|
HC PREP/HARVEST W PLATELET DEPLET
|
Facility
OP
|
$2,126.00
|
|
|
Service Code
|
CPT 38213
|
| Hospital Charge Code |
911800309
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$70.62 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$542.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$70.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$542.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,275.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,337.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,039.61
|
| Rate for Payer: Caremore Medicare Advantage |
$542.38
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Cigna of CA HMO |
$1,360.64
|
| Rate for Payer: Cigna of CA PPO |
$1,573.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$542.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$542.38
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,594.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$889.50
|
| Rate for Payer: IEHP medi-cal |
$894.93
|
| Rate for Payer: IEHP Medicare Advantage |
$542.38
|
| Rate for Payer: Innovage PACE Commercial |
$813.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$542.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$726.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$726.79
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
| Rate for Payer: Prime Health Services Medicare |
$574.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,275.60
|
| Rate for Payer: Riverside University Health MISP |
$596.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,275.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,275.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,063.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,063.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,063.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,063.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$542.38
|
| Rate for Payer: Vantage Medical Group Senior |
$542.38
|
|
|
HC PREP/HARVEST W PLATELET DEPLET
|
Facility
IP
|
$2,126.00
|
|
|
Service Code
|
CPT 38213
|
| Hospital Charge Code |
911800309
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.40
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
|
|
HC PREP/HARVEST W RBC REMOVAL
|
Facility
OP
|
$2,126.00
|
|
|
Service Code
|
CPT 38212
|
| Hospital Charge Code |
911800308
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$273.96 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$542.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$273.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$542.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,275.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,337.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,039.61
|
| Rate for Payer: Caremore Medicare Advantage |
$542.38
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Cigna of CA HMO |
$1,360.64
|
| Rate for Payer: Cigna of CA PPO |
$1,573.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$542.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$542.38
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,594.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$889.50
|
| Rate for Payer: IEHP medi-cal |
$894.93
|
| Rate for Payer: IEHP Medicare Advantage |
$542.38
|
| Rate for Payer: Innovage PACE Commercial |
$813.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$542.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$726.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$726.79
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
| Rate for Payer: Prime Health Services Medicare |
$574.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,275.60
|
| Rate for Payer: Riverside University Health MISP |
$596.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,275.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,275.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,063.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,063.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,063.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,063.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$542.38
|
| Rate for Payer: Vantage Medical Group Senior |
$542.38
|
|
|
HC PREP/HARVEST W RBC REMOVAL
|
Facility
IP
|
$2,126.00
|
|
|
Service Code
|
CPT 38212
|
| Hospital Charge Code |
911800308
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.40
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
|
|
HC PREP/HARVEST W T-CELL DEPLETIO
|
Facility
OP
|
$2,126.00
|
|
|
Service Code
|
CPT 38210
|
| Hospital Charge Code |
911800306
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$542.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$459.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$542.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,275.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,337.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,039.61
|
| Rate for Payer: Caremore Medicare Advantage |
$542.38
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Cigna of CA HMO |
$1,360.64
|
| Rate for Payer: Cigna of CA PPO |
$1,573.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$542.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$542.38
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,594.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$889.50
|
| Rate for Payer: IEHP medi-cal |
$894.93
|
| Rate for Payer: IEHP Medicare Advantage |
$542.38
|
| Rate for Payer: Innovage PACE Commercial |
$813.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$542.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$726.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$726.79
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
| Rate for Payer: Prime Health Services Medicare |
$574.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,275.60
|
| Rate for Payer: Riverside University Health MISP |
$596.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,275.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,275.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,063.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,063.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,063.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,063.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$542.38
|
| Rate for Payer: Vantage Medical Group Senior |
$542.38
|
|
|
HC PREP/HARVEST W T-CELL DEPLETIO
|
Facility
IP
|
$2,126.00
|
|
|
Service Code
|
CPT 38210
|
| Hospital Charge Code |
911800306
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.40
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
|
|
HC PREP/HARVEST W TUMOR CELL DEP
|
Facility
IP
|
$2,126.00
|
|
|
Service Code
|
CPT 38211
|
| Hospital Charge Code |
911800307
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.40
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
|
|
HC PREP/HARVEST W TUMOR CELL DEP
|
Facility
OP
|
$2,126.00
|
|
|
Service Code
|
CPT 38211
|
| Hospital Charge Code |
911800307
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$416.25 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$542.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$416.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$542.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,275.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,337.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,039.61
