|
HC TRANSCATH RMVL REPL SC LEADLESS PMKR RA
|
Facility
|
IP
|
$45,636.00
|
|
|
Service Code
|
CPT 0825T
|
| Hospital Charge Code |
906819775
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,260.12 |
| Max. Negotiated Rate |
$34,227.00 |
| Rate for Payer: Adventist Health Commercial |
$9,127.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29,389.58
|
| Rate for Payer: Cash Price |
$20,536.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$30,895.57
|
| Rate for Payer: Heritage Provider Network Senior |
$30,895.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,409.00
|
| Rate for Payer: Multiplan Commercial |
$34,227.00
|
|
|
HC TRANSCATH RMVL REPL SC LEADLESS PMKR RA
|
Facility
|
OP
|
$45,636.00
|
|
|
Service Code
|
CPT 0825T
|
| Hospital Charge Code |
906819775
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$47,070.12 |
| Rate for Payer: Adventist Health Commercial |
$9,127.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28,203.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37,160.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27,251.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,773.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,827.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$20,536.20
|
| Rate for Payer: Cash Price |
$20,536.20
|
| Rate for Payer: Cash Price |
$20,536.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29,663.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37,160.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,251.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,773.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$24,773.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$28,248.68
|
| Rate for Payer: Heritage Provider Network Senior |
$30,471.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,773.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$47,070.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,260.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,489.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,409.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33,196.82
|
| Rate for Payer: Multiplan Commercial |
$34,227.00
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$27,251.12
|
| Rate for Payer: TriValley Medical Group Senior |
$27,251.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22,818.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22,818.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37,160.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,251.12
|
| Rate for Payer: Vantage Medical Group Senior |
$24,773.75
|
|
|
HC TRANSCATH RMVL SC LEADLESS PMKR RA
|
Facility
|
OP
|
$7,466.00
|
|
|
Service Code
|
CPT 0824T
|
| Hospital Charge Code |
906819774
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,351.35 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,493.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,613.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,734.49
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,359.70
|
| Rate for Payer: Cash Price |
$3,359.70
|
| Rate for Payer: Cash Price |
$3,359.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,852.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,621.45
|
| Rate for Payer: Heritage Provider Network Senior |
$4,995.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,715.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,351.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,866.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$5,599.50
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,467.15
|
| Rate for Payer: TriValley Medical Group Senior |
$4,467.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,733.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,733.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC TRANSCATH RMVL SC LEADLESS PMKR RA
|
Facility
|
IP
|
$7,466.00
|
|
|
Service Code
|
CPT 0824T
|
| Hospital Charge Code |
906819774
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,351.35 |
| Max. Negotiated Rate |
$5,599.50 |
| Rate for Payer: Adventist Health Commercial |
$1,493.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,808.10
|
| Rate for Payer: Cash Price |
$3,359.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,054.48
|
| Rate for Payer: Heritage Provider Network Senior |
$5,054.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,351.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,866.50
|
| Rate for Payer: Multiplan Commercial |
$5,599.50
|
|
|
HC TRANSCATH THRPY EMBOLIZATION
|
Facility
|
IP
|
$8,656.00
|
|
|
Service Code
|
CPT 75894
|
| Hospital Charge Code |
906812173
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,566.74 |
| Max. Negotiated Rate |
$6,492.00 |
| Rate for Payer: Adventist Health Commercial |
$1,731.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,574.46
|
| Rate for Payer: Cash Price |
$3,895.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,860.11
|
| Rate for Payer: Heritage Provider Network Senior |
$5,860.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,566.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,164.00
|
| Rate for Payer: Multiplan Commercial |
$6,492.00
|
|
|
HC TRANSCATH THRPY EMBOLIZATION
|
Facility
|
OP
|
$8,656.00
|
|
|
Service Code
|
CPT 75894
|
| Hospital Charge Code |
906812173
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,566.74 |
| Max. Negotiated Rate |
$7,357.60 |
| Rate for Payer: Adventist Health Commercial |
$1,731.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,349.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,357.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,760.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,492.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,519.92
|
| Rate for Payer: Blue Shield of California Commercial |
$5,075.81
|
| Rate for Payer: Blue Shield of California EPN |
$4,081.80
|
| Rate for Payer: Cash Price |
$3,895.20
|
| Rate for Payer: Cash Price |
$3,895.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,626.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,357.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,357.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,357.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,107.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,358.06
