|
HC AORTOGRAPH ABDOMINAL
|
Facility
|
OP
|
$12,988.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
909081602
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$218.46 |
| Max. Negotiated Rate |
$11,689.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$887.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,181.45
|
| Rate for Payer: Blue Distinction Transplant |
$7,792.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8,026.58
|
| Rate for Payer: Blue Shield of California EPN |
$6,312.17
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$5,844.60
|
| Rate for Payer: Cash Price |
$5,844.60
|
| Rate for Payer: Central Health Plan Commercial |
$10,390.40
|
| Rate for Payer: Cigna of CA HMO |
$8,312.32
|
| Rate for Payer: Cigna of CA PPO |
$9,611.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$11,039.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,792.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,689.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,741.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,663.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,597.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$9,741.00
|
| Rate for Payer: Networks By Design Commercial |
$8,442.20
|
| Rate for Payer: Prime Health Services Commercial |
$11,039.80
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,792.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,792.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC AORTOGRAPH ABDOMINAL
|
Facility
|
IP
|
$12,988.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
906820189
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,597.60 |
| Max. Negotiated Rate |
$11,689.20 |
| Rate for Payer: Cash Price |
$5,844.60
|
| Rate for Payer: Central Health Plan Commercial |
$10,390.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,195.20
|
| Rate for Payer: Galaxy Health WC |
$11,039.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,792.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,689.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,663.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,948.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,597.60
|
| Rate for Payer: Multiplan Commercial |
$9,741.00
|
| Rate for Payer: Networks By Design Commercial |
$8,442.20
|
| Rate for Payer: Prime Health Services Commercial |
$11,039.80
|
|
|
HC AORTOGRAPH ABDOMINAL AIF
|
Facility
|
IP
|
$14,336.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
909081603
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,867.20 |
| Max. Negotiated Rate |
$12,902.40 |
| Rate for Payer: Cash Price |
$6,451.20
|
| Rate for Payer: Central Health Plan Commercial |
$11,468.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,734.40
|
| Rate for Payer: Galaxy Health WC |
$12,185.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,601.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,902.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,562.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,462.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,867.20
|
| Rate for Payer: Multiplan Commercial |
$10,752.00
|
| Rate for Payer: Networks By Design Commercial |
$9,318.40
|
| Rate for Payer: Prime Health Services Commercial |
$12,185.60
|
|
|
HC AORTOGRAPH ABDOMINAL AIF
|
Facility
|
OP
|
$14,336.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
909081603
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$270.22 |
| Max. Negotiated Rate |
$12,902.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$908.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,718.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,315.75
|
| Rate for Payer: Blue Distinction Transplant |
$8,601.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,859.65
|
| Rate for Payer: Blue Shield of California EPN |
$6,967.30
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$6,451.20
|
| Rate for Payer: Cash Price |
$6,451.20
|
| Rate for Payer: Central Health Plan Commercial |
$11,468.80
|
| Rate for Payer: Cigna of CA HMO |
$9,175.04
|
| Rate for Payer: Cigna of CA PPO |
$10,608.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$12,185.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,601.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,902.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,752.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,562.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,867.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$10,752.00
|
| Rate for Payer: Networks By Design Commercial |
$9,318.40
|
| Rate for Payer: Prime Health Services Commercial |
$12,185.60
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,601.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,601.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC AORTOGRAPH ABDOMINAL AIF
|
Facility
|
IP
|
$14,336.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
906820190
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,867.20 |
| Max. Negotiated Rate |
$12,902.40 |
| Rate for Payer: Cash Price |
$6,451.20
|
| Rate for Payer: Central Health Plan Commercial |
$11,468.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,734.40
|
| Rate for Payer: Galaxy Health WC |
$12,185.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,601.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,902.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,562.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,462.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,867.20
|
| Rate for Payer: Multiplan Commercial |
$10,752.00
|
| Rate for Payer: Networks By Design Commercial |
$9,318.40
|
| Rate for Payer: Prime Health Services Commercial |
$12,185.60
|
|
|
HC AORTOGRAPH ABDOMINAL AIF
|
Facility
|
OP
|
$14,336.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
909081603
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$270.22 |
| Max. Negotiated Rate |
