|
HC PLASTY BALLOON/LP/PF+ CORDIS
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$396.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$540.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$435.82
|
| Rate for Payer: Blue Shield of California Commercial |
$365.04
|
| Rate for Payer: Blue Shield of California Commercial |
$553.68
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$504.00
|
| Rate for Payer: Cigna of CA PPO |
$504.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$612.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$612.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$504.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.00
|
| Rate for Payer: EPIC Health Plan Senior |
$288.00
|
| Rate for Payer: Galaxy Health WC |
$612.00
|
| Rate for Payer: Global Benefits Group Commercial |
$432.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$457.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$261.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$504.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$504.00
|
| Rate for Payer: Multiplan Commercial |
$576.00
|
| Rate for Payer: Networks By Design Commercial |
$360.00
|
| Rate for Payer: Prime Health Services Commercial |
$612.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$432.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$432.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.22
|
| Rate for Payer: United Healthcare All Other HMO |
$263.02
|
| Rate for Payer: United Healthcare HMO Rider |
$257.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$612.00
|
| Rate for Payer: Vantage Medical Group Senior |
$612.00
|
|
|
HC PLASTY BALLOON/LP/PF+ CORDIS
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$504.00
|
| Rate for Payer: Cigna of CA PPO |
$504.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$504.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.00
|
| Rate for Payer: EPIC Health Plan Senior |
$288.00
|
| Rate for Payer: Galaxy Health WC |
$612.00
|
| Rate for Payer: Global Benefits Group Commercial |
$432.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$457.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.80
|
| Rate for Payer: Multiplan Commercial |
$576.00
|
| Rate for Payer: Networks By Design Commercial |
$360.00
|
| Rate for Payer: Prime Health Services Commercial |
$612.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.22
|
| Rate for Payer: United Healthcare All Other HMO |
$263.02
|
| Rate for Payer: United Healthcare HMO Rider |
$257.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.80
|
|
|
HC PLASTY BALLOON/XXL/MAXI
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.00 |
| Max. Negotiated Rate |
$977.50 |
| Rate for Payer: Adventist Health Commercial |
$230.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$977.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$862.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$696.10
|
| Rate for Payer: Blue Shield of California Commercial |
$583.05
|
| Rate for Payer: Blue Shield of California Commercial |
$884.35
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna of CA HMO |
$805.00
|
| Rate for Payer: Cigna of CA PPO |
$805.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$977.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$977.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$977.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$805.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$460.00
|
| Rate for Payer: EPIC Health Plan Senior |
$460.00
|
| Rate for Payer: Galaxy Health WC |
$977.50
|
| Rate for Payer: Global Benefits Group Commercial |
$690.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$730.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$417.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$678.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$805.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$805.00
|
| Rate for Payer: Multiplan Commercial |
$920.00
|
| Rate for Payer: Networks By Design Commercial |
$575.00
|
| Rate for Payer: Prime Health Services Commercial |
$977.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$690.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$690.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$431.60
|
| Rate for Payer: United Healthcare All Other HMO |
$420.10
|
| Rate for Payer: United Healthcare HMO Rider |
$411.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$376.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$977.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$977.50
|
| Rate for Payer: Vantage Medical Group Senior |
$977.50
|
|
|
HC PLASTY BALLOON/XXL/MAXI
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$230.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna of CA HMO |
$805.00
|
| Rate for Payer: Cigna of CA PPO |
$805.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$805.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$460.00
|
| Rate for Payer: EPIC Health Plan Senior |
$460.00
|
| Rate for Payer: Galaxy Health WC |
$977.50
|
| Rate for Payer: Global Benefits Group Commercial |
$690.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$730.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$678.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.00
|
| Rate for Payer: Multiplan Commercial |
$920.00
|
| Rate for Payer: Networks By Design Commercial |
$575.00
|
| Rate for Payer: Prime Health Services Commercial |
$977.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$431.60
|
| Rate for Payer: United Healthcare All Other HMO |
$420.10
|
| Rate for Payer: United Healthcare HMO Rider |
$411.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$376.62
|
|
|
HC PLATELET AGGREGATION ASA
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 85576 QW,91
|
| Hospital Charge Code |
900912034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$62.60 |
| Max. Negotiated Rate |
$266.05 |
| Rate for Payer: Adventist Health Commercial |
$62.60
|
| Rate for Payer: Cash Price |
$140.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$219.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.20
|
| Rate for Payer: EPIC Health Plan Senior |
$125.20
|