|
| Rate for Payer: Caremore Medicare Advantage |
$542.38
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Cigna of CA HMO |
$1,360.64
|
| Rate for Payer: Cigna of CA PPO |
$1,573.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$542.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$542.38
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,594.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$889.50
|
| Rate for Payer: IEHP medi-cal |
$894.93
|
| Rate for Payer: IEHP Medicare Advantage |
$542.38
|
| Rate for Payer: Innovage PACE Commercial |
$813.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$542.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$726.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$726.79
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
| Rate for Payer: Prime Health Services Medicare |
$574.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,275.60
|
| Rate for Payer: Riverside University Health MISP |
$596.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,275.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,275.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,063.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,063.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,063.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,063.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$542.38
|
| Rate for Payer: Vantage Medical Group Senior |
$542.38
|
|
|
HC PRE POST CHALLENGE SPIROMETRY
|
Facility
IP
|
$1,086.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
900801002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$217.20 |
| Max. Negotiated Rate |
$977.40 |
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Central Health Plan Commercial |
$868.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.40
|
| Rate for Payer: Galaxy Health WC |
$923.10
|
| Rate for Payer: Global Benefits Group Commercial |
$651.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$977.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$724.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.20
|
| Rate for Payer: Multiplan Commercial |
$814.50
|
| Rate for Payer: Networks By Design Commercial |
$705.90
|
| Rate for Payer: Prime Health Services Commercial |
$923.10
|
|
|
HC PRE POST CHALLENGE SPIROMETRY
|
Facility
OP
|
$1,086.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
900801002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$217.20 |
| Max. Negotiated Rate |
$977.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$392.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$280.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$241.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$641.61
|
| Rate for Payer: BCBS Transplant Transplant |
$651.60
|
| Rate for Payer: Blue Shield of California Commercial |
$671.15
|
| Rate for Payer: Blue Shield of California EPN |
$527.80
|
| Rate for Payer: Caremore Medicare Advantage |
$392.17
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Central Health Plan Commercial |
$868.80
|
| Rate for Payer: Cigna of CA HMO |
$695.04
|
| Rate for Payer: Cigna of CA PPO |
$803.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$923.10
|
| Rate for Payer: Global Benefits Group Commercial |
$651.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$977.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$814.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$643.16
|
| Rate for Payer: IEHP medi-cal |
$647.08
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Innovage PACE Commercial |
$588.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$724.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$814.50
|
| Rate for Payer: Networks By Design Commercial |
$705.90
|
| Rate for Payer: Prime Health Services Commercial |
$923.10
|
| Rate for Payer: Prime Health Services Medicare |
$415.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$651.60
|
| Rate for Payer: Riverside University Health MISP |
$431.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$651.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$651.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC PRE-TIBIAL SHELL MOLDED ADDITON LE
|
Facility
IP
|
$1,065.00
|
|
|
Service Code
|
CPT L2340
|
| Hospital Charge Code |
905352340
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$213.00 |
| Max. Negotiated Rate |
$958.50 |
| Rate for Payer: Blue Shield of California EPN |
$568.71
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Central Health Plan Commercial |
$852.00
|
| Rate for Payer: Cigna of CA HMO |
$745.50
|
| Rate for Payer: Cigna of CA PPO |
$745.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$426.00
|
| Rate for Payer: Galaxy Health WC |
$905.25
|
| Rate for Payer: Global Benefits Group Commercial |
$639.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$958.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$710.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.00
|
| Rate for Payer: Multiplan Commercial |
$798.75
|
| Rate for Payer: Networks By Design Commercial |
$532.50
|
| Rate for Payer: Prime Health Services Commercial |
$905.25
|
|
|
HC PRE-TIBIAL SHELL MOLDED ADDITON LE
|
Facility
OP
|
$1,065.00
|
|
|
Service Code
|
CPT L2340
|
| Hospital Charge Code |
905352340
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$372.75 |
| Max. Negotiated Rate |
$1,855.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,855.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$905.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$585.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$585.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$515.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$629.20
|
| Rate for Payer: BCBS Transplant Transplant |
$639.00
|
| Rate for Payer: Blue Shield of California Commercial |
$798.75
|
| Rate for Payer: Blue Shield of California EPN |
$579.36
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Central Health Plan Commercial |
$852.00
|
| Rate for Payer: Cigna of CA HMO |
$745.50
|
| Rate for Payer: Cigna of CA PPO |
$745.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$905.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$426.00
|
| Rate for Payer: Galaxy Health WC |
$905.25
|
| Rate for Payer: Global Benefits Group Commercial |
$639.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$958.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$798.75
|
| Rate for Payer: IEHP medi-cal |
$372.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$710.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$436.65
|
| Rate for Payer: Multiplan Commercial |
$798.75
|
| Rate for Payer: Networks By Design Commercial |
$532.50
|
| Rate for Payer: Prime Health Services Commercial |
$905.25
|
| Rate for Payer: Riverside University Health MISP |
$426.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$639.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$639.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$532.50
|
| Rate for Payer: United Healthcare All Other HMO |
$532.50
|
| Rate for Payer: United Healthcare HMO Rider |
