galaxy Health WC |
$7,818.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,518.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,898.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,502.40
|
| Rate for Payer: Heritage Provider Network Transplant |
$15,502.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15,313.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$15,313.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,452.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,135.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,054.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,452.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,207.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,910.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,666.59
|
| Rate for Payer: Multiplan Commercial |
$7,358.40
|
| Rate for Payer: Multiplan WC |
$12,923.16
|
| Rate for Payer: Networks By Design Commercial |
$5,978.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,818.30
|
| Rate for Payer: Prime Health Services WC |
$12,791.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,518.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,179.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,397.95
|
| Rate for Payer: Vantage Medical Group Senior |
$9,452.68
|
|
|
HC PLCMNT LCL DVC PERC 1ST LESION
|
Facility
|
IP
|
$1,796.00
|
|
|
Service Code
|
CPT 10035
|
| Hospital Charge Code |
909010035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$431.04 |
| Max. Negotiated Rate |
$1,526.60 |
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$718.40
|
| Rate for Payer: Galaxy Health WC |
$1,526.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,077.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,197.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$684.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$431.04
|
| Rate for Payer: Multiplan Commercial |
$1,436.80
|
| Rate for Payer: Networks By Design Commercial |
$1,167.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,526.60
|
|
|
HC PLCMNT LCL DVC PERC 1ST LESION
|
Facility
|
OP
|
$1,796.00
|
|
|
Service Code
|
CPT 10035
|
| Hospital Charge Code |
909010035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$431.04 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,077.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,061.44
|
| Rate for Payer: Blue Shield of California EPN |
$842.32
|
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Cigna of CA HMO |
$1,149.44
|
| Rate for Payer: Cigna of CA PPO |
$1,329.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$1,526.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,077.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,347.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,441.67
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,424.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,424.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,197.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$935.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$431.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$1,436.80
|
| Rate for Payer: Networks By Design Commercial |
$1,167.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,526.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,077.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,077.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$898.00
|
| Rate for Payer: United Healthcare All Other HMO |
$898.00
|
| Rate for Payer: United Healthcare HMO Rider |
$898.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$898.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC PLCMNT LCL DVC PERC ADD LESION
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT 10036
|
| Hospital Charge Code |
909010036
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$215.52 |
| Max. Negotiated Rate |
$763.30 |
| Rate for Payer: Cash Price |
$404.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$359.20
|
| Rate for Payer: Galaxy Health WC |
$763.30
|
| Rate for Payer: Global Benefits Group Commercial |
$538.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$598.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.52
|
| Rate for Payer: Multiplan Commercial |
$718.40
|
| Rate for Payer: Networks By Design Commercial |
$583.70
|
| Rate for Payer: Prime Health Services Commercial |
$763.30
|
|
|
HC PLCMNT LCL DVC PERC ADD LESION
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT 10036
|
| Hospital Charge Code |
909010036
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$215.52 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$763.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$493.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$538.80
|
| Rate for Payer: Blue Shield of California Commercial |
$530.72
|
| Rate for Payer: Blue Shield of California EPN |
$421.16
|
| Rate for Payer: Cash Price |
$404.10
|
| Rate for Payer: Cash Price |
$404.10
|
| Rate for Payer: Cigna of CA HMO |
$574.72
|
| Rate for Payer: Cigna of CA PPO |
$664.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$763.30
|
| Rate for Payer: Dignity Health Media |
$763.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$359.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$359.20
|
| Rate for Payer: Galaxy Health WC |
$763.30
|
| Rate for Payer: Global Benefits Group Commercial |
$538.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$673.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$598.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$818.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.52
|
| Rate for Payer: Multiplan Commercial |
$718.40
|
| Rate for Payer: Networks By Design Commercial |
$583.70
|
| Rate for Payer: Prime Health Services Commercial |
$763.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$538.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$538.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$449.00
|
| Rate for Payer: United Healthcare All Other HMO |
$449.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$449.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$763.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.30
|
| Rate for Payer: Vantage Medical Group Senior |
$763.30
|
|
|
HC PLCMNT NEPH CATH PERCU
|
Facility
|
IP
|
$11,074.00
|
|
|
Service Code
|
CPT 50432
|
| Hospital Charge Code |
909050432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,657.76 |
| Max. Negotiated Rate |
$9,412.90 |
| Rate for Payer: Cash Price |
$4,983.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,429.60
|
| Rate for Payer: Galaxy Health WC |
$9,412.90
|
| Rate for Payer: Global Benefits Group Commercial |
$6,644.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,386.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,219.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,657.76
|
| Rate for Payer: Multiplan Commercial |
$8,859.20
|
| Rate for Payer: Networks By Design Commercial |
$7,198.10
|
| Rate for Payer: Prime Health Services Commercial |
$9,412.90
|
|
|
HC PLCMNT NEPH CATH PERCU
|
Facility
|
OP
|
$11,074.00
|
|
|
Service Code
|
CPT 50432
|
| Hospital Charge Code |
