|
HC PLACEMENT OF IVC FILTER
|
Facility
IP
|
$17,541.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
906820197
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,508.20 |
| Max. Negotiated Rate |
$15,786.90 |
| Rate for Payer: Cash Price |
$7,893.45
|
| Rate for Payer: Central Health Plan Commercial |
$14,032.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,016.40
|
| Rate for Payer: Galaxy Health WC |
$14,909.85
|
| Rate for Payer: Global Benefits Group Commercial |
$10,524.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,786.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,699.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,508.20
|
| Rate for Payer: Multiplan Commercial |
$13,155.75
|
| Rate for Payer: Networks By Design Commercial |
$11,401.65
|
| Rate for Payer: Prime Health Services Commercial |
$14,909.85
|
|
|
HC PLACEMENT OF IVC FILTER
|
Facility
IP
|
$17,541.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
909081666
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,508.20 |
| Max. Negotiated Rate |
$15,786.90 |
| Rate for Payer: Cash Price |
$7,893.45
|
| Rate for Payer: Central Health Plan Commercial |
$14,032.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,016.40
|
| Rate for Payer: Galaxy Health WC |
$14,909.85
|
| Rate for Payer: Global Benefits Group Commercial |
$10,524.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,786.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,699.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,508.20
|
| Rate for Payer: Multiplan Commercial |
$13,155.75
|
| Rate for Payer: Networks By Design Commercial |
$11,401.65
|
| Rate for Payer: Prime Health Services Commercial |
$14,909.85
|
|
|
HC PLACEMENT OF IVC FILTER
|
Facility
OP
|
$17,541.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
909081666
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,960.28 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,866.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: BCBS Transplant Transplant |
$10,524.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$6,866.07
|
| Rate for Payer: Cash Price |
$7,893.45
|
| Rate for Payer: Cash Price |
$7,893.45
|
| Rate for Payer: Central Health Plan Commercial |
$14,032.80
|
| Rate for Payer: Cigna of CA PPO |
$12,980.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| 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 |
$14,909.85
|
| Rate for Payer: Global Benefits Group Commercial |
$10,524.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,786.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13,155.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,260.35
|
| Rate for Payer: IEHP medi-cal |
$11,329.02
|
| Rate for Payer: 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 |
$11,699.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,508.20
|
| 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 |
$13,155.75
|
| Rate for Payer: Networks By Design Commercial |
$11,401.65
|
| Rate for Payer: Prime Health Services Commercial |
$14,909.85
|
| Rate for Payer: Prime Health Services Medicare |
$7,278.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10,524.60
|
| Rate for Payer: Riverside University Health MISP |
$7,552.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,524.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| 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 PLACENTAL ALPHA MICROGLOB-1POC
|
Facility
OP
|
$246.00
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
900912139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$472.69 |
| Rate for Payer: Adventist Health Medi-Cal |
$98.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$472.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$147.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$107.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$98.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$371.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$453.19
|
| Rate for Payer: BCBS Transplant Transplant |
$147.60
|
| Rate for Payer: Blue Shield of California Commercial |
$152.03
|
| Rate for Payer: Blue Shield of California EPN |
$119.56
|
| Rate for Payer: Caremore Medicare Advantage |
$98.11
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Central Health Plan Commercial |
$196.80
|
| Rate for Payer: Cigna of CA HMO |
$157.44
|
| Rate for Payer: Cigna of CA PPO |
$182.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$98.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$98.11
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$221.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$184.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$160.90
|
| Rate for Payer: IEHP medi-cal |
$161.88
|
| Rate for Payer: IEHP Medicare Advantage |
$98.11
|
| Rate for Payer: Innovage PACE Commercial |
$147.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$98.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$131.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$131.47
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
| Rate for Payer: Prime Health Services Medicare |
$104.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$147.60
|
| Rate for Payer: Riverside University Health MISP |
$107.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.47
|
| Rate for Payer: United Healthcare All Other HMO |
$79.47
|
| Rate for Payer: United Healthcare HMO Rider |
$79.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$147.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$107.92
|
| Rate for Payer: Vantage Medical Group Senior |
$98.11
|
|
|
HC PLACENTAL ALPHA MICROGLOB-1POC
|
Facility
IP
|
$868.00
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
900912139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$781.20 |
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Central Health Plan Commercial |
$694.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.20
|
| Rate for Payer: Galaxy Health WC |
$737.80
|
| Rate for Payer: Global Benefits Group Commercial |
$520.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$781.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$578.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.60
|
| Rate for Payer: Multiplan Commercial |
$651.00
|
| Rate for Payer: Networks By Design Commercial |
$564.20
|
| Rate for Payer: Prime Health Services Commercial |
$737.80
|
|
|
HC PLASMA IRON TURNOVER
|
Facility
OP
|
$1,071.00
|
|
| Hospital Charge Code |
909301337
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$214.20 |
| Max. Negotiated Rate |
$963.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$650.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$910.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$589.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$589.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$518.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$632.75