| Rate for Payer: Galaxy Health WC |
$266.05
|
| Rate for Payer: Global Benefits Group Commercial |
$187.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$198.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.12
|
| Rate for Payer: Multiplan Commercial |
$250.40
|
| Rate for Payer: Networks By Design Commercial |
$203.45
|
| Rate for Payer: Prime Health Services Commercial |
$266.05
|
|
|
HC PLATELET AGGREGATION ASA
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
CPT 85576 QW,91
|
| Hospital Charge Code |
900912034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$266.05 |
| Rate for Payer: Adventist Health Commercial |
$62.60
|
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$178.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$178.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$189.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$266.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$172.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$167.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$234.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.38
|
| Rate for Payer: Blue Shield of California Commercial |
$218.16
|
| Rate for Payer: Blue Shield of California Commercial |
$155.43
|
| Rate for Payer: Blue Shield of California Commercial |
$102.80
|
| Rate for Payer: Blue Shield of California Commercial |
$144.29
|
| Rate for Payer: Cash Price |
$140.85
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Cash Price |
$140.85
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Cigna of CA HMO |
$200.32
|
| Rate for Payer: Cigna of CA HMO |
$142.72
|
| Rate for Payer: Cigna of CA PPO |
$165.02
|
| Rate for Payer: Cigna of CA PPO |
$231.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$189.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$266.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$189.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$266.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$189.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$266.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$219.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$156.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.20
|
| Rate for Payer: EPIC Health Plan Senior |
$125.20
|
| Rate for Payer: EPIC Health Plan Senior |
$89.20
|
| Rate for Payer: Galaxy Health WC |
$266.05
|
| Rate for Payer: Galaxy Health WC |
$189.55
|
| Rate for Payer: Global Benefits Group Commercial |
$133.80
|
| Rate for Payer: Global Benefits Group Commercial |
$187.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$198.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$141.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$131.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$156.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$156.10
|
| Rate for Payer: Multiplan Commercial |
$250.40
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: Networks By Design Commercial |
$144.95
|
| Rate for Payer: Networks By Design Commercial |
$203.45
|
| Rate for Payer: Prime Health Services Commercial |
$266.05
|
| Rate for Payer: Prime Health Services Commercial |
$189.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$187.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$187.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.18
|
| Rate for Payer: United Healthcare All Other HMO |
$20.18
|
| Rate for Payer: United Healthcare All Other HMO |
$20.18
|
| Rate for Payer: United Healthcare HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$266.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$189.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$189.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$266.05
|
| Rate for Payer: Vantage Medical Group Senior |
$266.05
|
| Rate for Payer: Vantage Medical Group Senior |
$189.55
|
|
|
HC PLATELET AGGREGATION PRU P2Y12
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT 85576 91
|
| Hospital Charge Code |
900912033
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$353.60 |
| Rate for Payer: Adventist Health Commercial |
$83.20
|
| Rate for Payer: Adventist Health Commercial |
$61.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$178.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$178.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$262.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$353.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$169.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$312.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.38
|
| Rate for Payer: Blue Shield of California Commercial |
$289.95
|
| Rate for Payer: Blue Shield of California Commercial |
$215.37
|
| Rate for Payer: Blue Shield of California Commercial |
$142.45
|
| Rate for Payer: Blue Shield of California Commercial |
$191.78
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$139.05
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$139.05
|
| Rate for Payer: Cigna of CA HMO |
$266.24
|
| Rate for Payer: Cigna of CA HMO |
$197.76
|
| Rate for Payer: Cigna of CA PPO |
$228.66
|
| Rate for Payer: Cigna of CA PPO |
$307.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$262.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$353.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$262.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$262.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$353.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$291.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$216.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.60
|
| Rate for Payer: EPIC Health Plan Senior |
$166.40
|
| Rate for Payer: EPIC Health Plan Senior |
$123.60
|
| Rate for Payer: Galaxy Health WC |
$353.60
|
| Rate for Payer: Galaxy Health WC |
$262.65
|
| Rate for Payer: Global Benefits Group Commercial |
$185.40
|
| Rate for Payer: Global Benefits Group Commercial |
$249.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$264.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$196.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$245.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$291.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$216.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$216.30