|
| Rate for Payer: Heritage Provider Network Senior |
$5,358.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,128.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,566.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,164.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,059.20
|
| Rate for Payer: Multiplan Commercial |
$6,492.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,328.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,328.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,357.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,357.60
|
| Rate for Payer: Vantage Medical Group Senior |
$7,357.60
|
|
|
HC TRANSCATH TRICUSP VALVE ADDT
|
Facility
|
IP
|
$18,441.00
|
|
|
Service Code
|
CPT 0570T
|
| Hospital Charge Code |
906810570
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,337.82 |
| Max. Negotiated Rate |
$13,830.75 |
| Rate for Payer: Adventist Health Commercial |
$3,688.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,876.00
|
| Rate for Payer: Cash Price |
$8,298.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,484.56
|
| Rate for Payer: Heritage Provider Network Senior |
$12,484.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,337.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,610.25
|
| Rate for Payer: Multiplan Commercial |
$13,830.75
|
|
|
HC TRANSCATH TRICUSP VALVE ADDT
|
Facility
|
OP
|
$18,441.00
|
|
|
Service Code
|
CPT 0570T
|
| Hospital Charge Code |
906810570
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$15,674.85 |
| Rate for Payer: Adventist Health Commercial |
$3,688.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,396.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,674.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,142.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,830.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,185.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$8,298.45
|
| Rate for Payer: Cash Price |
$8,298.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,986.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,674.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,674.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,674.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,414.98
|
| Rate for Payer: Heritage Provider Network Senior |
$11,414.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,796.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,337.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,610.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,908.70
|
| Rate for Payer: Multiplan Commercial |
$13,830.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,674.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,674.85
|
| Rate for Payer: Vantage Medical Group Senior |
$15,674.85
|
|
|
HC TRANSCATH TRICUSP VALVE ANNUL
|
Facility
|
OP
|
$59,559.00
|
|
|
Service Code
|
CPT 0545T
|
| Hospital Charge Code |
906810545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$50,625.15 |
| Rate for Payer: Adventist Health Commercial |
$11,911.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,807.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50,625.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32,757.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44,669.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,185.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$26,801.55
|
| Rate for Payer: Cash Price |
$26,801.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38,713.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50,625.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$50,625.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50,625.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$36,867.02
|
| Rate for Payer: Heritage Provider Network Senior |
$36,867.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28,409.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,780.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,889.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41,691.30
|
| Rate for Payer: Multiplan Commercial |
$44,669.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50,625.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50,625.15
|
| Rate for Payer: Vantage Medical Group Senior |
$50,625.15
|
|
|
HC TRANSCATH TRICUSP VALVE ANNUL
|
Facility
|
IP
|
$59,559.00
|
|
|
Service Code
|
CPT 0545T
|
| Hospital Charge Code |
906810545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,780.18 |
| Max. Negotiated Rate |
$44,669.25 |
| Rate for Payer: Adventist Health Commercial |
$11,911.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38,356.00
|
| Rate for Payer: Cash Price |
$26,801.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$40,321.44
|
| Rate for Payer: Heritage Provider Network Senior |
$40,321.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,780.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,889.75
|
| Rate for Payer: Multiplan Commercial |
$44,669.25
|
|
|
HC TRANSCATH TRICUSPVALVE IMPLANT
|
Facility
|
IP
|
$65,993.00
|
|
|
Service Code
|
CPT 0646T
|
| Hospital Charge Code |
906803799
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,944.73 |
| Max. Negotiated Rate |
$49,494.75 |
| Rate for Payer: Adventist Health Commercial |
$13,198.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42,499.49
|
| Rate for Payer: Cash Price |
$29,696.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$44,677.26
|
| Rate for Payer: Heritage Provider Network Senior |
$44,677.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,944.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16,498.25
|
| Rate for Payer: Multiplan Commercial |
$49,494.75
|
|
|
HC TRANSCATH TRICUSPVALVE IMPLANT
|
Facility
|
OP
|
$65,993.00
|
|
|
Service Code
|
CPT 0646T
|
| Hospital Charge Code |
906803799
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$56,094.05 |
| Rate for Payer: Adventist Health Commercial |