$532.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$532.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$905.25
|
| Rate for Payer: Vantage Medical Group Senior |
$905.25
|
|
|
HC PREVIEW TRT PLANNING
|
Facility
OP
|
$2,719.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201982
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$2,447.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,311.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,495.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,495.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$739.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,606.39
|
| Rate for Payer: BCBS Transplant Transplant |
$1,631.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,680.34
|
| Rate for Payer: Blue Shield of California EPN |
$1,321.43
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,175.20
|
| Rate for Payer: Cigna of CA HMO |
$1,740.16
|
| Rate for Payer: Cigna of CA PPO |
$2,012.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,311.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,087.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,087.60
|
| Rate for Payer: Galaxy Health WC |
$2,311.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,631.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,447.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,039.25
|
| Rate for Payer: IEHP medi-cal |
$951.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,813.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$543.80
|
| Rate for Payer: Multiplan Commercial |
$2,039.25
|
| Rate for Payer: Networks By Design Commercial |
$1,767.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,311.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| Rate for Payer: Riverside University Health MISP |
$1,087.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,631.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,631.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,359.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,359.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,359.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,359.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,311.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,311.15
|
|
|
HC PREVIEW TRT PLANNING
|
Facility
IP
|
$2,719.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201982
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$543.80 |
| Max. Negotiated Rate |
$2,447.10 |
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,175.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,087.60
|
| Rate for Payer: Galaxy Health WC |
$2,311.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,631.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,447.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,813.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$543.80
|
| Rate for Payer: Multiplan Commercial |
$2,039.25
|
| Rate for Payer: Networks By Design Commercial |
$1,767.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,311.15
|
|
|
HC PREVNAR ADMINISTRATION
|
Facility
IP
|
$23.00
|
|
| Hospital Charge Code |
902890224
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
|
|
HC PREVNAR ADMINISTRATION
|
Facility
OP
|
$23.00
|
|
| Hospital Charge Code |
902890224
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$13.80
|
| Rate for Payer: Blue Shield of California Commercial |
$14.47
|
| Rate for Payer: Blue Shield of California EPN |
$11.25
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$18.40
|
| Rate for Payer: Cigna of CA HMO |
$14.72
|
| Rate for Payer: Cigna of CA PPO |
$17.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$17.25
|
| Rate for Payer: IEHP medi-cal |
$8.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.80
|
| Rate for Payer: Riverside University Health MISP |
$9.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.50
|
| Rate for Payer: United Healthcare All Other HMO |
$11.50
|
| Rate for Payer: United Healthcare HMO Rider |
$11.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.55
|
| Rate for Payer: Vantage Medical Group Senior |
$19.55
|
|
|
HC PRGRMG DEV EVAL IMPLTBL SYS
|
Facility
OP
|
$115.00
|
|
|
Service Code
|
CPT 93260
|
| Hospital Charge Code |
900293260
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$656.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$47.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$70.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$51.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$47.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$201.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.94
|
| Rate for Payer: BCBS Transplant Transplant |
$69.00
|
| Rate for Payer: Blue Shield of California Commercial |
$71.07
|
| Rate for Payer: Blue Shield of California EPN |
$55.89
|
| Rate for Payer: Caremore Medicare Advantage |
$47.12
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Central Health Plan Commercial |
$92.00
|
| Rate for Payer: Cigna of CA HMO |
$73.60
|
| Rate for Payer: Cigna of CA PPO |
$85.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$47.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.12
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$86.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$77.28
|
| Rate for Payer: IEHP medi-cal |
$77.75
|
| Rate for Payer: IEHP Medicare Advantage |
$47.12
|
| Rate for Payer: Innovage PACE Commercial |
$70.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.14
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
| Rate for Payer: Prime Health Services Medicare |
$49.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$69.00
|
| Rate for Payer: Riverside University Health MISP |
$51.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$656.00
|
| Rate for Payer: United Healthcare All Other HMO |
$399.00
|
| Rate for Payer: United Healthcare HMO Rider |
$302.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.83
|
| Rate for Payer: Vantage Medical Group Senior |
$47.12
|
|
|
HC PRGRMG DEV EVAL IMPLTBL SYS
|
Facility
IP
|
$115.00
|
|
|
Service Code
|
CPT 93260
|
| Hospital Charge Code |
900293260
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Central Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
|
|
HC PRGRMG DVC EVAL LEADLESS PMKR SC
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
CPT 0826T
|
| Hospital Charge Code |
906819776
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$47.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$70.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$51.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$47.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.03
|
| Rate for Payer: BCBS Transplant Transplant |
$63.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$47.12
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Central Health Plan Commercial |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$77.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$47.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.12
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$78.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$77.28
|
| Rate for Payer: IEHP medi-cal |
$77.75
|
