|
HC TRANSCATH TRICUSP VALVE REPAIR
|
Facility
|
IP
|
$66,433.00
|
|
|
Service Code
|
CPT 0569T
|
| Hospital Charge Code |
906810569
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$13,286.60 |
| Max. Negotiated Rate |
$59,789.70 |
| Rate for Payer: Adventist Health Commercial |
$13,286.60
|
| Rate for Payer: Cash Price |
$36,538.15
|
| Rate for Payer: Central Health Plan Commercial |
$53,146.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$26,573.20
|
| Rate for Payer: EPIC Health Plan Senior |
$26,573.20
|
| Rate for Payer: Galaxy Health WC |
$56,468.05
|
| Rate for Payer: Global Benefits Group Commercial |
$39,859.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$59,789.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44,310.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25,310.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41,122.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,286.60
|
| Rate for Payer: Multiplan Commercial |
$49,824.75
|
| Rate for Payer: Networks By Design Commercial |
$43,181.45
|
| Rate for Payer: Prime Health Services Commercial |
$56,468.05
|
|
|
HC TRANSCATH TRICUSP VALVE REPAIR
|
Facility
|
OP
|
$66,433.00
|
|
|
Service Code
|
CPT 0569T
|
| Hospital Charge Code |
906810569
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$59,789.70 |
| Rate for Payer: Adventist Health Commercial |
$13,286.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56,468.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36,538.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49,824.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32,166.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39,016.10
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$36,538.15
|
| Rate for Payer: Cash Price |
$36,538.15
|
| Rate for Payer: Central Health Plan Commercial |
$53,146.40
|
| Rate for Payer: Cigna of CA HMO |
$42,517.12
|
| Rate for Payer: Cigna of CA PPO |
$49,160.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56,468.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$56,468.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56,468.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$26,573.20
|
| Rate for Payer: EPIC Health Plan Senior |
$26,573.20
|
| Rate for Payer: Galaxy Health WC |
$56,468.05
|
| Rate for Payer: Global Benefits Group Commercial |
$39,859.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$59,789.70
|
| Rate for Payer: InnovAge PACE Commercial |
$33,216.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44,310.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25,310.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41,122.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,286.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46,503.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46,503.10
|
| Rate for Payer: Multiplan Commercial |
$49,824.75
|
| Rate for Payer: Networks By Design Commercial |
$43,181.45
|
| Rate for Payer: Prime Health Services Commercial |
$56,468.05
|
| Rate for Payer: Riverside University Health System MISP |
$26,573.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39,859.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56,468.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56,468.05
|
| Rate for Payer: Vantage Medical Group Senior |
$56,468.05
|
|
|
HC TRANSCRANIAL DUPLEX/DOPPLER
|
Facility
|
IP
|
$2,204.00
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
906601143
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$440.80 |
| Max. Negotiated Rate |
$1,983.60 |
| Rate for Payer: Adventist Health Commercial |
$440.80
|
| Rate for Payer: Cash Price |
$1,212.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,763.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$881.60
|
| Rate for Payer: EPIC Health Plan Senior |
$881.60
|
| Rate for Payer: Galaxy Health WC |
$1,873.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,322.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,983.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,470.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$839.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,364.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.80
|
| Rate for Payer: Multiplan Commercial |
$1,653.00
|
| Rate for Payer: Networks By Design Commercial |
$1,432.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,873.40
|
|
|
HC TRANSCRANIAL DUPLEX/DOPPLER
|
Facility
|
OP
|
$1,090.00
|
|
|
Service Code
|
CPT 93888
|
| Hospital Charge Code |
906601144
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$1,588.00 |
| Rate for Payer: Adventist Health Commercial |
$218.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$661.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$642.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$640.16
|
| Rate for Payer: Blue Shield of California Commercial |
$661.63
|
| Rate for Payer: Blue Shield of California EPN |
$432.73
|
| Rate for Payer: Cash Price |
$599.50
|
| Rate for Payer: Cash Price |
$599.50
|
| Rate for Payer: Cash Price |
$599.50
|
| Rate for Payer: Central Health Plan Commercial |
$872.00
|
| Rate for Payer: Cigna of CA HMO |
$697.60
|
| Rate for Payer: Cigna of CA PPO |
$806.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$926.50
|
| Rate for Payer: Global Benefits Group Commercial |
$654.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$981.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$223.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$727.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$817.50
|
| Rate for Payer: Networks By Design Commercial |
$708.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$926.50
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$654.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$654.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC TRANSCRANIAL DUPLEX/DOPPLER
|
Facility
|
OP
|
$2,204.00
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
906601143
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$1,983.60 |
| Rate for Payer: Adventist Health Commercial |
$440.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,338.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$974.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,294.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1,337.83
|
| Rate for Payer: Blue Shield of California EPN |
$874.99
|
| Rate for Payer: Cash Price |
$1,212.20
|
| Rate for Payer: Cash Price |
$1,212.20
|