|
| Rate for Payer: BCBS Transplant Transplant |
$642.60
|
| Rate for Payer: Blue Shield of California Commercial |
$661.88
|
| Rate for Payer: Blue Shield of California EPN |
$520.51
|
| Rate for Payer: Cash Price |
$481.95
|
| Rate for Payer: Central Health Plan Commercial |
$856.80
|
| Rate for Payer: Cigna of CA HMO |
$685.44
|
| Rate for Payer: Cigna of CA PPO |
$792.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$910.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$428.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$428.40
|
| Rate for Payer: Galaxy Health WC |
$910.35
|
| Rate for Payer: Global Benefits Group Commercial |
$642.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$963.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$803.25
|
| Rate for Payer: IEHP medi-cal |
$374.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$714.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.20
|
| Rate for Payer: Multiplan Commercial |
$803.25
|
| Rate for Payer: Networks By Design Commercial |
$696.15
|
| Rate for Payer: Prime Health Services Commercial |
$910.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$642.60
|
| Rate for Payer: Riverside University Health MISP |
$428.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$642.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$642.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$535.50
|
| Rate for Payer: United Healthcare All Other HMO |
$535.50
|
| Rate for Payer: United Healthcare HMO Rider |
$535.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$535.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$910.35
|
| Rate for Payer: Vantage Medical Group Senior |
$910.35
|
|
|
HC PLASMA IRON TURNOVER
|
Facility
IP
|
$1,071.00
|
|
| Hospital Charge Code |
909301337
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$214.20 |
| Max. Negotiated Rate |
$963.90 |
| Rate for Payer: Cash Price |
$481.95
|
| Rate for Payer: Central Health Plan Commercial |
$856.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$428.40
|
| Rate for Payer: Galaxy Health WC |
$910.35
|
| Rate for Payer: Global Benefits Group Commercial |
$642.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$963.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$714.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.20
|
| Rate for Payer: Multiplan Commercial |
$803.25
|
| Rate for Payer: Networks By Design Commercial |
$696.15
|
| Rate for Payer: Prime Health Services Commercial |
$910.35
|
|
|
HC PLASTIC REPAIR OF CANALICULI
|
Facility
OP
|
$8,325.00
|
|
|
Service Code
|
CPT 68700
|
| Hospital Charge Code |
900501395
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$7,492.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,995.00
|
| Rate for Payer: Caremore Medicare Advantage |
$2,919.67
|
| Rate for Payer: Cash Price |
$3,746.25
|
| Rate for Payer: Cash Price |
$3,746.25
|
| Rate for Payer: Cash Price |
$3,746.25
|
| Rate for Payer: Cash Price |
$3,746.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,660.00
|
| Rate for Payer: Cigna of CA PPO |
$6,160.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Galaxy Health WC |
$7,076.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,995.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,492.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,243.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,788.26
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,919.67
|
| Rate for Payer: Innovage PACE Commercial |
$4,379.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,552.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,665.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,912.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Multiplan Commercial |
$6,243.75
|
| Rate for Payer: Networks By Design Commercial |
$5,411.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,076.25
|
| Rate for Payer: Prime Health Services Medicare |
$3,094.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,995.00
|
| Rate for Payer: Riverside University Health MISP |
$3,211.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,995.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,162.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,162.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,162.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,162.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
HC PLASTIC REPAIR OF CANALICULI
|
Facility
IP
|
$8,325.00
|
|
|
Service Code
|
CPT 68700
|
| Hospital Charge Code |
900501395
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,665.00 |
| Max. Negotiated Rate |
$7,492.50 |
| Rate for Payer: Cash Price |
$3,746.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,660.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,330.00
|
| Rate for Payer: Galaxy Health WC |
$7,076.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,995.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,492.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,552.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,665.00
|
| Rate for Payer: Multiplan Commercial |
$6,243.75
|
| Rate for Payer: Networks By Design Commercial |
$5,411.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,076.25
|
|
|
HC PLASTIC REPAIR OF CANALICULI
|
Facility
IP
|
$8,325.00
|
|
|
Service Code
|
CPT 68700
|
| Hospital Charge Code |
900501395
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,665.00 |
| Max. Negotiated Rate |
$7,492.50 |
| Rate for Payer: Cash Price |
$3,746.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,660.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,330.00
|
| Rate for Payer: Galaxy Health WC |
$7,076.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,995.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,492.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,552.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,665.00
|
| Rate for Payer: Multiplan Commercial |
$6,243.75
|
| Rate for Payer: Networks By Design Commercial |
$5,411.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,076.25
|
|
|
HC PLASTIC REPAIR OF CANALICULI
|
Facility
OP
|
$8,325.00
|
|
|
Service Code
|
CPT 68700
|
| Hospital Charge Code |
900501395
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,665.00 |
| Max. Negotiated Rate |
$7,492.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,919.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,995.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,236.42
|
| Rate for Payer: Blue Shield of California EPN |
$4,070.92
|
| Rate for Payer: Caremore Medicare Advantage |
$2,919.67
|
| Rate for Payer: Cash Price |
$3,746.25
|
| Rate for Payer: Cash Price |
$3,746.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,660.00
|
| Rate for Payer: Cigna of CA HMO |
$5,328.00
|
| Rate for Payer: Cigna of CA PPO |