|
| Rate for Payer: Multiplan Commercial |
$332.80
|
| Rate for Payer: Multiplan Commercial |
$247.20
|
| Rate for Payer: Networks By Design Commercial |
$200.85
|
| Rate for Payer: Networks By Design Commercial |
$270.40
|
| Rate for Payer: Prime Health Services Commercial |
$353.60
|
| Rate for Payer: Prime Health Services Commercial |
$262.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$185.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$249.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$249.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$185.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.18
|
| Rate for Payer: United Healthcare All Other HMO |
$20.18
|
| Rate for Payer: United Healthcare All Other HMO |
$20.18
|
| Rate for Payer: United Healthcare HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$353.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$262.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$262.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.60
|
| Rate for Payer: Vantage Medical Group Senior |
$353.60
|
| Rate for Payer: Vantage Medical Group Senior |
$262.65
|
|
|
HC PLATELET AGGREGATION PRU P2Y12
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT 85576 91
|
| Hospital Charge Code |
900912033
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$353.60 |
| Rate for Payer: Adventist Health Commercial |
$83.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$291.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.40
|
| Rate for Payer: EPIC Health Plan Senior |
$166.40
|
| Rate for Payer: Galaxy Health WC |
$353.60
|
| Rate for Payer: Global Benefits Group Commercial |
$249.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$264.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$245.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.84
|
| Rate for Payer: Multiplan Commercial |
$332.80
|
| Rate for Payer: Networks By Design Commercial |
$270.40
|
| Rate for Payer: Prime Health Services Commercial |
$353.60
|
|
|
HC PLATELET COUNT
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
900910101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$101.15 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.19
|
| 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 Commercial/Exchange |
$6.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.93
|
| 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: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.21
|
| Rate for Payer: Blue Shield of California Commercial |
$14.75
|
| Rate for Payer: Blue Shield of California Commercial |
$54.86
|
| Rate for Payer: Blue Shield of California Commercial |
$22.30
|
| Rate for Payer: Blue Shield of California Commercial |
$82.94
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Cigna of CA HMO |
$20.48
|
| Rate for Payer: Cigna of CA HMO |
$76.16
|
| Rate for Payer: Cigna of CA PPO |
$88.06
|
| Rate for Payer: Cigna of CA PPO |
$23.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.39
|
| Rate for Payer: EPIC Health Plan Senior |
$4.93
|
| Rate for Payer: EPIC Health Plan Senior |
$4.93
|
| Rate for Payer: Galaxy Health WC |
$101.15
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Global Benefits Group Commercial |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.35
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$25.60
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: Networks By Design Commercial |
$77.35
|
| Rate for Payer: Prime Health Services Commercial |
$101.15
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.63
|
| 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 All Other HMO |
$3.63
|
| Rate for Payer: United Healthcare HMO Rider |
$3.63
|
| Rate for Payer: United Healthcare HMO Rider |
$3.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.63
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.72
|
| 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 Medi-Cal |
$4.93
|
| Rate for Payer: Vantage Medical Group Senior |
$4.48
|
| Rate for Payer: Vantage Medical Group Senior |
$4.48
|
|
|
HC PLATELET COUNT
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
900910101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$101.15 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.60
|
| Rate for Payer: EPIC Health Plan Senior |
$47.60
|
| Rate for Payer: Galaxy Health WC |
$101.15
|
| Rate for Payer: Global Benefits Group Commercial |
$71.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.56
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: Networks By Design Commercial |
$77.35
|
| Rate for Payer: Prime Health Services Commercial |
$101.15
|
|
|
HC PLATELET COUNT CITRATED
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
900912026
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$101.15 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.60
|
| Rate for Payer: EPIC Health Plan Senior |
$47.60
|
| Rate for Payer: Galaxy Health WC |
$101.15
|
| Rate for Payer: Global Benefits Group Commercial |
$71.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.56
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: Networks By Design Commercial |
$77.35
|
| Rate for Payer: Prime Health Services Commercial |
$101.15
|
|
|
HC PLATELET COUNT CITRATED
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
900912026
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$101.15 |
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Cigna of CA HMO |
$20.48
|
| Rate for Payer: Cigna of CA HMO |
$76.16
|
| Rate for Payer: Cigna of CA PPO |
$88.06
|
| Rate for Payer: Cigna of CA PPO |
$23.68
|
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.19
|
| 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 Commercial/Exchange |
$6.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.93
|
| 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: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.21
|
| Rate for Payer: Blue Shield of California Commercial |
$14.75
|
| Rate for Payer: Blue Shield of California Commercial |
$54.86
|
| Rate for Payer: Blue Shield of California Commercial |
$22.30
|
| Rate for Payer: Blue Shield of California Commercial |
$82.94