$12,902.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$908.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,718.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,469.71
|
| Rate for Payer: Blue Distinction Transplant |
$8,601.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$6,451.20
|
| Rate for Payer: Cash Price |
$6,451.20
|
| Rate for Payer: Cash Price |
$6,451.20
|
| Rate for Payer: Central Health Plan Commercial |
$11,468.80
|
| Rate for Payer: Cigna of CA HMO |
$9,175.04
|
| Rate for Payer: Cigna of CA PPO |
$10,608.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$12,185.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,601.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,902.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,752.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,562.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,867.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$10,752.00
|
| Rate for Payer: Networks By Design Commercial |
$9,318.40
|
| Rate for Payer: Prime Health Services Commercial |
$12,185.60
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,601.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,601.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC AORTOGRAPH ABDOMINAL AIF
|
Facility
|
IP
|
$14,336.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
909081603
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,867.20 |
| Max. Negotiated Rate |
$12,902.40 |
| Rate for Payer: Cash Price |
$6,451.20
|
| Rate for Payer: Central Health Plan Commercial |
$11,468.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,734.40
|
| Rate for Payer: Galaxy Health WC |
$12,185.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,601.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,902.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,562.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,462.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,867.20
|
| Rate for Payer: Multiplan Commercial |
$10,752.00
|
| Rate for Payer: Networks By Design Commercial |
$9,318.40
|
| Rate for Payer: Prime Health Services Commercial |
$12,185.60
|
|
|
HC AORTOGRAPH ABDOMINAL AIF
|
Facility
|
OP
|
$14,336.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
906820190
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$270.22 |
| Max. Negotiated Rate |
$12,902.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$908.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,718.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,315.75
|
| Rate for Payer: Blue Distinction Transplant |
$8,601.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,859.65
|
| Rate for Payer: Blue Shield of California EPN |
$6,967.30
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$6,451.20
|
| Rate for Payer: Cash Price |
$6,451.20
|
| Rate for Payer: Central Health Plan Commercial |
$11,468.80
|
| Rate for Payer: Cigna of CA HMO |
$9,175.04
|
| Rate for Payer: Cigna of CA PPO |
$10,608.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$12,185.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,601.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,902.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,752.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,562.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,867.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$10,752.00
|
| Rate for Payer: Networks By Design Commercial |
$9,318.40
|
| Rate for Payer: Prime Health Services Commercial |
$12,185.60
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,601.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,601.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC AORTOGRAPH THORACIC
|
Facility
|
IP
|
$11,713.00
|
|
|
Service Code
|
CPT 75605
|
| Hospital Charge Code |
909081600
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,342.60 |
| Max. Negotiated Rate |
$10,541.70 |
| Rate for Payer: Cash Price |
$5,270.85
|
| Rate for Payer: Central Health Plan Commercial |
$9,370.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,685.20
|
| Rate for Payer: Galaxy Health WC |
$9,956.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,027.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,541.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,812.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,462.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,342.60
|
| Rate for Payer: Multiplan Commercial |
$8,784.75
|
| Rate for Payer: Networks By Design Commercial |
$7,613.45
|
| Rate for Payer: Prime Health Services Commercial |
$9,956.05
|
|
|
HC AORTOGRAPH THORACIC
|
Facility
|
OP
|
$11,713.00
|
|
|
Service Code
|
CPT 75605
|
| Hospital Charge Code |
906820188
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$210.04 |
| Max. Negotiated Rate |
$11,329.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,866.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$885.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,181.45
|
| Rate for Payer: Blue Distinction Transplant |
$7,027.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,238.63
|
| Rate for Payer: Blue Shield of California EPN |
$5,692.52
|
| Rate for Payer: Caremore Medicare Advantage |
$6,866.07
|
| Rate for Payer: Cash Price |
$5,270.85
|
| Rate for Payer: Cash Price |
$5,270.85
|
| Rate for Payer: Central Health Plan Commercial |
$9,370.40
|
| Rate for Payer: Cigna of CA HMO |
$7,496.32
|
| Rate for Payer: Cigna of CA PPO |
$8,667.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Media |
$6,866.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$9,956.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,027.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,541.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,784.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,260.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,329.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: InnovAge PACE Commercial |
