|
HC BLEPHAROTOMY DRAIN ABSCESS EYE
|
Facility
|
IP
|
$1,732.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
900501547
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$346.40 |
| Max. Negotiated Rate |
$1,558.80 |
| Rate for Payer: Adventist Health Commercial |
$346.40
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,385.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,212.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$692.80
|
| Rate for Payer: EPIC Health Plan Senior |
$692.80
|
| Rate for Payer: Galaxy Health WC |
$1,472.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,039.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,558.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,099.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,021.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.40
|
| Rate for Payer: Multiplan Commercial |
$1,299.00
|
| Rate for Payer: Networks By Design Commercial |
$1,125.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,472.20
|
|
|
HC BLEPHAROTOMY DRAIN ABSCESS EYE
|
Facility
|
OP
|
$1,732.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
900501547
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$236.97 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$346.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$605.18
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,385.60
|
| Rate for Payer: Cigna of CA HMO |
$1,108.48
|
| Rate for Payer: Cigna of CA PPO |
$1,281.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,212.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$673.60
|
| Rate for Payer: EPIC Health Plan Senior |
$449.06
|
| Rate for Payer: Galaxy Health WC |
$1,472.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,039.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,558.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$669.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$408.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,099.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$236.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$438.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$547.04
|
| Rate for Payer: Multiplan Commercial |
$1,299.00
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$1,125.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$408.24
|
| Rate for Payer: Preferred Health Network WC |
$617.53
|
| Rate for Payer: Prime Health Services Commercial |
$1,472.20
|
| Rate for Payer: Prime Health Services Medicare |
$432.73
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Riverside University Health System MISP |
$449.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,039.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.00
|
| Rate for Payer: United Healthcare All Other HMO |
$866.00
|
| Rate for Payer: United Healthcare HMO Rider |
$866.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$408.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Vantage Medical Group Senior |
$408.24
|
|
|
HC BLEPHAROTOMY DRAIN ABSCESS EYE
|
Facility
|
OP
|
$1,732.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
900501547
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$236.97 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$710.12
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$617.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$605.18
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,385.60
|
| Rate for Payer: Cigna of CA HMO |
$1,108.48
|
| Rate for Payer: Cigna of CA PPO |
$1,281.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,212.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$673.60
|
| Rate for Payer: EPIC Health Plan Senior |
$449.06
|
| Rate for Payer: Galaxy Health WC |
$1,472.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,039.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,558.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$669.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$408.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,099.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$236.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$438.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$547.04
|
| Rate for Payer: Multiplan Commercial |
$1,299.00
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$1,125.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$408.24
|
| Rate for Payer: Preferred Health Network WC |
$617.53
|
| Rate for Payer: Prime Health Services Commercial |
$1,472.20
|
| Rate for Payer: Prime Health Services Medicare |
$432.73
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Riverside University Health System MISP |
$449.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,039.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,039.20
|
| 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 |
$408.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Vantage Medical Group Senior |
$408.24
|
|
|
HC BLEPHAROTOMY DRAIN ABSCESS EYE
|
Facility
|
IP
|
$1,732.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
900501547
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$346.40 |
| Max. Negotiated Rate |
$1,558.80 |
| Rate for Payer: Adventist Health Commercial |
$346.40
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,385.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,212.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$692.80
|
| Rate for Payer: EPIC Health Plan Senior |
$692.80
|
| Rate for Payer: Galaxy Health WC |
$1,472.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,039.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,558.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,099.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,021.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.40
|
| Rate for Payer: Multiplan Commercial |
$1,299.00
|
| Rate for Payer: Networks By Design Commercial |
$1,125.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,472.20
|
|
|
HC BLLN ANGIO CNTRL DIALYSIS SEG
|
Facility
|
IP
|
$6,886.00
|
|
|
Service Code
|
CPT 36907
|
| Hospital Charge Code |
909036907
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,377.20 |
| Max. Negotiated Rate |
$6,197.40 |
| Rate for Payer: Adventist Health Commercial |
$1,377.20
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,508.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,820.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,754.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,754.40
|
| Rate for Payer: Galaxy Health WC |
$5,853.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,131.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,197.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,372.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,062.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,377.20
|
| Rate for Payer: Multiplan Commercial |
$5,164.50
|
| Rate for Payer: Networks By Design Commercial |
$4,475.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,853.10
|
|
|
HC BLLN ANGIO CNTRL DIALYSIS SEG
|
Facility
|
OP
|
$6,886.00
|
|
|
Service Code
|
CPT 36907
|
| Hospital Charge Code |
909036907
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,377.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,853.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,787.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,164.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,508.80
|
| Rate for Payer: Cigna of CA HMO |
$4,407.04
|
| Rate for Payer: Cigna of CA PPO |
