|
HC PLASTIC REPAIR OF CANALICULI
|
Facility
|
IP
|
$10,307.00
|
|
|
Service Code
|
CPT 68700
|
| Hospital Charge Code |
900501395
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$2,061.40 |
| Max. Negotiated Rate |
$9,276.30 |
| Rate for Payer: Adventist Health Commercial |
$2,061.40
|
| Rate for Payer: Cash Price |
$4,638.15
|
| Rate for Payer: Central Health Plan Commercial |
$8,245.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,214.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,122.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.80
|
| Rate for Payer: Galaxy Health WC |
$8,760.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,184.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,276.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,544.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,081.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,061.40
|
| Rate for Payer: Multiplan Commercial |
$7,730.25
|
| Rate for Payer: Networks By Design Commercial |
$6,699.55
|
| Rate for Payer: Prime Health Services Commercial |
$8,760.95
|
|
|
HC PLASTIC REPAIR OF CANALICULI
|
Facility
|
OP
|
$10,307.00
|
|
|
Service Code
|
CPT 68700
|
| Hospital Charge Code |
900501395
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$9,276.30 |
| Rate for Payer: Adventist Health Commercial |
$2,061.40
|
| 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 |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| 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: Anthem Blue Cross of CA Workers' Comp |
$4,723.01
|
| Rate for Payer: Cash Price |
$4,638.15
|
| Rate for Payer: Cash Price |
$4,638.15
|
| Rate for Payer: Cash Price |
$4,638.15
|
| Rate for Payer: Cash Price |
$4,638.15
|
| Rate for Payer: Central Health Plan Commercial |
$8,245.60
|
| Rate for Payer: Cigna of CA HMO |
$6,596.48
|
| Rate for Payer: Cigna of CA PPO |
$7,627.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,214.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,045.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3,363.62
|
| Rate for Payer: Galaxy Health WC |
$8,760.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,184.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,276.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,014.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,544.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,576.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,287.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,061.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: Multiplan Commercial |
$7,730.25
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Networks By Design Commercial |
$6,699.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Preferred Health Network WC |
$4,819.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,760.95
|
| Rate for Payer: Prime Health Services Medicare |
$3,241.31
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Riverside University Health System MISP |
$3,363.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,184.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,153.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,153.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,153.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,153.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,057.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
HC PLASTIC REPAIR OF CANALICULI
|
Facility
|
OP
|
$10,307.00
|
|
|
Service Code
|
CPT 68700
|
| Hospital Charge Code |
900501395
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$9,276.30 |
| Rate for Payer: Adventist Health Commercial |
$4,225.87
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,245.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| 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: Anthem Blue Cross of CA Workers' Comp |
$4,723.01
|
| Rate for Payer: Cash Price |
$4,638.15
|
| Rate for Payer: Cash Price |
$4,638.15
|
| Rate for Payer: Cash Price |
$4,638.15
|
| Rate for Payer: Cash Price |
$4,638.15
|
| Rate for Payer: Central Health Plan Commercial |
$8,245.60
|
| Rate for Payer: Cigna of CA HMO |
$6,596.48
|
| Rate for Payer: Cigna of CA PPO |
$7,627.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,214.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,045.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3,363.62
|
| Rate for Payer: Galaxy Health WC |
$8,760.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,184.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,276.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,014.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,544.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,576.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,287.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,061.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: Multiplan Commercial |
$7,730.25
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Networks By Design Commercial |
$6,699.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Preferred Health Network WC |
$4,819.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,760.95
|
| Rate for Payer: Prime Health Services Medicare |
$3,241.31
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Riverside University Health System MISP |
$3,363.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,184.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,184.20
|
| 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 |
$3,057.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
HC PLASTY BALLOON/ACCENT
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Blue Shield of California Commercial |