| Rate for Payer: IEHP Medicare Advantage |
$47.12
|
| Rate for Payer: Innovage PACE Commercial |
$70.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.14
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
| Rate for Payer: Prime Health Services Medicare |
$49.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$63.00
|
| Rate for Payer: Riverside University Health MISP |
$51.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.83
|
| Rate for Payer: Vantage Medical Group Senior |
$47.12
|
|
|
HC PRGRMG DVC EVAL LEADLESS PMKR SC
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
CPT 0826T
|
| Hospital Charge Code |
906819776
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Central Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.00
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
IP
|
$14,829.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
909081843
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,965.80 |
| Max. Negotiated Rate |
$13,346.10 |
| Rate for Payer: Cash Price |
$6,673.05
|
| Rate for Payer: Central Health Plan Commercial |
$11,863.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,931.60
|
| Rate for Payer: Galaxy Health WC |
$12,604.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,897.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,346.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,890.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,965.80
|
| Rate for Payer: Multiplan Commercial |
$11,121.75
|
| Rate for Payer: Networks By Design Commercial |
$9,638.85
|
| Rate for Payer: Prime Health Services Commercial |
$12,604.65
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
OP
|
$14,829.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
906820231
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,965.80 |
| Max. Negotiated Rate |
$36,149.78 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,908.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26,109.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: BCBS Transplant Transplant |
$8,897.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$21,908.96
|
| Rate for Payer: Cash Price |
$6,673.05
|
| Rate for Payer: Cash Price |
$6,673.05
|
| Rate for Payer: Central Health Plan Commercial |
$11,863.20
|
| Rate for Payer: Cigna of CA PPO |
$10,973.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$12,604.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,897.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,346.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11,121.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35,930.69
|
| Rate for Payer: IEHP medi-cal |
$36,149.78
|
| Rate for Payer: IEHP Medicare Advantage |
$21,908.96
|
| Rate for Payer: Innovage PACE Commercial |
$32,863.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,890.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,965.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,358.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$11,121.75
|
| Rate for Payer: Networks By Design Commercial |
$9,638.85
|
| Rate for Payer: Prime Health Services Commercial |
$12,604.65
|
| Rate for Payer: Prime Health Services Medicare |
$23,223.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8,897.40
|
| Rate for Payer: Riverside University Health MISP |
$24,099.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,897.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,897.40
|
| 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 |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
IP
|
$14,829.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
906820231
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,965.80 |
| Max. Negotiated Rate |
$13,346.10 |
| Rate for Payer: Cash Price |
$6,673.05
|
| Rate for Payer: Central Health Plan Commercial |
$11,863.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,931.60
|
| Rate for Payer: Galaxy Health WC |
$12,604.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,897.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,346.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,890.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,965.80
|
| Rate for Payer: Multiplan Commercial |
$11,121.75
|
| Rate for Payer: Networks By Design Commercial |
$9,638.85
|
| Rate for Payer: Prime Health Services Commercial |
$12,604.65
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
IP
|
$14,829.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
906811428
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,965.80 |
| Max. Negotiated Rate |
$13,346.10 |
| Rate for Payer: Cash Price |
$6,673.05
|
| Rate for Payer: Central Health Plan Commercial |
$11,863.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,931.60
|
| Rate for Payer: Galaxy Health WC |
$12,604.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,897.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,346.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,890.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,965.80
|
| Rate for Payer: Multiplan Commercial |
$11,121.75
|
| Rate for Payer: Networks By Design Commercial |
$9,638.85
|
| Rate for Payer: Prime Health Services Commercial |
$12,604.65
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
OP
|
$14,829.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
909081843
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,965.80 |
| Max. Negotiated Rate |
$36,149.78 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,908.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26,109.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$29,952.68
|
| Rate for Payer: BCBS Transplant Transplant |
$8,897.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$21,908.96
|
| Rate for Payer: Cash Price |
$6,673.05
|
| Rate for Payer: Cash Price |
$6,673.05
|
| Rate for Payer: Central Health Plan Commercial |
$11,863.20
|
| Rate for Payer: Cigna of CA PPO |
$10,973.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$12,604.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,897.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,346.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11,121.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35,930.69
|
| Rate for Payer: IEHP medi-cal |
$36,149.78
|
| Rate for Payer: IEHP Medicare Advantage |
$21,908.96
|
| Rate for Payer: Innovage PACE Commercial |
$32,863.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,890.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,965.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,358.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$11,121.75
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: Networks By Design Commercial |
$9,638.85
|
| Rate for Payer: Preferred Health Network WC |
$30,563.96
|
| Rate for Payer: Prime Health Services Commercial |
$12,604.65
|
| Rate for Payer: Prime Health Services Medicare |
$23,223.50
|
| Rate for Payer: Prime Health Services WC |
$29,647.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8,897.40
|
| Rate for Payer: Riverside University Health MISP |
$24,099.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,897.40
|
| 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 |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