$6,160.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Galaxy Health WC |
$7,076.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,995.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,492.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,243.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,788.26
|
| Rate for Payer: IEHP medi-cal |
$4,817.46
|
| Rate for Payer: IEHP Medicare Advantage |
$2,919.67
|
| Rate for Payer: Innovage PACE Commercial |
$4,379.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,552.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,665.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,912.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Multiplan Commercial |
$6,243.75
|
| Rate for Payer: Networks By Design Commercial |
$5,411.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,076.25
|
| Rate for Payer: Prime Health Services Medicare |
$3,094.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,995.00
|
| Rate for Payer: Riverside University Health MISP |
$3,211.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,995.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,995.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,162.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,162.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,162.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,162.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
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 |
$2,679.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,679.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$165.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$136.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.10
|
| Rate for Payer: BCBS Transplant Transplant |
$180.00
|
| Rate for Payer: Blue Shield of California Commercial |
$225.00
|
| Rate for Payer: Blue Shield of California EPN |
$163.20
|
| Rate for Payer: Cash Price |
$135.00
|
| 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: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$225.00
|
| Rate for Payer: IEHP medi-cal |
$105.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| 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: Riverside University Health 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 |
$150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
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: Blue Shield of California EPN |
$160.20
|
| 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: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Prime Health Services Commercial |
$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 |
$2,679.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,679.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$612.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$396.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$396.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$328.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$401.04
|
| Rate for Payer: BCBS Transplant Transplant |
$432.00
|
| Rate for Payer: Blue Shield of California Commercial |
$540.00
|
| Rate for Payer: Blue Shield of California EPN |
$391.68
|
| Rate for Payer: Cash Price |
$324.00
|
| 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: EPIC Health Plan Commercial |
$288.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$540.00
|
| Rate for Payer: IEHP medi-cal |
$252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$480.24
|
| 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: Riverside University Health 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 |
$360.00
|
| Rate for Payer: United Healthcare All Other HMO |
$360.00
|
| Rate for Payer: United Healthcare HMO Rider |
$360.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$360.00
|
| 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: Blue Shield of California EPN |
$384.48
|
| 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: EPIC Health Plan Commercial |
$288.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$480.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Prime Health Services Commercial |
$612.00
|
|
|
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 |
$2,679.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,679.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$977.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$632.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$632.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$525.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$640.55
|
| Rate for Payer: BCBS Transplant Transplant |
$690.00
|
| Rate for Payer: Blue Shield of California Commercial |
$862.50
|
| Rate for Payer: Blue Shield of California EPN |
$625.60
|
| Rate for Payer: Cash Price |
$517.50
|
| 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: EPIC Health Plan Commercial |
$460.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$862.50
|
| Rate for Payer: IEHP medi-cal |
$402.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$767.05
|
| 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: Riverside University Health 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 |
$575.00
|
| Rate for Payer: United Healthcare All Other HMO |
$575.00
|
| Rate for Payer: United Healthcare HMO Rider |
$575.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$977.50
|
| Rate for Payer: Vantage Medical Group Senior |
$977.50
|
|
|
HC PLASTY BALLOON/XXL/MAXI
|
Facility
IP
|
$1,150.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.00 |
| Max. Negotiated Rate |
$1,035.00 |
| Rate for Payer: Blue Shield of California EPN |
$614.10
|
| 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: EPIC Health Plan Commercial |
$460.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$767.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.00
|
| Rate for Payer: Multiplan Commercial |
$862.50
|
| Rate for Payer: Prime Health Services Commercial |
$977.50
|
|
|
HC PLATELET AGGREGATION ASA
|
Facility
OP
|
$235.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.18 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$24.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$37.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.96
|
| Rate for Payer: BCBS Transplant Transplant |
$141.00
|
| Rate for Payer: Blue Shield of California Commercial |
$145.23
|
| Rate for Payer: Blue Shield of California EPN |
$114.21
|
| Rate for Payer: Caremore Medicare Advantage |
$24.91
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Central Health Plan Commercial |
$188.00
|
| Rate for Payer: Cigna of CA HMO |
$150.40
|
| Rate for Payer: Cigna of CA PPO |
$173.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.91
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$176.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$40.85
|