$240.60
|
| Rate for Payer: Blue Shield of California EPN |
$151.20
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$190.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
|
|
HC PLASTY BALLOON/ACCENT
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$136.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.52
|
| Rate for Payer: Blue Shield of California Commercial |
$240.60
|
| Rate for Payer: Blue Shield of California EPN |
$151.20
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$190.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Riverside University Health System MISP |
$120.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC PLASTY BALLOON/LP/PF+ CORDIS
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$396.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$540.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$328.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$394.85
|
| Rate for Payer: Blue Shield of California Commercial |
$577.44
|
| Rate for Payer: Blue Shield of California EPN |
$362.88
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Central Health Plan Commercial |
$576.00
|
| Rate for Payer: Cigna of CA HMO |
$504.00
|
| Rate for Payer: Cigna of CA PPO |
$504.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$612.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$612.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$504.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.00
|
| Rate for Payer: EPIC Health Plan Senior |
$288.00
|
| Rate for Payer: Galaxy Health WC |
$612.00
|
| Rate for Payer: Global Benefits Group Commercial |
$432.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$648.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$457.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$261.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$504.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Networks By Design Commercial |
$360.00
|
| Rate for Payer: Prime Health Services Commercial |
$612.00
|
| Rate for Payer: Riverside University Health System MISP |
$288.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$432.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$432.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.22
|
| Rate for Payer: United Healthcare All Other HMO |
$263.02
|
| Rate for Payer: United Healthcare HMO Rider |
$257.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$612.00
|
| Rate for Payer: Vantage Medical Group Senior |
$612.00
|
|
|
HC PLASTY BALLOON/LP/PF+ CORDIS
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Blue Shield of California Commercial |
$577.44
|
| Rate for Payer: Blue Shield of California EPN |
$362.88
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Central Health Plan Commercial |
$576.00
|
| Rate for Payer: Cigna of CA HMO |
$504.00
|
| Rate for Payer: Cigna of CA PPO |
$504.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$504.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.00
|
| Rate for Payer: EPIC Health Plan Senior |
$288.00
|
| Rate for Payer: Galaxy Health WC |
$612.00
|
| Rate for Payer: Global Benefits Group Commercial |
$432.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$648.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$457.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Networks By Design Commercial |
$360.00
|
| Rate for Payer: Prime Health Services Commercial |
$612.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.22
|
| Rate for Payer: United Healthcare All Other HMO |
$263.02
|
| Rate for Payer: United Healthcare HMO Rider |
$257.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.80
|
|
|
HC PLASTY BALLOON/XXL/MAXI
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.00 |
| Max. Negotiated Rate |
$1,035.00 |
| Rate for Payer: Adventist Health Commercial |
$230.00
|
| Rate for Payer: Blue Shield of California Commercial |
$922.30
|
| Rate for Payer: Blue Shield of California EPN |
$579.60
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Central Health Plan Commercial |
$920.00
|
| Rate for Payer: Cigna of CA HMO |
$805.00
|
| Rate for Payer: Cigna of CA PPO |
$805.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$805.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$460.00
|
| Rate for Payer: EPIC Health Plan Senior |
$460.00
|
| Rate for Payer: Galaxy Health WC |
$977.50
|
| Rate for Payer: Global Benefits Group Commercial |
$690.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,035.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$730.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$678.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.00
|
| Rate for Payer: Multiplan Commercial |
$862.50
|
| Rate for Payer: Networks By Design Commercial |
$575.00
|
| Rate for Payer: Prime Health Services Commercial |
$977.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$431.60
|
| Rate for Payer: United Healthcare All Other HMO |
$420.10
|
| Rate for Payer: United Healthcare HMO Rider |
$411.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$376.62
|
|
|
HC PLASTY BALLOON/XXL/MAXI
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.00 |
| Max. Negotiated Rate |
$1,035.00 |
| Rate for Payer: Adventist Health Commercial |
$230.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$977.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$862.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$525.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$630.66
|
| Rate for Payer: Blue Shield of California Commercial |
$922.30
|
| Rate for Payer: Blue Shield of California EPN |
$579.60
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Central Health Plan Commercial |