$10,299.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,812.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,342.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,200.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$8,784.75
|
| Rate for Payer: Networks By Design Commercial |
$7,613.45
|
| Rate for Payer: Prime Health Services Commercial |
$9,956.05
|
| Rate for Payer: Prime Health Services Medicare |
$7,278.03
|
| Rate for Payer: Riverside University Health System MISP |
$7,552.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,027.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,027.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC AORTOGRAPH THORACIC
|
Facility
|
IP
|
$11,713.00
|
|
|
Service Code
|
CPT 75605
|
| Hospital Charge Code |
906820188
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,342.60 |
| Max. Negotiated Rate |
$10,541.70 |
| Rate for Payer: Cash Price |
$5,270.85
|
| Rate for Payer: Central Health Plan Commercial |
$9,370.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,685.20
|
| Rate for Payer: Galaxy Health WC |
$9,956.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,027.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,541.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,812.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,462.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,342.60
|
| Rate for Payer: Multiplan Commercial |
$8,784.75
|
| Rate for Payer: Networks By Design Commercial |
$7,613.45
|
| Rate for Payer: Prime Health Services Commercial |
$9,956.05
|
|
|
HC AORTOGRAPH THORACIC
|
Facility
|
OP
|
$11,713.00
|
|
|
Service Code
|
CPT 75605
|
| Hospital Charge Code |
909081600
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$210.04 |
| Max. Negotiated Rate |
$11,329.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,866.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$885.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,181.45
|
| Rate for Payer: Blue Distinction Transplant |
$7,027.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,238.63
|
| Rate for Payer: Blue Shield of California EPN |
$5,692.52
|
| Rate for Payer: Caremore Medicare Advantage |
$6,866.07
|
| Rate for Payer: Cash Price |
$5,270.85
|
| Rate for Payer: Cash Price |
$5,270.85
|
| Rate for Payer: Central Health Plan Commercial |
$9,370.40
|
| Rate for Payer: Cigna of CA HMO |
$7,496.32
|
| Rate for Payer: Cigna of CA PPO |
$8,667.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Media |
$6,866.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$9,956.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,027.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,541.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,784.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,260.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,329.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: InnovAge PACE Commercial |
$10,299.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,812.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,342.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,200.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$8,784.75
|
| Rate for Payer: Networks By Design Commercial |
$7,613.45
|
| Rate for Payer: Prime Health Services Commercial |
$9,956.05
|
| Rate for Payer: Prime Health Services Medicare |
$7,278.03
|
| Rate for Payer: Riverside University Health System MISP |
$7,552.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,027.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,027.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC AORTO TRNSLMBR NEEDL/CATH
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
CPT 36160
|
| Hospital Charge Code |
906820174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$722.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$467.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$510.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Central Health Plan Commercial |
$680.00
|
| Rate for Payer: Cigna of CA PPO |
$629.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$722.50
|
| Rate for Payer: Dignity Health Media |
$722.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$722.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$340.00
|
| Rate for Payer: Galaxy Health WC |
$722.50
|
| Rate for Payer: Global Benefits Group Commercial |
$510.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$765.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$637.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$297.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$566.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.00
|
| Rate for Payer: Multiplan Commercial |
$637.50
|
| Rate for Payer: Networks By Design Commercial |
$552.50
|
| Rate for Payer: Prime Health Services Commercial |
$722.50
|
| Rate for Payer: Riverside University Health System MISP |
$340.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$510.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$722.50
|
| Rate for Payer: Vantage Medical Group Senior |
$722.50
|
|
|
HC AORTO TRNSLMBR NEEDL/CATH
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
CPT 36160
|
| Hospital Charge Code |
909081317
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$722.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$467.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$510.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Central Health Plan Commercial |
$680.00
|
| Rate for Payer: Cigna of CA PPO |
$629.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$722.50
|
| Rate for Payer: Dignity Health Media |
$722.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$722.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$340.00
|
| Rate for Payer: Galaxy Health WC |
$722.50
|
| Rate for Payer: Global Benefits Group Commercial |