| Rate for Payer: IEHP medi-cal |
$41.10
|
| Rate for Payer: IEHP Medicare Advantage |
$24.91
|
| Rate for Payer: Innovage PACE Commercial |
$37.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.38
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| Rate for Payer: Prime Health Services Medicare |
$26.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$141.00
|
| Rate for Payer: Riverside University Health MISP |
$27.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.00
|
| 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 HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Senior |
$24.91
|
|
|
HC PLATELET AGGREGATION ASA
|
Facility
IP
|
$329.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Cash Price |
$148.05
|
| Rate for Payer: Central Health Plan Commercial |
$263.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.60
|
| Rate for Payer: Galaxy Health WC |
$279.65
|
| Rate for Payer: Global Benefits Group Commercial |
$197.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$296.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$219.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$246.75
|
| Rate for Payer: Networks By Design Commercial |
$213.85
|
| Rate for Payer: Prime Health Services Commercial |
$279.65
|
|
|
HC PLATELET AGGREGATION PRU P2Y12
|
Facility
OP
|
$325.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912033
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.18 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$24.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$37.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.96
|
| Rate for Payer: BCBS Transplant Transplant |
$195.00
|
| Rate for Payer: Blue Shield of California Commercial |
$200.85
|
| Rate for Payer: Blue Shield of California EPN |
$157.95
|
| Rate for Payer: Caremore Medicare Advantage |
$24.91
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Central Health Plan Commercial |
$260.00
|
| Rate for Payer: Cigna of CA HMO |
$208.00
|
| Rate for Payer: Cigna of CA PPO |
$240.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.91
|
| Rate for Payer: Galaxy Health WC |
$276.25
|
| Rate for Payer: Global Benefits Group Commercial |
$195.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$243.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$40.85
|
| Rate for Payer: IEHP medi-cal |
$41.10
|
| Rate for Payer: IEHP Medicare Advantage |
$24.91
|
| Rate for Payer: Innovage PACE Commercial |
$37.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.38
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
| Rate for Payer: Networks By Design Commercial |
$211.25
|
| Rate for Payer: Prime Health Services Commercial |
$276.25
|
| Rate for Payer: Prime Health Services Medicare |
$26.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$195.00
|
| Rate for Payer: Riverside University Health MISP |
$27.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.00
|
| 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 HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Senior |
$24.91
|
|
|
HC PLATELET AGGREGATION PRU P2Y12
|
Facility
IP
|
$438.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912033
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$394.20 |
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Central Health Plan Commercial |
$350.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.20
|
| Rate for Payer: Galaxy Health WC |
$372.30
|
| Rate for Payer: Global Benefits Group Commercial |
$262.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$394.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$292.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.60
|
| Rate for Payer: Multiplan Commercial |
$328.50
|
| Rate for Payer: Networks By Design Commercial |
$284.70
|
| Rate for Payer: Prime Health Services Commercial |
$372.30
|
|
|
HC PLATELET COUNT
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
900910101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$39.73 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.93
|
| Rate for Payer: AlphaCare 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 HMO/PPO |
$39.73
|
| Rate for Payer: BCBS Transplant Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.51
|
| Rate for Payer: Blue Shield of California EPN |
$8.26
|
| Rate for Payer: Caremore Medicare Advantage |
$4.48
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Central Health Plan Commercial |
$13.60
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.48
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.35
|
| Rate for Payer: IEHP medi-cal |
$7.39
|
| Rate for Payer: IEHP Medicare Advantage |
$4.48
|
| Rate for Payer: Innovage PACE Commercial |
$6.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Prime Health Services Medicare |
$4.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: Riverside University Health MISP |
$4.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| 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 HMO Rider |
$3.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.63
|
| 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 Senior |
$4.48
|
|
|
HC PLATELET COUNT
|
Facility
IP
|
$125.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
900910101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Central Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
|
|
HC PLATELET COUNT CITRATED
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
900912026
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$39.73 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.93
|
| Rate for Payer: AlphaCare 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 HMO/PPO |
$39.73
|
| Rate for Payer: BCBS Transplant Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.51
|
| Rate for Payer: Blue Shield of California EPN |
$8.26
|
| Rate for Payer: Caremore Medicare Advantage |
$4.48
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Central Health Plan Commercial |
$13.60
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.48
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.35
|
| Rate for Payer: IEHP medi-cal |
$7.39
|
| Rate for Payer: IEHP Medicare Advantage |
$4.48
|
| Rate for Payer: Innovage PACE Commercial |
$6.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Prime Health Services Medicare |
$4.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: Riverside University Health MISP |
$4.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| 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 HMO Rider |
$3.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.63
|
| 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 Senior |
$4.48
|
|
|
HC PLATELET COUNT CITRATED
|
Facility
IP
|
$125.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
900912026
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Central Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
|