$920.00
|
| Rate for Payer: Cigna of CA HMO |
$805.00
|
| Rate for Payer: Cigna of CA PPO |
$805.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$977.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$977.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$977.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$805.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$460.00
|
| Rate for Payer: EPIC Health Plan Senior |
$460.00
|
| Rate for Payer: Galaxy Health WC |
$977.50
|
| Rate for Payer: Global Benefits Group Commercial |
$690.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,035.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$730.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$417.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$678.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$805.00
|
| Rate for Payer: Multiplan Commercial |
$862.50
|
| Rate for Payer: Networks By Design Commercial |
$575.00
|
| Rate for Payer: Prime Health Services Commercial |
$977.50
|
| Rate for Payer: Riverside University Health System MISP |
$460.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$690.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$690.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$431.60
|
| Rate for Payer: United Healthcare All Other HMO |
$420.10
|
| Rate for Payer: United Healthcare HMO Rider |
$411.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$376.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$977.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$977.50
|
| Rate for Payer: Vantage Medical Group Senior |
$977.50
|
|
|
HC PLATELET AGGREGATION ASA
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 85576 QW,91
|
| Hospital Charge Code |
900912034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$62.60 |
| Max. Negotiated Rate |
$281.70 |
| Rate for Payer: Adventist Health Commercial |
$62.60
|
| Rate for Payer: Cash Price |
$140.85
|
| Rate for Payer: Central Health Plan Commercial |
$250.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$219.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.20
|
| Rate for Payer: EPIC Health Plan Senior |
$125.20
|
| Rate for Payer: Galaxy Health WC |
$266.05
|
| Rate for Payer: Global Benefits Group Commercial |
$187.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$281.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$198.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.60
|
| Rate for Payer: Multiplan Commercial |
$234.75
|
| Rate for Payer: Networks By Design Commercial |
$203.45
|
| Rate for Payer: Prime Health Services Commercial |
$266.05
|
|
|
HC PLATELET AGGREGATION ASA
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
CPT 85576 QW,91
|
| Hospital Charge Code |
900912034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.18 |
| Max. Negotiated Rate |
$281.70 |
| Rate for Payer: Adventist Health Commercial |
$62.60
|
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$266.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$189.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$172.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$167.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$234.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.59
|
| Rate for Payer: Blue Shield of California Commercial |
$140.49
|
| Rate for Payer: Blue Shield of California Commercial |
$197.19
|
| Rate for Payer: Blue Shield of California EPN |
$88.53
|
| Rate for Payer: Blue Shield of California EPN |
$124.26
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Cash Price |
$140.85
|
| Rate for Payer: Cash Price |
$140.85
|
| Rate for Payer: Central Health Plan Commercial |
$250.40
|
| Rate for Payer: Central Health Plan Commercial |
$178.40
|
| Rate for Payer: Cigna of CA HMO |
$142.72
|
| Rate for Payer: Cigna of CA HMO |
$200.32
|
| Rate for Payer: Cigna of CA PPO |
$165.02
|
| Rate for Payer: Cigna of CA PPO |
$231.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$189.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$266.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$266.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$189.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$189.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$266.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$156.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$219.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.20
|
| Rate for Payer: EPIC Health Plan Senior |
$125.20
|
| Rate for Payer: EPIC Health Plan Senior |
$89.20
|
| Rate for Payer: Galaxy Health WC |
$189.55
|
| Rate for Payer: Galaxy Health WC |
$266.05
|
| Rate for Payer: Global Benefits Group Commercial |
$187.80
|
| Rate for Payer: Global Benefits Group Commercial |
$133.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$200.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$281.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$141.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$198.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$131.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$219.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$156.10
|
| Rate for Payer: Multiplan Commercial |
$234.75
|
| Rate for Payer: Multiplan Commercial |
$167.25
|
| Rate for Payer: Networks By Design Commercial |
$203.45
|
| Rate for Payer: Networks By Design Commercial |
$144.95
|
| Rate for Payer: Prime Health Services Commercial |
$189.55
|
| Rate for Payer: Prime Health Services Commercial |
$266.05
|
| Rate for Payer: Riverside University Health System MISP |
$125.20
|
| Rate for Payer: Riverside University Health System MISP |