| Rate for Payer: Cash Price |
$1,212.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,763.20
|
| Rate for Payer: Cigna of CA HMO |
$1,410.56
|
| Rate for Payer: Cigna of CA PPO |
$1,630.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$1,873.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,322.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,983.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$336.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: InnovAge PACE Commercial |
$460.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,470.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$1,653.00
|
| Rate for Payer: Networks By Design Commercial |
$1,432.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$1,873.40
|
| Rate for Payer: Prime Health Services Medicare |
$325.56
|
| Rate for Payer: Riverside University Health System MISP |
$337.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,322.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,322.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC TRANSCRANIAL DUPLEX/DOPPLER
|
Facility
|
IP
|
$1,090.00
|
|
|
Service Code
|
CPT 93888
|
| Hospital Charge Code |
906601144
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$218.00 |
| Max. Negotiated Rate |
$981.00 |
| Rate for Payer: Adventist Health Commercial |
$218.00
|
| Rate for Payer: Cash Price |
$599.50
|
| Rate for Payer: Central Health Plan Commercial |
$872.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$436.00
|
| Rate for Payer: EPIC Health Plan Senior |
$436.00
|
| Rate for Payer: Galaxy Health WC |
$926.50
|
| Rate for Payer: Global Benefits Group Commercial |
$654.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$981.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$727.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.00
|
| Rate for Payer: Multiplan Commercial |
$817.50
|
| Rate for Payer: Networks By Design Commercial |
$708.50
|
| Rate for Payer: Prime Health Services Commercial |
$926.50
|
|
|
HC TRANSDUCER PED A-LINE CVP
|
Facility
|
OP
|
$241.64
|
|
| Hospital Charge Code |
901604261
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.33 |
| Max. Negotiated Rate |
$217.48 |
| Rate for Payer: Adventist Health Commercial |
$48.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$132.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$181.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.92
|
| Rate for Payer: Blue Shield of California Commercial |
$147.64
|
| Rate for Payer: Blue Shield of California EPN |
$96.41
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Central Health Plan Commercial |
$193.31
|
| Rate for Payer: Cigna of CA HMO |
$154.65
|
| Rate for Payer: Cigna of CA PPO |
$178.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$205.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$205.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.66
|
| Rate for Payer: EPIC Health Plan Senior |
$96.66
|
| Rate for Payer: Galaxy Health WC |
$205.39
|
| Rate for Payer: Global Benefits Group Commercial |
$144.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.48
|
| Rate for Payer: InnovAge PACE Commercial |
$120.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$169.15
|
| Rate for Payer: Multiplan Commercial |
$181.23
|
| Rate for Payer: Networks By Design Commercial |
$157.07
|
| Rate for Payer: Prime Health Services Commercial |
$205.39
|
| Rate for Payer: Riverside University Health System MISP |
$96.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$144.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$144.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$120.82
|
| Rate for Payer: United Healthcare All Other HMO |
$120.82
|
| Rate for Payer: United Healthcare HMO Rider |
$120.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.39
|
| Rate for Payer: Vantage Medical Group Senior |
$205.39
|
|
|
HC TRANSDUCER PED A-LINE CVP
|
Facility
|
IP
|
$241.64
|
|
| Hospital Charge Code |
901604261
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.33 |
| Max. Negotiated Rate |
$217.48 |
| Rate for Payer: Adventist Health Commercial |
$48.33
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Central Health Plan Commercial |
$193.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.66
|
| Rate for Payer: EPIC Health Plan Senior |
$96.66
|
| Rate for Payer: Galaxy Health WC |
$205.39
|
| Rate for Payer: Global Benefits Group Commercial |
$144.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.33
|
| Rate for Payer: Multiplan Commercial |
$181.23
|
| Rate for Payer: Networks By Design Commercial |
$157.07
|
| Rate for Payer: Prime Health Services Commercial |
$205.39
|
|
|
HC TRANSESOPHOGEAL CARDIAC OUTPUT
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
900800525
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$168.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$510.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$406.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$493.33
|
| Rate for Payer: Blue Shield of California Commercial |
$509.88
|
| Rate for Payer: Blue Shield of California EPN |
$333.48
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Central Health Plan Commercial |
$672.00
|
| Rate for Payer: Cigna of CA HMO |
$537.60
|
| Rate for Payer: Cigna of CA PPO |
$621.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$756.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$630.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
| Rate for Payer: Prime Health Services Medicare |
$210.73
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$504.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$504.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC TRANSESOPHOGEAL CARDIAC OUTPUT
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
900800525
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Adventist Health Commercial |
$168.00
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Central Health Plan Commercial |
$672.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: EPIC Health Plan Senior |
$336.00
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$756.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$519.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$630.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
|
|
HC TRANSFERRIN
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
900910854
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Central Health Plan Commercial |
$86.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Senior |