$5,095.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,853.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,853.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,853.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,820.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,754.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,754.40
|
| Rate for Payer: Galaxy Health WC |
$5,853.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,131.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,197.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,144.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,372.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,264.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,062.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,377.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,820.20
|
| Rate for Payer: Multiplan Commercial |
$5,164.50
|
| Rate for Payer: Networks By Design Commercial |
$4,475.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,853.10
|
| Rate for Payer: Riverside University Health System MISP |
$2,754.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,131.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,443.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,853.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,853.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5,853.10
|
|
|
HC BLLN ANGIOPLASTY, PULM, ADD'L
|
Facility
|
OP
|
$12,366.00
|
|
|
Service Code
|
CPT 92998
|
| Hospital Charge Code |
906812072
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$487.98 |
| Max. Negotiated Rate |
$11,129.40 |
| Rate for Payer: Adventist Health Commercial |
$2,473.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,933.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,511.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,801.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,274.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$5,564.70
|
| Rate for Payer: Cash Price |
$5,564.70
|
| Rate for Payer: Cash Price |
$5,564.70
|
| Rate for Payer: Cash Price |
$5,564.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,892.80
|
| Rate for Payer: Cigna of CA HMO |
$7,914.24
|
| Rate for Payer: Cigna of CA PPO |
$9,150.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,511.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,511.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,511.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,656.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,946.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,946.40
|
| Rate for Payer: Galaxy Health WC |
$10,511.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,419.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,129.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$487.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,852.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$539.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,295.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,473.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,656.20
|
| Rate for Payer: Multiplan Commercial |
$9,274.50
|
| Rate for Payer: Networks By Design Commercial |
$8,037.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,511.10
|
| Rate for Payer: Riverside University Health System MISP |
$4,946.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,419.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,419.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,511.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,511.10
|
| Rate for Payer: Vantage Medical Group Senior |
$10,511.10
|
|
|
HC BLLN ANGIOPLASTY, PULM, ADD'L
|
Facility
|
IP
|
$12,366.00
|
|
|
Service Code
|
CPT 92998
|
| Hospital Charge Code |
906812072
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,473.20 |
| Max. Negotiated Rate |
$11,129.40 |
| Rate for Payer: Adventist Health Commercial |
$2,473.20
|
| Rate for Payer: Cash Price |
$5,564.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,892.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,656.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,946.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,946.40
|
| Rate for Payer: Galaxy Health WC |
$10,511.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,419.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,129.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,852.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,295.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,473.20
|
| Rate for Payer: Multiplan Commercial |
$9,274.50
|
| Rate for Payer: Networks By Design Commercial |
$8,037.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,511.10
|
|
|
HC BLLN ANGIOPLASTY, PULM, INIT
|
Facility
|
IP
|
$12,366.00
|
|
|
Service Code
|
CPT 92997
|
| Hospital Charge Code |
906812071
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,473.20 |
| Max. Negotiated Rate |
$11,129.40 |
| Rate for Payer: Adventist Health Commercial |
$2,473.20
|
| Rate for Payer: Cash Price |
$5,564.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,892.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,656.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,946.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,946.40
|
| Rate for Payer: Galaxy Health WC |
$10,511.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,419.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,129.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,852.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,295.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,473.20
|
| Rate for Payer: Multiplan Commercial |
$9,274.50
|
| Rate for Payer: Networks By Design Commercial |
$8,037.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,511.10
|
|
|
HC BLLN ANGIOPLASTY, PULM, INIT
|
Facility
|
OP
|
$12,366.00
|
|
|
Service Code
|
CPT 92997
|
| Hospital Charge Code |
906812071
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$24,498.80 |
| Rate for Payer: Adventist Health Commercial |
$2,473.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,847.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,840.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$5,564.70
|
| Rate for Payer: Cash Price |
$5,564.70
|
| Rate for Payer: Cash Price |
$5,564.70
|
| Rate for Payer: Cash Price |
$5,564.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,892.80
|
| Rate for Payer: Cigna of CA HMO |
$7,914.24
|
| Rate for Payer: Cigna of CA PPO |
$9,150.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,656.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Galaxy Health WC |
$10,511.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,419.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,129.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$937.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,852.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,035.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,473.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$9,274.50
|
| Rate for Payer: Networks By Design Commercial |
$8,037.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Prime Health Services Commercial |
$10,511.10
|
| Rate for Payer: Prime Health Services Medicare |
$15,738.63
|
| Rate for Payer: Riverside University Health System MISP |
$16,332.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,419.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,419.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC BLLN DILATION URETERAL STRCTR
|
Facility
|
IP
|
$6,462.00
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
909050706