$89.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$187.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$187.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.18
|
| Rate for Payer: United Healthcare All Other HMO |
$20.18
|
| Rate for Payer: United Healthcare All Other HMO |
$20.18
|
| Rate for Payer: United Healthcare HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$189.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$266.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$266.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$189.55
|
| Rate for Payer: Vantage Medical Group Senior |
$189.55
|
| Rate for Payer: Vantage Medical Group Senior |
$266.05
|
|
|
HC PLATELET AGGREGATION PRU P2Y12
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT 85576 91
|
| Hospital Charge Code |
900912033
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.18 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Adventist Health Commercial |
$83.20
|
| Rate for Payer: Adventist Health Commercial |
$61.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$353.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$262.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$169.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$312.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.59
|
| Rate for Payer: Blue Shield of California Commercial |
$194.67
|
| Rate for Payer: Blue Shield of California Commercial |
$262.08
|
| Rate for Payer: Blue Shield of California EPN |
$122.67
|
| Rate for Payer: Blue Shield of California EPN |
$165.15
|
| Rate for Payer: Cash Price |
$139.05
|
| Rate for Payer: Cash Price |
$139.05
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Central Health Plan Commercial |
$332.80
|
| Rate for Payer: Central Health Plan Commercial |
$247.20
|
| Rate for Payer: Cigna of CA HMO |
$197.76
|
| Rate for Payer: Cigna of CA HMO |
$266.24
|
| Rate for Payer: Cigna of CA PPO |
$228.66
|
| Rate for Payer: Cigna of CA PPO |
$307.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$262.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$353.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$262.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$262.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$353.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$216.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$291.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.60
|
| Rate for Payer: EPIC Health Plan Senior |
$166.40
|
| Rate for Payer: EPIC Health Plan Senior |
$123.60
|
| Rate for Payer: Galaxy Health WC |
$262.65
|
| Rate for Payer: Galaxy Health WC |
$353.60
|
| Rate for Payer: Global Benefits Group Commercial |
$249.60
|
| Rate for Payer: Global Benefits Group Commercial |
$185.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$278.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$374.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$196.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$264.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$245.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$291.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$216.30
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Multiplan Commercial |
$231.75
|
| Rate for Payer: Networks By Design Commercial |
$270.40
|
| Rate for Payer: Networks By Design Commercial |
$200.85
|
| Rate for Payer: Prime Health Services Commercial |
$262.65
|
| Rate for Payer: Prime Health Services Commercial |
$353.60
|
| Rate for Payer: Riverside University Health System MISP |
$166.40
|
| Rate for Payer: Riverside University Health System MISP |
$123.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$185.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$249.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$249.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$185.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.18
|
| Rate for Payer: United Healthcare All Other HMO |
$20.18
|
| Rate for Payer: United Healthcare All Other HMO |
$20.18
|
| Rate for Payer: United Healthcare HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$262.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$353.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$262.65
|
| Rate for Payer: Vantage Medical Group Senior |
$262.65
|
| Rate for Payer: Vantage Medical Group Senior |
$353.60
|
|
|
HC PLATELET AGGREGATION PRU P2Y12
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT 85576 91
|
| Hospital Charge Code |
900912033
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Adventist Health Commercial |
$83.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Central Health Plan Commercial |
$332.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$291.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.40
|
| Rate for Payer: EPIC Health Plan Senior |
$166.40
|
| Rate for Payer: Galaxy Health WC |
$353.60
|
| Rate for Payer: Global Benefits Group Commercial |
$249.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$374.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$264.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$245.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.20
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Networks By Design Commercial |
$270.40
|
| Rate for Payer: Prime Health Services Commercial |
$353.60
|
|
|
HC PLATELET COUNT
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
900910101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Central Health Plan Commercial |
$95.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.60
|
| Rate for Payer: EPIC Health Plan Senior |
$47.60
|
| Rate for Payer: Galaxy Health WC |