$510.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$765.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$637.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$297.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$566.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.00
|
| Rate for Payer: Multiplan Commercial |
$637.50
|
| Rate for Payer: Networks By Design Commercial |
$552.50
|
| Rate for Payer: Prime Health Services Commercial |
$722.50
|
| Rate for Payer: Riverside University Health System MISP |
$340.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$510.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$722.50
|
| Rate for Payer: Vantage Medical Group Senior |
$722.50
|
|
|
HC AORTO TRNSLMBR NEEDL/CATH
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
CPT 36160
|
| Hospital Charge Code |
906820174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Central Health Plan Commercial |
$680.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.00
|
| Rate for Payer: Galaxy Health WC |
$722.50
|
| Rate for Payer: Global Benefits Group Commercial |
$510.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$765.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$566.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$323.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.00
|
| Rate for Payer: Multiplan Commercial |
$637.50
|
| Rate for Payer: Networks By Design Commercial |
$552.50
|
| Rate for Payer: Prime Health Services Commercial |
$722.50
|
|
|
HC AORTO TRNSLMBR NEEDL/CATH
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
CPT 36160
|
| Hospital Charge Code |
909081317
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Central Health Plan Commercial |
$680.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.00
|
| Rate for Payer: Galaxy Health WC |
$722.50
|
| Rate for Payer: Global Benefits Group Commercial |
$510.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$765.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$566.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$323.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.00
|
| Rate for Payer: Multiplan Commercial |
$637.50
|
| Rate for Payer: Networks By Design Commercial |
$552.50
|
| Rate for Payer: Prime Health Services Commercial |
$722.50
|
|
|
HC APHERESIS PLASMA EXCHANGE
|
Facility
|
OP
|
$15,788.00
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
945000103
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$14,209.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,917.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,917.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,472.80
|
| Rate for Payer: Blue Shield of California Commercial |
$9,930.65
|
| Rate for Payer: Blue Shield of California EPN |
$7,720.33
|
| Rate for Payer: Caremore Medicare Advantage |
$1,917.03
|
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: Central Health Plan Commercial |
$12,630.40
|
| Rate for Payer: Cigna of CA HMO |
$10,104.32
|
| Rate for Payer: Cigna of CA PPO |
$11,683.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Dignity Health Media |
$1,917.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,108.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,587.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,917.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,917.03
|
| Rate for Payer: Galaxy Health WC |
$13,419.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,472.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,209.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,841.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,143.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,163.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,917.03
|
| Rate for Payer: InnovAge PACE Commercial |
$2,875.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,530.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,856.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,917.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,157.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,568.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,568.82
|
| Rate for Payer: Multiplan Commercial |
$11,841.00
|
| Rate for Payer: Networks By Design Commercial |
$10,262.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,419.80
|
| Rate for Payer: Prime Health Services Medicare |
$2,032.05
|
| Rate for Payer: Riverside University Health System MISP |
$2,108.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,472.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,472.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Vantage Medical Group Senior |
$1,917.03
|
|
|
HC APHERESIS PLASMA EXCHANGE
|
Facility
|
OP
|
$15,788.00
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
907201026
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$14,209.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,917.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,917.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,472.80
|
| Rate for Payer: Blue Shield of California Commercial |
$9,930.65
|
| Rate for Payer: Blue Shield of California EPN |
$7,720.33
|
| Rate for Payer: Caremore Medicare Advantage |
$1,917.03
|
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: Central Health Plan Commercial |
$12,630.40
|
| Rate for Payer: Cigna of CA HMO |
$10,104.32
|
| Rate for Payer: Cigna of CA PPO |
$11,683.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Dignity Health Media |
$1,917.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,108.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,587.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,917.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,917.03
|
| Rate for Payer: Galaxy Health WC |
$13,419.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,472.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,209.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,841.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,143.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,163.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,917.03