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.39
|
| Rate for Payer: EPIC Health Plan Senior |
$4.93
|
| Rate for Payer: EPIC Health Plan Senior |
$4.93
|
| Rate for Payer: Galaxy Health WC |
$101.15
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Global Benefits Group Commercial |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.35
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$25.60
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: Networks By Design Commercial |
$77.35
|
| Rate for Payer: Prime Health Services Commercial |
$101.15
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.63
|
| 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 All Other HMO |
$3.63
|
| Rate for Payer: United Healthcare HMO Rider |
$3.63
|
| Rate for Payer: United Healthcare HMO Rider |
$3.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.63
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.72
|
| 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 Medi-Cal |
$4.93
|
| Rate for Payer: Vantage Medical Group Senior |
$4.48
|
| Rate for Payer: Vantage Medical Group Senior |
$4.48
|
|
|
HC PLATELET NEUTRALIZATION
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
900912007
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC PLATELET NEUTRALIZATION
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
900912007
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$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 Commercial/Exchange |
$26.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.78
|
| 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: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.60
|
| Rate for Payer: Blue Shield of California Commercial |
$29.96
|
| Rate for Payer: Blue Shield of California Commercial |
$161.35
|
| Rate for Payer: Blue Shield of California Commercial |
$45.30
|
| Rate for Payer: Blue Shield of California Commercial |
$243.95
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$41.60
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Cigna of CA PPO |
$48.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.67
|
| Rate for Payer: EPIC Health Plan Senior |
$19.78
|
| Rate for Payer: EPIC Health Plan Senior |
$19.78
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$52.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.56
|
| 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 All Other HMO |
$14.56
|
| Rate for Payer: United Healthcare HMO Rider |
$14.56
|
| Rate for Payer: United Healthcare HMO Rider |
$14.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.97
|
| 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 Medi-Cal |
$19.78
|
| Rate for Payer: Vantage Medical Group Senior |
$17.98
|
| Rate for Payer: Vantage Medical Group Senior |
$17.98
|
|
|
HC PLATELET SURVIVAL
|
Facility
|
OP
|
$848.00
|
|
|
Service Code
|
CPT 78191
|
| Hospital Charge Code |
909301642
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$169.60 |
| Max. Negotiated Rate |
$1,054.16 |
| Rate for Payer: Adventist Health Commercial |
$169.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,054.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$544.16
|
| Rate for Payer: Blue Shield of California Commercial |
$541.02
|
| Rate for Payer: Blue Shield of California Commercial |
$357.01
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Cigna of CA HMO |
$542.72
|
| Rate for Payer: Cigna of CA PPO |
$627.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$593.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$720.80
|
| Rate for Payer: Global Benefits Group Commercial |
$508.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$193.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$538.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$219.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$647.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$678.40
|
| Rate for Payer: Networks By Design Commercial |
$551.20
|
| Rate for Payer: Prime Health Services Commercial |
$720.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$508.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$508.80
|
| 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: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC PLATELET SURVIVAL
|
Facility
|
IP
|
$848.00
|
|
|
Service Code
|
CPT 78191
|
| Hospital Charge Code |
909301642
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$169.60 |
| Max. Negotiated Rate |
$720.80 |
| Rate for Payer: Adventist Health Commercial |
$169.60
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$593.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$339.20
|
| Rate for Payer: EPIC Health Plan Senior |
$339.20
|
| Rate for Payer: Galaxy Health WC |
$720.80
|
| Rate for Payer: Global Benefits Group Commercial |
$508.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$538.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$500.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.52
|
| Rate for Payer: Multiplan Commercial |
$678.40
|
| Rate for Payer: Networks By Design Commercial |
$551.20
|
| Rate for Payer: Prime Health Services Commercial |
$720.80
|
|
|
HC PLCMNT ACC BILIARY TREE PERCU
|
Facility
|
OP
|
$7,427.00
|
|
|
Service Code
|
CPT 47541
|
| Hospital Charge Code |
909047541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,485.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,485.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,489.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,159.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,326.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Cash Price |
$3,342.15
|
| Rate for Payer: Cash Price |
$3,342.15
|
| Rate for Payer: Cash Price |
$3,342.15
|
| Rate for Payer: Cigna of CA HMO |
$4,753.28
|
| Rate for Payer: Cigna of CA PPO |
$5,495.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,489.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,159.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,326.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,198.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,738.58
|
| Rate for Payer: EPIC Health Plan Senior |
$9,159.05
|
| Rate for Payer: Galaxy Health WC |