$101.15
|
| Rate for Payer: Global Benefits Group Commercial |
$71.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.80
|
| Rate for Payer: Multiplan Commercial |
$89.25
|
| Rate for Payer: Networks By Design Commercial |
$77.35
|
| Rate for Payer: Prime Health Services Commercial |
$101.15
|
|
|
HC PLATELET COUNT
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
900910101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.48
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.28
|
| Rate for Payer: Blue Shield of California Commercial |
$20.16
|
| Rate for Payer: Blue Shield of California Commercial |
$74.97
|
| Rate for Payer: Blue Shield of California EPN |
$12.70
|
| Rate for Payer: Blue Shield of California EPN |
$47.24
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Central Health Plan Commercial |
$95.20
|
| Rate for Payer: Central Health Plan Commercial |
$25.60
|
| Rate for Payer: Cigna of CA HMO |
$20.48
|
| Rate for Payer: Cigna of CA HMO |
$76.16
|
| Rate for Payer: Cigna of CA PPO |
$23.68
|
| Rate for Payer: Cigna of CA PPO |
$88.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.39
|
| Rate for Payer: EPIC Health Plan Senior |
$4.93
|
| Rate for Payer: EPIC Health Plan Senior |
$4.93
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Galaxy Health WC |
$101.15
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Global Benefits Group Commercial |
$71.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.35
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$89.25
|
| Rate for Payer: Networks By Design Commercial |
$77.35
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.48
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.48
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
| Rate for Payer: Prime Health Services Commercial |
$101.15
|
| Rate for Payer: Prime Health Services Medicare |
$4.75
|
| Rate for Payer: Prime Health Services Medicare |
$4.75
|
| Rate for Payer: Riverside University Health System MISP |
$4.93
|
| Rate for Payer: Riverside University Health System MISP |
$4.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.63
|
| Rate for Payer: United Healthcare All Other HMO |
$3.63
|
| Rate for Payer: United Healthcare All Other HMO |
$3.63
|
| Rate for Payer: United Healthcare HMO Rider |
$3.63
|
| Rate for Payer: United Healthcare HMO Rider |
$3.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.63
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.93
|
| Rate for Payer: Vantage Medical Group Senior |
$4.48
|
| Rate for Payer: Vantage Medical Group Senior |
$4.48
|
|
|
HC PLATELET COUNT CITRATED
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
900912026
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Central Health Plan Commercial |
$95.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.60
|
| Rate for Payer: EPIC Health Plan Senior |
$47.60
|
| Rate for Payer: Galaxy Health WC |
$101.15
|
| Rate for Payer: Global Benefits Group Commercial |
$71.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.80
|
| Rate for Payer: Multiplan Commercial |
$89.25
|
| Rate for Payer: Networks By Design Commercial |
$77.35
|
| Rate for Payer: Prime Health Services Commercial |
$101.15
|
|
|
HC PLATELET COUNT CITRATED
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
900912026
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.48
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.28
|
| Rate for Payer: Blue Shield of California Commercial |
$20.16
|
| Rate for Payer: Blue Shield of California Commercial |
$74.97
|
| Rate for Payer: Blue Shield of California EPN |
$12.70
|
| Rate for Payer: Blue Shield of California EPN |
$47.24
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Central Health Plan Commercial |
$95.20
|
| Rate for Payer: Central Health Plan Commercial |
$25.60
|
| Rate for Payer: Cigna of CA HMO |
$20.48
|
| Rate for Payer: Cigna of CA HMO |
$76.16
|
| Rate for Payer: Cigna of CA PPO |
$23.68
|
| Rate for Payer: Cigna of CA PPO |
$88.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.39
|
| Rate for Payer: EPIC Health Plan Senior |
$4.93
|
| Rate for Payer: EPIC Health Plan Senior |
$4.93
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Galaxy Health WC |
$101.15
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Global Benefits Group Commercial |
$71.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.35
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$89.25
|
| Rate for Payer: Networks By Design Commercial |
$77.35
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.48
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.48
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
| Rate for Payer: Prime Health Services Commercial |
$101.15
|
| Rate for Payer: Prime Health Services Medicare |
$4.75
|
| Rate for Payer: Prime Health Services Medicare |
$4.75
|
| Rate for Payer: Riverside University Health System MISP |
$4.93
|
| Rate for Payer: Riverside University Health System MISP |
$4.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.63
|
| Rate for Payer: United Healthcare All Other HMO |
$3.63
|
| Rate for Payer: United Healthcare All Other HMO |
$3.63
|
| Rate for Payer: United Healthcare HMO Rider |
$3.63
|
| Rate for Payer: United Healthcare HMO Rider |
$3.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.63
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.93
|
| Rate for Payer: Vantage Medical Group Senior |
$4.48
|
| Rate for Payer: Vantage Medical Group Senior |
$4.48
|
|
|
HC PLATELET NEUTRALIZATION
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
900912007
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.98