|
| Rate for Payer: InnovAge PACE Commercial |
$2,875.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,530.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,856.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,917.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,157.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,568.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,568.82
|
| Rate for Payer: Multiplan Commercial |
$11,841.00
|
| Rate for Payer: Networks By Design Commercial |
$10,262.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,419.80
|
| Rate for Payer: Prime Health Services Medicare |
$2,032.05
|
| Rate for Payer: Riverside University Health System MISP |
$2,108.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,472.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,472.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Vantage Medical Group Senior |
$1,917.03
|
|
|
HC APHERESIS PLASMA EXCHANGE
|
Facility
|
IP
|
$15,788.00
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
946100103
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$3,157.60 |
| Max. Negotiated Rate |
$14,209.20 |
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: Central Health Plan Commercial |
$12,630.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,315.20
|
| Rate for Payer: Galaxy Health WC |
$13,419.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,472.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,209.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,530.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,015.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,157.60
|
| Rate for Payer: Multiplan Commercial |
$11,841.00
|
| Rate for Payer: Networks By Design Commercial |
$10,262.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,419.80
|
|
|
HC APHERESIS PLASMA EXCHANGE
|
Facility
|
IP
|
$15,788.00
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
945000103
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$3,157.60 |
| Max. Negotiated Rate |
$14,209.20 |
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: Central Health Plan Commercial |
$12,630.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,315.20
|
| Rate for Payer: Galaxy Health WC |
$13,419.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,472.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,209.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,530.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,015.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,157.60
|
| Rate for Payer: Multiplan Commercial |
$11,841.00
|
| Rate for Payer: Networks By Design Commercial |
$10,262.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,419.80
|
|
|
HC APHERESIS PLASMA EXCHANGE
|
Facility
|
OP
|
$15,788.00
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
946000103
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$14,209.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,917.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,917.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,472.80
|
| Rate for Payer: Blue Shield of California Commercial |
$9,930.65
|
| Rate for Payer: Blue Shield of California EPN |
$7,720.33
|
| Rate for Payer: Caremore Medicare Advantage |
$1,917.03
|
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: Central Health Plan Commercial |
$12,630.40
|
| Rate for Payer: Cigna of CA HMO |
$10,104.32
|
| Rate for Payer: Cigna of CA PPO |
$11,683.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Dignity Health Media |
$1,917.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,108.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,587.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,917.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,917.03
|
| Rate for Payer: Galaxy Health WC |
$13,419.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,472.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,209.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,841.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,143.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,163.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,917.03
|
| Rate for Payer: InnovAge PACE Commercial |
$2,875.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,530.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,856.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,917.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,157.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,568.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,568.82
|
| Rate for Payer: Multiplan Commercial |
$11,841.00
|
| Rate for Payer: Networks By Design Commercial |
$10,262.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,419.80
|
| Rate for Payer: Prime Health Services Medicare |
$2,032.05
|
| Rate for Payer: Riverside University Health System MISP |
$2,108.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,472.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,472.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Vantage Medical Group Senior |
$1,917.03
|
|
|
HC APHERESIS PLASMA EXCHANGE
|
Facility
|
IP
|
$15,788.00
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
945100103
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$3,157.60 |
| Max. Negotiated Rate |
$14,209.20 |
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: Central Health Plan Commercial |
$12,630.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,315.20
|
| Rate for Payer: Galaxy Health WC |
$13,419.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,472.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,209.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,530.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,015.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,157.60