$13,198.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40,783.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56,094.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36,296.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49,494.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33,009.70
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$29,696.85
|
| Rate for Payer: Cash Price |
$29,696.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42,895.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56,094.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$56,094.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56,094.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$40,849.67
|
| Rate for Payer: Heritage Provider Network Senior |
$40,849.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$31,478.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,944.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16,498.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$46,195.10
|
| Rate for Payer: Multiplan Commercial |
$49,494.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56,094.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56,094.05
|
| Rate for Payer: Vantage Medical Group Senior |
$56,094.05
|
|
|
HC TRANSCATH TRICUSP VALVE REPAIR
|
Facility
|
IP
|
$59,559.00
|
|
|
Service Code
|
CPT 0569T
|
| Hospital Charge Code |
906810569
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,780.18 |
| Max. Negotiated Rate |
$44,669.25 |
| Rate for Payer: Adventist Health Commercial |
$11,911.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38,356.00
|
| Rate for Payer: Cash Price |
$26,801.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$40,321.44
|
| Rate for Payer: Heritage Provider Network Senior |
$40,321.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,780.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,889.75
|
| Rate for Payer: Multiplan Commercial |
$44,669.25
|
|
|
HC TRANSCATH TRICUSP VALVE REPAIR
|
Facility
|
OP
|
$59,559.00
|
|
|
Service Code
|
CPT 0569T
|
| Hospital Charge Code |
906810569
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$50,625.15 |
| Rate for Payer: Adventist Health Commercial |
$11,911.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,807.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50,625.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32,757.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44,669.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,185.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$26,801.55
|
| Rate for Payer: Cash Price |
$26,801.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38,713.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50,625.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$50,625.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50,625.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$36,867.02
|
| Rate for Payer: Heritage Provider Network Senior |
$36,867.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28,409.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,780.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,889.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41,691.30
|
| Rate for Payer: Multiplan Commercial |
$44,669.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50,625.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50,625.15
|
| Rate for Payer: Vantage Medical Group Senior |
$50,625.15
|
|
|
HC TRANSCRANIAL DUPLEX/DOPPLER
|
Facility
|
OP
|
$1,090.00
|
|
|
Service Code
|
CPT 93888
|
| Hospital Charge Code |
906601144
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,077.00 |
| Rate for Payer: Adventist Health Commercial |
$218.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$673.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$545.22
|
| Rate for Payer: Blue Shield of California Commercial |
$602.59
|
| Rate for Payer: Blue Shield of California EPN |
$484.58
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$708.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$643.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$674.71
|
| Rate for Payer: Heritage Provider Network Senior |
$674.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$519.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$197.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$817.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$147.91
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC TRANSCRANIAL DUPLEX/DOPPLER
|
Facility
|
OP
|
$2,204.00
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
906601143
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$1,653.00 |
| Rate for Payer: Adventist Health Commercial |
$440.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,362.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,102.44
|
| Rate for Payer: Blue Shield of California Commercial |
$884.54
|
| Rate for Payer: Blue Shield of California EPN |
$711.32
|
| Rate for Payer: Cash Price |
$991.80
|
| Rate for Payer: Cash Price |
$991.80
|
| Rate for Payer: Cash Price |
$991.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,432.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,300.36
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,364.28
|
| Rate for Payer: Heritage Provider Network Senior |
$1,364.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,051.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$398.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$551.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,653.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$337.57
|
| Rate for Payer: TriValley Medical Group Senior |
$306.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC TRANSCRANIAL DUPLEX/DOPPLER
|
Facility
|
IP
|
$1,090.00
|
|
|
Service Code
|
CPT 93888
|
| Hospital Charge Code |
906601144
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$197.29 |
| Max. Negotiated Rate |
$817.50 |
| Rate for Payer: Adventist Health Commercial |
$218.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$701.96
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$737.93
|
| Rate for Payer: Heritage Provider Network Senior |
$737.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$197.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.50