909050432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,469.92 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,644.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$4,983.30
|
| Rate for Payer: Cash Price |
$4,983.30
|
| Rate for Payer: Cigna of CA PPO |
$8,194.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Media |
$2,544.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Galaxy Health WC |
$9,412.90
|
| Rate for Payer: Global Benefits Group Commercial |
$6,644.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,305.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,173.59
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,173.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,122.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$4,122.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,544.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,386.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,469.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,657.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,206.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Multiplan Commercial |
$8,859.20
|
| Rate for Payer: Networks By Design Commercial |
$7,198.10
|
| Rate for Payer: Prime Health Services Commercial |
$9,412.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,644.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC PLCMNT NEPHU CATH PERCU
|
Facility
|
OP
|
$6,365.00
|
|
|
Service Code
|
CPT 50433
|
| Hospital Charge Code |
909050433
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,527.60 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,819.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$2,864.25
|
| Rate for Payer: Cash Price |
$2,864.25
|
| Rate for Payer: Cigna of CA PPO |
$4,710.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Dignity Health Media |
$4,355.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,791.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,355.72
|
| Rate for Payer: Galaxy Health WC |
$5,410.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,819.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,773.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,143.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,143.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,056.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7,056.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,355.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,245.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,982.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,355.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,527.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,836.66
|
| Rate for Payer: Multiplan Commercial |
$5,092.00
|
| Rate for Payer: Networks By Design Commercial |
$4,137.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,410.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,819.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
HC PLCMNT NEPHU CATH PERCU
|
Facility
|
IP
|
$6,365.00
|
|
|
Service Code
|
CPT 50433
|
| Hospital Charge Code |
909050433
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,527.60 |
| Max. Negotiated Rate |
$5,410.25 |
| Rate for Payer: Cash Price |
$2,864.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,546.00
|
| Rate for Payer: Galaxy Health WC |
$5,410.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,819.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,245.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,425.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,527.60
|
| Rate for Payer: Multiplan Commercial |
$5,092.00
|
| Rate for Payer: Networks By Design Commercial |
$4,137.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,410.25
|
|
|
HC PLCMNT TRANSESOPHEAGEAL PROBE
|
Facility
|
OP
|
$2,439.00
|
|
|
Service Code
|
CPT 93316
|
| Hospital Charge Code |
900501593
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$288.31 |
| Max. Negotiated Rate |
$2,299.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$288.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,463.40
|
| Rate for Payer: Cash Price |
$1,097.55
|
| Rate for Payer: Cash Price |
$1,097.55
|
| Rate for Payer: Cash Price |
$1,097.55
|
| Rate for Payer: Cigna of CA PPO |
$1,804.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Dignity Health Media |
$689.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$689.28
|
| Rate for Payer: Galaxy Health WC |
$2,073.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,463.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,829.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,130.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,130.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$689.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,626.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$929.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$689.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$868.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$923.64
|
| Rate for Payer: Multiplan Commercial |
$1,951.20
|
| Rate for Payer: Networks By Design Commercial |
$1,585.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,073.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,463.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,219.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,219.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,219.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,219.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC PLCMNT TRANSESOPHEAGEAL PROBE
|
Facility
|
IP
|
$2,439.00
|
|
|
Service Code
|
CPT 93316
|
| Hospital Charge Code |
900501593
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$585.36 |
| Max. Negotiated Rate |
$2,073.15 |
| Rate for Payer: Cash Price |
$1,097.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$975.60
|
| Rate for Payer: Galaxy Health WC |
$2,073.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,463.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,626.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$929.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.36
|
| Rate for Payer: Multiplan Commercial |
$1,951.20
|
| Rate for Payer: Networks By Design Commercial |
$1,585.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,073.15
|
|
|
HC PLCMT CENTRLY INSERT TUN CVP GT 5YR
|
Facility
|
IP
|
$12,581.00
|
|
|
Service Code
|
CPT 36558
|
| Hospital Charge Code |
909080010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,019.44 |
| Max. Negotiated Rate |
$10,693.85 |
| Rate for Payer: Cash Price |
$5,661.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,032.40
|
| Rate for Payer: Galaxy Health WC |
$10,693.85
|
| Rate for Payer: Global Benefits Group Commercial |
$7,548.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,391.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,793.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,019.44
|
| Rate for Payer: Multiplan Commercial |
$10,064.80
|
| Rate for Payer: Networks By Design Commercial |
$8,177.65
|
| Rate for Payer: Prime Health Services Commercial |
$10,693.85
|
|