$6,312.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,456.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13,655.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,816.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,326.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,716.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,054.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,656.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,782.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,491.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,157.39
|
| Rate for Payer: Multiplan Commercial |
$5,941.60
|
| Rate for Payer: Multiplan WC |
$12,632.22
|
| Rate for Payer: Networks By Design Commercial |
$4,827.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,312.95
|
| Rate for Payer: Prime Health Services WC |
$12,503.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,456.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,713.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$8,326.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,489.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,159.05
|
| Rate for Payer: Vantage Medical Group Senior |
$8,326.41
|
|
|
HC PLCMNT ACC BILIARY TREE PERCU
|
Facility
|
IP
|
$7,427.00
|
|
|
Service Code
|
CPT 47541
|
| Hospital Charge Code |
909047541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,485.40 |
| Max. Negotiated Rate |
$6,312.95 |
| Rate for Payer: Adventist Health Commercial |
$1,485.40
|
| Rate for Payer: Cash Price |
$3,342.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,198.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,970.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,970.80
|
| Rate for Payer: Galaxy Health WC |
$6,312.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,456.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,716.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,381.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,782.48
|
| Rate for Payer: Multiplan Commercial |
$5,941.60
|
| Rate for Payer: Networks By Design Commercial |
$4,827.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,312.95
|
|
|
HC PLCMNT LCL DVC PERC 1ST LESION
|
Facility
|
IP
|
$1,527.00
|
|
|
Service Code
|
CPT 10035
|
| Hospital Charge Code |
909010035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$305.40 |
| Max. Negotiated Rate |
$1,297.95 |
| Rate for Payer: Adventist Health Commercial |
$305.40
|
| Rate for Payer: Cash Price |
$687.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,068.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$610.80
|
| Rate for Payer: EPIC Health Plan Senior |
$610.80
|
| Rate for Payer: Galaxy Health WC |
$1,297.95
|
| Rate for Payer: Global Benefits Group Commercial |
$916.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$969.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$900.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.48
|
| Rate for Payer: Multiplan Commercial |
$1,221.60
|
| Rate for Payer: Networks By Design Commercial |
$992.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,297.95
|
|
|
HC PLCMNT LCL DVC PERC 1ST LESION
|
Facility
|
OP
|
$1,527.00
|
|
|
Service Code
|
CPT 10035
|
| Hospital Charge Code |
909010035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$305.40 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$305.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$550.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$974.23
|
| Rate for Payer: Blue Shield of California Commercial |
$642.87
|
| Rate for Payer: Cash Price |
$687.15
|
| Rate for Payer: Cash Price |
$687.15
|
| Rate for Payer: Cash Price |
$687.15
|
| Rate for Payer: Cigna of CA HMO |
$977.28
|
| Rate for Payer: Cigna of CA PPO |
$1,129.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,068.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$1,297.95
|
| Rate for Payer: Global Benefits Group Commercial |
$916.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$827.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$969.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$935.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,147.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$1,221.60
|
| Rate for Payer: Networks By Design Commercial |
$992.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,297.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$916.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$916.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$763.50
|
| Rate for Payer: United Healthcare All Other HMO |
$763.50
|
| Rate for Payer: United Healthcare HMO Rider |
$763.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$763.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC PLCMNT LCL DVC PERC ADD LESION
|
Facility
|
OP
|
$763.00
|
|
|
Service Code
|
CPT 10036
|
| Hospital Charge Code |
909010036
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$152.60 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$152.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$277.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$648.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$419.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$572.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$321.22
|
| Rate for Payer: Blue Shield of California Commercial |
$486.79
|
| Rate for Payer: Cash Price |
$343.35
|
| Rate for Payer: Cash Price |
$343.35
|
| Rate for Payer: Cash Price |
$343.35
|
| Rate for Payer: Cigna of CA HMO |
$488.32
|
| Rate for Payer: Cigna of CA PPO |
$564.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$648.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$648.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$648.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$534.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.20
|
| Rate for Payer: EPIC Health Plan Senior |
$305.20
|
| Rate for Payer: Galaxy Health WC |
$648.55
|
| Rate for Payer: Global Benefits Group Commercial |
$457.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$723.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$484.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$818.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$450.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$534.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$534.10