$43.20
|
| Rate for Payer: Galaxy Health WC |
$91.80
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$81.00
|
| Rate for Payer: Networks By Design Commercial |
$70.20
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
|
|
HC TRANSFERRIN
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
900910854
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.40
|
| Rate for Payer: Blue Shield of California Commercial |
$65.56
|
| Rate for Payer: Blue Shield of California EPN |
$42.88
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Central Health Plan Commercial |
$86.40
|
| Rate for Payer: Cigna of CA HMO |
$69.12
|
| Rate for Payer: Cigna of CA PPO |
$79.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.23
|
| Rate for Payer: EPIC Health Plan Senior |
$12.76
|
| Rate for Payer: Galaxy Health WC |
$91.80
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.76
|
| Rate for Payer: InnovAge PACE Commercial |
$19.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.10
|
| Rate for Payer: Multiplan Commercial |
$81.00
|
| Rate for Payer: Networks By Design Commercial |
$70.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.76
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
| Rate for Payer: Prime Health Services Medicare |
$13.53
|
| Rate for Payer: Riverside University Health System MISP |
$14.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.33
|
| Rate for Payer: United Healthcare All Other HMO |
$10.33
|
| Rate for Payer: United Healthcare HMO Rider |
$10.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.33
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.04
|
| Rate for Payer: Vantage Medical Group Senior |
$12.76
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
OP
|
$3,391.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
906536430
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$555.48 |
| Max. Negotiated Rate |
$3,051.90 |
| Rate for Payer: Adventist Health Commercial |
$678.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$555.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,641.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,071.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,353.01
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,712.80
|
| Rate for Payer: Cigna of CA HMO |
$2,170.24
|
| Rate for Payer: Cigna of CA PPO |
$2,509.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| Rate for Payer: Galaxy Health WC |
$2,882.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,034.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,051.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: InnovAge PACE Commercial |
$833.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,261.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,291.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$744.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| Rate for Payer: Multiplan Commercial |
$2,543.25
|
| Rate for Payer: Networks By Design Commercial |
$2,204.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$555.48
|
| Rate for Payer: Prime Health Services Commercial |
$2,882.35
|
| Rate for Payer: Prime Health Services Medicare |
$588.81
|
| Rate for Payer: Riverside University Health System MISP |
$611.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,034.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,034.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
OP
|
$3,391.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$3,051.90 |
| Rate for Payer: Adventist Health Commercial |
$678.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$885.06
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,712.80
|
| Rate for Payer: Cigna of CA HMO |
$2,170.24
|
| Rate for Payer: Cigna of CA PPO |
$2,509.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| Rate for Payer: Galaxy Health WC |
$2,882.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,034.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,051.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: InnovAge PACE Commercial |
$833.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,261.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,291.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$744.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| Rate for Payer: Multiplan Commercial |
$2,543.25
|
| Rate for Payer: Multiplan WC |
$885.06
|
| Rate for Payer: Networks By Design Commercial |
$2,204.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$555.48
|
| Rate for Payer: Preferred Health Network WC |
$903.12
|
| Rate for Payer: Prime Health Services Commercial |
$2,882.35
|
| Rate for Payer: Prime Health Services Medicare |
$588.81
|
| Rate for Payer: Prime Health Services WC |
$876.03
|
| Rate for Payer: Riverside University Health System MISP |
$611.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,034.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,695.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,695.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,695.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,695.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
IP
|
$3,391.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$678.20 |
| Max. Negotiated Rate |
$3,051.90 |
| Rate for Payer: Adventist Health Commercial |
$678.20
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,712.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,356.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,356.40
|
| Rate for Payer: Galaxy Health WC |
$2,882.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,034.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,051.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,261.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,291.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,099.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.20
|
| Rate for Payer: Multiplan Commercial |
$2,543.25
|
| Rate for Payer: Networks By Design Commercial |
$2,204.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,882.35
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
OP
|
$3,391.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$555.48 |
| Max. Negotiated Rate |
$3,051.90 |
| Rate for Payer: Adventist Health Commercial |
$678.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$555.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,641.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,071.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,353.01