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.43
|
| Rate for Payer: Blue Shield of California Commercial |
$40.95
|
| Rate for Payer: Blue Shield of California Commercial |
$220.50
|
| Rate for Payer: Blue Shield of California EPN |
$25.80
|
| Rate for Payer: Blue Shield of California EPN |
$138.95
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Central Health Plan Commercial |
$52.00
|
| Rate for Payer: Cigna of CA HMO |
$41.60
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$48.10
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.67
|
| Rate for Payer: EPIC Health Plan Senior |
$19.78
|
| Rate for Payer: EPIC Health Plan Senior |
$19.78
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.98
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.98
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Prime Health Services Medicare |
$19.06
|
| Rate for Payer: Prime Health Services Medicare |
$19.06
|
| Rate for Payer: Riverside University Health System MISP |
$19.78
|
| Rate for Payer: Riverside University Health System MISP |
$19.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.56
|
| Rate for Payer: United Healthcare All Other HMO |
$14.56
|
| Rate for Payer: United Healthcare All Other HMO |
$14.56
|
| Rate for Payer: United Healthcare HMO Rider |
$14.56
|
| Rate for Payer: United Healthcare HMO Rider |
$14.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.78
|
| Rate for Payer: Vantage Medical Group Senior |
$17.98
|
| Rate for Payer: Vantage Medical Group Senior |
$17.98
|
|
|
HC PLATELET NEUTRALIZATION
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
900912007
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC PLATELET SURVIVAL
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT 78191
|
| Hospital Charge Code |
909301642
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$153.20 |
| Max. Negotiated Rate |
$1,526.91 |
| Rate for Payer: Adventist Health Commercial |
$153.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$514.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$930.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,526.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$445.58
|
| Rate for Payer: Blue Shield of California Commercial |
$482.58
|
| Rate for Payer: Blue Shield of California EPN |
$304.10
|
| Rate for Payer: Cash Price |
$344.70
|
| Rate for Payer: Cash Price |
$344.70
|
| Rate for Payer: Central Health Plan Commercial |
$612.80
|
| Rate for Payer: Cigna of CA HMO |
$490.24
|
| Rate for Payer: Cigna of CA PPO |
$566.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$536.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$651.10
|
| Rate for Payer: Global Benefits Group Commercial |
$459.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$689.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$198.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$486.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$219.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$574.50
|
| Rate for Payer: Networks By Design Commercial |
$497.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$514.17
|
| Rate for Payer: Prime Health Services Commercial |
$651.10
|
| Rate for Payer: Prime Health Services Medicare |
$545.02
|
| Rate for Payer: Riverside University Health System MISP |
$565.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$459.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$459.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$409.89
|
| Rate for Payer: United Healthcare All Other HMO |
$409.89
|
| Rate for Payer: United Healthcare HMO Rider |
$409.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$409.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC PLATELET SURVIVAL
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 78191
|
| Hospital Charge Code |
909301642
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$153.20 |
| Max. Negotiated Rate |
$689.40 |
| Rate for Payer: Adventist Health Commercial |
$153.20
|
| Rate for Payer: Cash Price |
$344.70
|
| Rate for Payer: Central Health Plan Commercial |
$612.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$536.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$306.40
|
| Rate for Payer: EPIC Health Plan Senior |
$306.40
|
| Rate for Payer: Galaxy Health WC |
$651.10
|
| Rate for Payer: Global Benefits Group Commercial |
$459.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$689.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$486.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$451.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.20
|
| Rate for Payer: Multiplan Commercial |
$574.50
|
| Rate for Payer: Networks By Design Commercial |
$497.90
|
| Rate for Payer: Prime Health Services Commercial |
$651.10
|
|
|
HC PLCMNT ACC BILIARY TREE PERCU
|
Facility
|
IP
|
$14,725.00
|
|
|
Service Code
|
CPT 47541
|
| Hospital Charge Code |
909047541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,945.00 |
| Max. Negotiated Rate |
$13,252.50 |
| Rate for Payer: Adventist Health Commercial |
$2,945.00
|
| Rate for Payer: Cash Price |
$6,626.25
|
| Rate for Payer: Central Health Plan Commercial |
$11,780.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,307.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,890.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,890.00
|
| Rate for Payer: Galaxy Health WC |
$12,516.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,835.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,252.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,350.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,687.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,945.00