|
| Rate for Payer: Multiplan Commercial |
$610.40
|
| Rate for Payer: Networks By Design Commercial |
$495.95
|
| Rate for Payer: Prime Health Services Commercial |
$648.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$457.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$457.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$381.50
|
| Rate for Payer: United Healthcare All Other HMO |
$381.50
|
| Rate for Payer: United Healthcare HMO Rider |
$381.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$381.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$648.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$648.55
|
| Rate for Payer: Vantage Medical Group Senior |
$648.55
|
|
|
HC PLCMNT LCL DVC PERC ADD LESION
|
Facility
|
IP
|
$763.00
|
|
|
Service Code
|
CPT 10036
|
| Hospital Charge Code |
909010036
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$152.60 |
| Max. Negotiated Rate |
$648.55 |
| Rate for Payer: Adventist Health Commercial |
$152.60
|
| Rate for Payer: Cash Price |
$343.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$534.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.20
|
| Rate for Payer: EPIC Health Plan Senior |
$305.20
|
| Rate for Payer: Galaxy Health WC |
$648.55
|
| Rate for Payer: Global Benefits Group Commercial |
$457.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$484.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$450.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.12
|
| Rate for Payer: Multiplan Commercial |
$610.40
|
| Rate for Payer: Networks By Design Commercial |
$495.95
|
| Rate for Payer: Prime Health Services Commercial |
$648.55
|
|
|
HC PLCMNT NEPH CATH PERCU
|
Facility
|
IP
|
$8,942.00
|
|
|
Service Code
|
CPT 50432
|
| Hospital Charge Code |
909050432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,788.40 |
| Max. Negotiated Rate |
$7,600.70 |
| Rate for Payer: Adventist Health Commercial |
$1,788.40
|
| Rate for Payer: Cash Price |
$4,023.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,259.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,576.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,576.80
|
| Rate for Payer: Galaxy Health WC |
$7,600.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,365.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,678.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,275.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,146.08
|
| Rate for Payer: Multiplan Commercial |
$7,153.60
|
| Rate for Payer: Networks By Design Commercial |
$5,812.30
|
| Rate for Payer: Prime Health Services Commercial |
$7,600.70
|
|
|
HC PLCMNT NEPH CATH PERCU
|
Facility
|
OP
|
$8,942.00
|
|
|
Service Code
|
CPT 50432
|
| Hospital Charge Code |
909050432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,299.72 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,788.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$4,023.90
|
| Rate for Payer: Cash Price |
$4,023.90
|
| Rate for Payer: Cash Price |
$4,023.90
|
| Rate for Payer: Cigna of CA HMO |
$5,722.88
|
| Rate for Payer: Cigna of CA PPO |
$6,617.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,259.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,436.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,957.44
|
| Rate for Payer: Galaxy Health WC |
$7,600.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,365.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,299.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,678.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,469.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,764.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,146.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,387.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$7,153.60
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$5,812.30
|
| Rate for Payer: Prime Health Services Commercial |
$7,600.70
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,365.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,471.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,688.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
HC PLCMNT NEPHU CATH PERCU
|
Facility
|
OP
|
$5,139.00
|
|
|
Service Code
|
CPT 50433
|
| Hospital Charge Code |
909050433
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,027.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,027.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,533.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$2,312.55
|
| Rate for Payer: Cash Price |
$2,312.55
|
| Rate for Payer: Cash Price |
$2,312.55
|
| Rate for Payer: Cigna of CA HMO |
$3,288.96
|
| Rate for Payer: Cigna of CA PPO |
$3,802.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,987.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,533.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,597.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,480.62
|
| Rate for Payer: EPIC Health Plan Senior |
$4,987.08
|
| Rate for Payer: Galaxy Health WC |
$4,368.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,083.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,435.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,752.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,263.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,982.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,347.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,233.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,712.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,075.17
|
| Rate for Payer: Multiplan Commercial |
$4,111.20
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: Networks By Design Commercial |
$3,340.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,368.15
|
| Rate for Payer: Prime Health Services WC |
$6,911.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,083.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,569.50
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,533.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Vantage Medical Group Senior |
$4,533.71
|
|