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,712.80
|
| Rate for Payer: Cigna of CA HMO |
$2,170.24
|
| Rate for Payer: Cigna of CA PPO |
$2,509.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| Rate for Payer: Galaxy Health WC |
$2,882.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,034.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,051.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: InnovAge PACE Commercial |
$833.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,261.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,291.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$744.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| Rate for Payer: Multiplan Commercial |
$2,543.25
|
| Rate for Payer: Networks By Design Commercial |
$2,204.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$555.48
|
| Rate for Payer: Prime Health Services Commercial |
$2,882.35
|
| Rate for Payer: Prime Health Services Medicare |
$588.81
|
| Rate for Payer: Riverside University Health System MISP |
$611.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,034.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,034.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
IP
|
$3,391.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
906536430
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$678.20 |
| Max. Negotiated Rate |
$3,051.90 |
| Rate for Payer: Adventist Health Commercial |
$678.20
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,712.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,356.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,356.40
|
| Rate for Payer: Galaxy Health WC |
$2,882.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,034.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,051.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,261.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,291.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,099.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.20
|
| Rate for Payer: Multiplan Commercial |
$2,543.25
|
| Rate for Payer: Networks By Design Commercial |
$2,204.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,882.35
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
IP
|
$3,391.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$678.20 |
| Max. Negotiated Rate |
$3,051.90 |
| Rate for Payer: Adventist Health Commercial |
$678.20
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,712.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,356.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,356.40
|
| Rate for Payer: Galaxy Health WC |
$2,882.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,034.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,051.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,261.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,291.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,099.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.20
|
| Rate for Payer: Multiplan Commercial |
$2,543.25
|
| Rate for Payer: Networks By Design Commercial |
$2,204.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,882.35
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
OP
|
$3,391.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$3,051.90 |
| Rate for Payer: Adventist Health Commercial |
$1,390.31
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$885.06
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,712.80
|
| Rate for Payer: Cigna of CA HMO |
$2,170.24
|
| Rate for Payer: Cigna of CA PPO |
$2,509.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| Rate for Payer: Galaxy Health WC |
$2,882.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,034.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,051.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: InnovAge PACE Commercial |
$833.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,261.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,291.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$744.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| Rate for Payer: Multiplan Commercial |
$2,543.25
|
| Rate for Payer: Multiplan WC |
$885.06
|
| Rate for Payer: Networks By Design Commercial |
$2,204.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$555.48
|
| Rate for Payer: Preferred Health Network WC |
$903.12
|
| Rate for Payer: Prime Health Services Commercial |
$2,882.35
|
| Rate for Payer: Prime Health Services Medicare |
$588.81
|
| Rate for Payer: Prime Health Services WC |
$876.03
|
| Rate for Payer: Riverside University Health System MISP |
$611.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,034.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,034.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
IP
|
$3,391.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$678.20 |
| Max. Negotiated Rate |
$3,051.90 |
| Rate for Payer: Adventist Health Commercial |
$678.20
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,712.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,356.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,356.40
|
| Rate for Payer: Galaxy Health WC |
$2,882.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,034.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,051.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,261.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,291.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,099.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.20
|
| Rate for Payer: Multiplan Commercial |
$2,543.25
|
| Rate for Payer: Networks By Design Commercial |
$2,204.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,882.35
|
|
|
HC TRANSFUS BLOOD OR BLOOD COMPONENT
|
Facility
|
OP
|
$3,391.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
940100115
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$555.48 |
| Max. Negotiated Rate |
$3,051.90 |
| Rate for Payer: Adventist Health Commercial |
$678.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$555.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,641.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,071.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,353.01
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,712.80
|
| Rate for Payer: Cigna of CA HMO |
$2,170.24
|
| Rate for Payer: Cigna of CA PPO |
$2,509.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| Rate for Payer: Galaxy Health WC |