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,292.40 |
| Max. Negotiated Rate |
$5,815.80 |
| Rate for Payer: Adventist Health Commercial |
$1,292.40
|
| Rate for Payer: Cash Price |
$2,907.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,169.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,523.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,584.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,584.80
|
| Rate for Payer: Galaxy Health WC |
$5,492.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,877.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,815.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,103.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,812.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,292.40
|
| Rate for Payer: Multiplan Commercial |
$4,846.50
|
| Rate for Payer: Networks By Design Commercial |
$4,200.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,492.70
|
|
|
HC BLLN DILATION URETERAL STRCTR
|
Facility
|
OP
|
$6,462.00
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
909050706
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,292.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,492.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,554.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,846.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$2,907.90
|
| Rate for Payer: Cash Price |
$2,907.90
|
| Rate for Payer: Cash Price |
$2,907.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,169.60
|
| Rate for Payer: Cigna of CA HMO |
$4,135.68
|
| Rate for Payer: Cigna of CA PPO |
$4,781.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,492.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,492.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,492.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,523.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,584.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,584.80
|
| Rate for Payer: Galaxy Health WC |
$5,492.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,877.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,815.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,203.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,103.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,329.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,812.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,292.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,523.40
|
| Rate for Payer: Multiplan Commercial |
$4,846.50
|
| Rate for Payer: Networks By Design Commercial |
$4,200.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,492.70
|
| Rate for Payer: Riverside University Health System MISP |
$2,584.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,877.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,231.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,492.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,492.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5,492.70
|
|
|
HC BLOOD ADMINISTRATION
|
Facility
|
IP
|
$3,391.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
941100364
|
|
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 |
$1,525.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,712.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,373.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,153.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,000.69
|
| 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 BLOOD ADMINISTRATION
|
Facility
|
OP
|
$3,391.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
945100364
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$624.16
|
| Rate for Payer: Adventist Health Commercial |
$678.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$567.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,149.89
|
| Rate for Payer: Blue Shield of California EPN |
$1,353.01
|
| Rate for Payer: Cash Price |
$1,525.95
|
| Rate for Payer: Cash Price |
$1,525.95
|
| Rate for Payer: Cash Price |
$1,525.95
|
| Rate for Payer: Cash Price |
$1,525.95
|
| 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 |
$851.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,373.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.24
|
| Rate for Payer: EPIC Health Plan Senior |
$624.16
|
| 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 |
$930.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,153.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,230.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$760.34
|
| 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 |
$567.42
|
| Rate for Payer: Prime Health Services Commercial |
$2,882.35
|
| Rate for Payer: Prime Health Services Medicare |
$601.47
|
| Rate for Payer: Riverside University Health System MISP |
$624.16
|
| 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 |
$567.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC BLOOD ADMINISTRATION
|
Facility
|
IP
|
$3,391.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
945100364
|
|
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 |
$1,525.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,712.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,373.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,153.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,000.69
|
| 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 BLOOD ADMINISTRATION
|
Facility
|
OP
|
$3,391.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
946100364
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$678.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$567.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,149.89
|
| Rate for Payer: Blue Shield of California EPN |
$1,353.01
|
| Rate for Payer: Cash Price |
$1,525.95
|
| Rate for Payer: Cash Price |
$1,525.95
|
| Rate for Payer: Cash Price |
$1,525.95
|
| Rate for Payer: Cash Price |
$1,525.95
|
| 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 |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,373.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.24
|
| Rate for Payer: EPIC Health Plan Senior |
$624.16
|
| 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 |
$930.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,153.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,230.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$760.34
|
| 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 |
$567.42
|
| Rate for Payer: Prime Health Services Commercial |
$2,882.35
|
| Rate for Payer: Prime Health Services Medicare |
$601.47
|
| Rate for Payer: Riverside University Health System MISP |
$624.16
|
| 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 |
$567.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC BLOOD ADMINISTRATION
|
Facility
|
OP
|
$3,391.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
941100364
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$678.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$567.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,149.89
|
| Rate for Payer: Blue Shield of California EPN |
$1,353.01
|
| Rate for Payer: Cash Price |
$1,525.95
|
| Rate for Payer: Cash Price |
$1,525.95
|
| Rate for Payer: Cash Price |
$1,525.95
|
| Rate for Payer: Cash Price |
$1,525.95
|
| 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 |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,373.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.24
|
| Rate for Payer: EPIC Health Plan Senior |
$624.16
|
| 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 |