|
| Rate for Payer: Multiplan Commercial |
$11,841.00
|
| Rate for Payer: Networks By Design Commercial |
$10,262.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,419.80
|
|
|
HC APHERESIS PLASMA EXCHANGE
|
Facility
|
OP
|
$15,788.00
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
945100103
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$14,209.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,917.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,917.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,472.80
|
| Rate for Payer: Blue Shield of California Commercial |
$9,930.65
|
| Rate for Payer: Blue Shield of California EPN |
$7,720.33
|
| Rate for Payer: Caremore Medicare Advantage |
$1,917.03
|
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: Central Health Plan Commercial |
$12,630.40
|
| Rate for Payer: Cigna of CA HMO |
$10,104.32
|
| Rate for Payer: Cigna of CA PPO |
$11,683.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Dignity Health Media |
$1,917.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,108.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,587.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,917.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,917.03
|
| Rate for Payer: Galaxy Health WC |
$13,419.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,472.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,209.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,841.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,143.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,163.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,917.03
|
| Rate for Payer: InnovAge PACE Commercial |
$2,875.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,530.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,856.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,917.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,157.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,568.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,568.82
|
| Rate for Payer: Multiplan Commercial |
$11,841.00
|
| Rate for Payer: Networks By Design Commercial |
$10,262.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,419.80
|
| Rate for Payer: Prime Health Services Medicare |
$2,032.05
|
| Rate for Payer: Riverside University Health System MISP |
$2,108.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,472.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,472.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Vantage Medical Group Senior |
$1,917.03
|
|
|
HC APHERESIS PLASMA EXCHANGE
|
Facility
|
IP
|
$15,788.00
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
946000103
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$3,157.60 |
| Max. Negotiated Rate |
$14,209.20 |
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: Central Health Plan Commercial |
$12,630.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,315.20
|
| Rate for Payer: Galaxy Health WC |
$13,419.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,472.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,209.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,530.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,015.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,157.60
|
| Rate for Payer: Multiplan Commercial |
$11,841.00
|
| Rate for Payer: Networks By Design Commercial |
$10,262.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,419.80
|
|
|
HC APHERESIS PLASMA EXCHANGE
|
Facility
|
OP
|
$15,788.00
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
946100103
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$14,209.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,917.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,917.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,472.80
|
| Rate for Payer: Blue Shield of California Commercial |
$9,930.65
|
| Rate for Payer: Blue Shield of California EPN |
$7,720.33
|
| Rate for Payer: Caremore Medicare Advantage |
$1,917.03
|
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: Cash Price |
$7,104.60
|
| Rate for Payer: Central Health Plan Commercial |
$12,630.40
|
| Rate for Payer: Cigna of CA HMO |
$10,104.32
|
| Rate for Payer: Cigna of CA PPO |
$11,683.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Dignity Health Media |
$1,917.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,108.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,587.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,917.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,917.03
|
| Rate for Payer: Galaxy Health WC |
$13,419.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,472.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,209.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,841.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,143.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,163.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,917.03
|
| Rate for Payer: InnovAge PACE Commercial |
$2,875.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,530.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,856.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,917.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,157.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,568.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,568.82
|
| Rate for Payer: Multiplan Commercial |
$11,841.00
|
| Rate for Payer: Networks By Design Commercial |
$10,262.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,419.80
|
| Rate for Payer: Prime Health Services Medicare |
$2,032.05
|
| Rate for Payer: Riverside University Health System MISP |
$2,108.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,472.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,472.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: Vantage Medical Group Senior |
$1,917.03
|
|