|
| Rate for Payer: Multiplan Commercial |
$11,043.75
|
| Rate for Payer: Networks By Design Commercial |
$9,571.25
|
| Rate for Payer: Prime Health Services Commercial |
$12,516.25
|
|
|
HC PLCMNT ACC BILIARY TREE PERCU
|
Facility
|
OP
|
$14,725.00
|
|
|
Service Code
|
CPT 47541
|
| Hospital Charge Code |
909047541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,860.23 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,945.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$8,326.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,489.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,159.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,326.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$12,632.22
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$6,626.25
|
| Rate for Payer: Cash Price |
$6,626.25
|
| Rate for Payer: Cash Price |
$6,626.25
|
| Rate for Payer: Central Health Plan Commercial |
$11,780.00
|
| Rate for Payer: Cigna of CA HMO |
$9,424.00
|
| Rate for Payer: Cigna of CA PPO |
$10,896.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,489.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,159.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,326.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,307.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,738.58
|
| Rate for Payer: EPIC Health Plan Senior |
$9,159.05
|
| Rate for Payer: Galaxy Health WC |
$12,516.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,835.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,252.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13,655.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,860.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,326.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,350.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,054.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,656.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,945.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11,157.39
|
| Rate for Payer: Multiplan Commercial |
$11,043.75
|
| Rate for Payer: Multiplan WC |
$12,632.22
|
| Rate for Payer: Networks By Design Commercial |
$9,571.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8,326.41
|
| Rate for Payer: Preferred Health Network WC |
$12,890.02
|
| Rate for Payer: Prime Health Services Commercial |
$12,516.25
|
| Rate for Payer: Prime Health Services Medicare |
$8,825.99
|
| Rate for Payer: Prime Health Services WC |
$12,503.32
|
| Rate for Payer: Riverside University Health System MISP |
$9,159.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,835.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,362.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$8,326.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,489.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,159.05
|
| Rate for Payer: Vantage Medical Group Senior |
$8,326.41
|
|
|
HC PLCMNT LCL DVC PERC 1ST LESION
|
Facility
|
OP
|
$1,755.00
|
|
|
Service Code
|
CPT 10035
|
| Hospital Charge Code |
909010035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$351.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$910.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$486.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$1,105.65
|
| Rate for Payer: Blue Shield of California EPN |
$696.74
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,404.00
|
| Rate for Payer: Cigna of CA HMO |
$1,123.20
|
| Rate for Payer: Cigna of CA PPO |
$1,298.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,228.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$1,491.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,053.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,579.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$847.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,114.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$935.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$1,316.25
|
| Rate for Payer: Networks By Design Commercial |
$1,140.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$910.78
|
| Rate for Payer: Prime Health Services Commercial |
$1,491.75
|
| Rate for Payer: Prime Health Services Medicare |
$965.43
|
| Rate for Payer: Riverside University Health System MISP |
$1,001.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,053.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,053.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$877.50
|
| Rate for Payer: United Healthcare All Other HMO |
$877.50
|
| Rate for Payer: United Healthcare HMO Rider |
$877.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$877.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC PLCMNT LCL DVC PERC 1ST LESION
|
Facility
|
IP
|
$1,755.00
|
|
|
Service Code
|
CPT 10035
|
| Hospital Charge Code |
909010035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$1,579.50 |
| Rate for Payer: Adventist Health Commercial |
$351.00
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,404.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,228.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$702.00
|
| Rate for Payer: EPIC Health Plan Senior |
$702.00
|
| Rate for Payer: Galaxy Health WC |
$1,491.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,053.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,579.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,114.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,035.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.00
|
| Rate for Payer: Multiplan Commercial |
$1,316.25
|
| Rate for Payer: Networks By Design Commercial |
$1,140.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,491.75
|
|