$2,882.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,034.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,051.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: InnovAge PACE Commercial |
$833.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,261.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,291.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$744.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| Rate for Payer: Multiplan Commercial |
$2,543.25
|
| Rate for Payer: Networks By Design Commercial |
$2,204.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$555.48
|
| Rate for Payer: Prime Health Services Commercial |
$2,882.35
|
| Rate for Payer: Prime Health Services Medicare |
$588.81
|
| Rate for Payer: Riverside University Health System MISP |
$611.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,034.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,034.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC TRANSFUS BLOOD OR BLOOD COMPONENT
|
Facility
|
IP
|
$3,391.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
940100115
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$678.20 |
| Max. Negotiated Rate |
$3,051.90 |
| Rate for Payer: Adventist Health Commercial |
$678.20
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,712.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,356.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,356.40
|
| Rate for Payer: Galaxy Health WC |
$2,882.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,034.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,051.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,261.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,291.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,099.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.20
|
| Rate for Payer: Multiplan Commercial |
$2,543.25
|
| Rate for Payer: Networks By Design Commercial |
$2,204.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,882.35
|
|
|
HC TRANSFUS BLOOD OR BLOOD COMPONENT
|
Facility
|
OP
|
$3,391.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
949000307
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$555.48 |
| Max. Negotiated Rate |
$3,051.90 |
| Rate for Payer: Adventist Health Commercial |
$678.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$555.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,641.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,071.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,353.01
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,712.80
|
| Rate for Payer: Cigna of CA HMO |
$2,170.24
|
| Rate for Payer: Cigna of CA PPO |
$2,509.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| Rate for Payer: Galaxy Health WC |
$2,882.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,034.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,051.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: InnovAge PACE Commercial |
$833.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,261.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,291.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$744.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| Rate for Payer: Multiplan Commercial |
$2,543.25
|
| Rate for Payer: Networks By Design Commercial |
$2,204.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$555.48
|
| Rate for Payer: Prime Health Services Commercial |
$2,882.35
|
| Rate for Payer: Prime Health Services Medicare |
$588.81
|
| Rate for Payer: Riverside University Health System MISP |
$611.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,034.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,034.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC TRANSFUS BLOOD OR BLOOD COMPONENT
|
Facility
|
IP
|
$3,391.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
949000307
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$678.20 |
| Max. Negotiated Rate |
$3,051.90 |
| Rate for Payer: Adventist Health Commercial |
$678.20
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,712.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,356.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,356.40
|
| Rate for Payer: Galaxy Health WC |
$2,882.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,034.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,051.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,261.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,291.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,099.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.20
|
| Rate for Payer: Multiplan Commercial |
$2,543.25
|
| Rate for Payer: Networks By Design Commercial |
$2,204.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,882.35
|
|
|
HC TRANSFUS BLOOD OR BLOOD COMPONENTS
|
Facility
|
OP
|
$3,391.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
910100056
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$555.48 |
| Max. Negotiated Rate |
$3,051.90 |
| Rate for Payer: Adventist Health Commercial |
$678.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$555.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,641.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,071.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,353.01
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Cash Price |
$1,865.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,712.80
|
| Rate for Payer: Cigna of CA HMO |
$2,170.24
|
| Rate for Payer: Cigna of CA PPO |
$2,509.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| Rate for Payer: Galaxy Health WC |
$2,882.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,034.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,051.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: InnovAge PACE Commercial |
$833.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,261.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,291.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$744.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| Rate for Payer: Multiplan Commercial |
$2,543.25
|
| Rate for Payer: Networks By Design Commercial |
$2,204.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$555.48
|
| Rate for Payer: Prime Health Services Commercial |
$2,882.35
|
| Rate for Payer: Prime Health Services Medicare |
$588.81
|
| Rate for Payer: Riverside University Health System MISP |
$611.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,034.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,034.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