$930.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,153.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,230.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$760.34
|
| 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 |
$567.42
|
| Rate for Payer: Prime Health Services Commercial |
$2,882.35
|
| Rate for Payer: Prime Health Services Medicare |
$601.47
|
| Rate for Payer: Riverside University Health System MISP |
$624.16
|
| 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 |
$567.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC BLOOD ADMINISTRATION
|
Facility
|
IP
|
$3,391.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
946100364
|
|
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 |
$1,525.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,712.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,373.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,153.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,000.69
|
| 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 BLOOD DRAW FOR VAD
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
910100007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$411.30 |
| Rate for Payer: Adventist Health Commercial |
$91.40
|
| Rate for Payer: Cash Price |
$205.65
|
| Rate for Payer: Central Health Plan Commercial |
$365.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$319.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.80
|
| Rate for Payer: EPIC Health Plan Senior |
$182.80
|
| Rate for Payer: Galaxy Health WC |
$388.45
|
| Rate for Payer: Global Benefits Group Commercial |
$274.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$411.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$290.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$269.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.40
|
| Rate for Payer: Multiplan Commercial |
$342.75
|
| Rate for Payer: Networks By Design Commercial |
$297.05
|
| Rate for Payer: Prime Health Services Commercial |
$388.45
|
|
|
HC BLOOD DRAW FOR VAD
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
901200031
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$411.30 |
| Rate for Payer: Adventist Health Commercial |
$91.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$151.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$155.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$216.53
|
| Rate for Payer: Blue Shield of California Commercial |
$287.91
|
| Rate for Payer: Blue Shield of California EPN |
$181.43
|
| Rate for Payer: Cash Price |
$205.65
|
| Rate for Payer: Cash Price |
$205.65
|
| Rate for Payer: Central Health Plan Commercial |
$365.60
|
| Rate for Payer: Cigna of CA HMO |
$292.48
|
| Rate for Payer: Cigna of CA PPO |
$338.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$319.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$388.45
|
| Rate for Payer: Global Benefits Group Commercial |
$274.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$411.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$290.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$165.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$342.75
|
| Rate for Payer: Networks By Design Commercial |
$297.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Prime Health Services Commercial |
$388.45
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$274.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$274.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.50
|
| Rate for Payer: United Healthcare All Other HMO |
$228.50
|
| Rate for Payer: United Healthcare HMO Rider |
$228.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC BLOOD DRAW FOR VAD
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
910100007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$411.30 |
| Rate for Payer: Adventist Health Commercial |
$91.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$151.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$155.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$216.53
|
| Rate for Payer: Blue Shield of California Commercial |
$287.91
|
| Rate for Payer: Blue Shield of California EPN |
$181.43
|
| Rate for Payer: Cash Price |
$205.65
|
| Rate for Payer: Cash Price |
$205.65
|
| Rate for Payer: Central Health Plan Commercial |
$365.60
|
| Rate for Payer: Cigna of CA HMO |
$292.48
|
| Rate for Payer: Cigna of CA PPO |
$338.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$319.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$388.45
|
| Rate for Payer: Global Benefits Group Commercial |
$274.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$411.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$290.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$165.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$342.75
|
| Rate for Payer: Networks By Design Commercial |
$297.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Prime Health Services Commercial |
$388.45
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$274.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$274.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.50
|
| Rate for Payer: United Healthcare All Other HMO |
$228.50
|
| Rate for Payer: United Healthcare HMO Rider |
$228.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC BLOOD DRAW FOR VAD
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
901200031
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$411.30 |
| Rate for Payer: Adventist Health Commercial |
$91.40
|
| Rate for Payer: Cash Price |
$205.65
|
| Rate for Payer: Central Health Plan Commercial |
$365.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$319.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.80
|
| Rate for Payer: EPIC Health Plan Senior |
$182.80
|
| Rate for Payer: Galaxy Health WC |
$388.45
|
| Rate for Payer: Global Benefits Group Commercial |
$274.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$411.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$290.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$269.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.40
|
| Rate for Payer: Multiplan Commercial |
$342.75
|
| Rate for Payer: Networks By Design Commercial |
$297.05
|
| Rate for Payer: Prime Health Services Commercial |
$388.45
|
|
|
HC BLOOD DRAW LT 3YRS FEM/JUGULAR
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 36400
|
| Hospital Charge Code |
900501687
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
|
|
HC BLOOD DRAW LT 3YRS FEM/JUGULAR
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 36400
|
| Hospital Charge Code |
900501687
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$31.82 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$148.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$131.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$129.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$148.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$148.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$122.50
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| Rate for Payer: Riverside University Health System MISP |
$70.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$87.50
|
| Rate for Payer: United Healthcare All Other HMO |
$87.50
|
| Rate for Payer: United Healthcare HMO Rider |
$87.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$148.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.75
|
| Rate for Payer: Vantage Medical Group Senior |
$148.75
|
|
|
HC BLOOD DRAW LT 3YRS FEM/JUGULAR
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 36400
|
| Hospital Charge Code |
900501687
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
|