|
| Rate for Payer: Multiplan Commercial |
$817.50
|
|
|
HC TRANSCRANIAL DUPLEX/DOPPLER
|
Facility
|
IP
|
$2,204.00
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
906601143
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$398.92 |
| Max. Negotiated Rate |
$1,653.00 |
| Rate for Payer: Adventist Health Commercial |
$440.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,419.38
|
| Rate for Payer: Cash Price |
$991.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,492.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1,492.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$398.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$551.00
|
| Rate for Payer: Multiplan Commercial |
$1,653.00
|
|
|
HC TRANSESOPHOGEAL CARDIAC OUTPUT
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
900800525
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$112.22 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$124.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$383.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.12
|
| Rate for Payer: Blue Shield of California Commercial |
$378.20
|
| Rate for Payer: Blue Shield of California EPN |
$302.56
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$403.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$365.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$165.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$383.78
|
| Rate for Payer: Heritage Provider Network Senior |
$383.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$295.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$112.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$190.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$465.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$182.04
|
| Rate for Payer: TriValley Medical Group Senior |
$165.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$310.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$310.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC TRANSESOPHOGEAL CARDIAC OUTPUT
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
900800525
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$112.22 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$124.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$399.28
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$419.74
|
| Rate for Payer: Heritage Provider Network Senior |
$419.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$112.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.00
|
| Rate for Payer: Multiplan Commercial |
$465.00
|
|
|
HC TRANSFERRIN
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
900910854
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.76 |
| Max. Negotiated Rate |
$179.25 |
| Rate for Payer: Adventist Health Commercial |
$47.80
|
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$147.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.78
|
| Rate for Payer: Blue Shield of California Commercial |
$102.76
|
| Rate for Payer: Blue Shield of California Commercial |
$102.76
|
| Rate for Payer: Blue Shield of California EPN |
$82.42
|
| Rate for Payer: Blue Shield of California EPN |
$82.42
|
| Rate for Payer: Cash Price |
$107.55
|
| Rate for Payer: Cash Price |
$107.55
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$70.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$155.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.72
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.94
|
| Rate for Payer: Heritage Provider Network Senior |
$66.85
|
| Rate for Payer: Heritage Provider Network Senior |
$147.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$51.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$114.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.10
|
| Rate for Payer: Multiplan Commercial |
$81.00
|
| Rate for Payer: Multiplan Commercial |
$179.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.76
|
| Rate for Payer: TriValley Medical Group Senior |
$12.76
|
| Rate for Payer: TriValley Medical Group Senior |
$12.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.04
|
| Rate for Payer: Vantage Medical Group Senior |
$12.76
|
| Rate for Payer: Vantage Medical Group Senior |
$12.76
|
|
|
HC TRANSFERRIN
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
900910854
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.26 |
| Max. Negotiated Rate |
$179.25 |
| Rate for Payer: Adventist Health Commercial |
$47.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$153.92
|
| Rate for Payer: Cash Price |
$107.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$161.80
|
| Rate for Payer: Heritage Provider Network Senior |
$161.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.75
|
| Rate for Payer: Multiplan Commercial |
$179.25
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
OP
|
$1,593.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
906536430
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$288.33 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$318.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$984.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$971.73
|
| Rate for Payer: Blue Shield of California EPN |
$777.38
|
| Rate for Payer: Cash Price |
$716.85
|
| Rate for Payer: Cash Price |
$716.85
|
| Rate for Payer: Cash Price |
$716.85
|
| Rate for Payer: Cash Price |
$716.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,035.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$567.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$986.07
|
| Rate for Payer: Heritage Provider Network Senior |
$986.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$759.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$288.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$652.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$760.34
|
| Rate for Payer: Multiplan Commercial |
$1,194.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$624.16
|
| Rate for Payer: TriValley Medical Group Senior |
$567.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
OP
|
$1,593.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$288.33 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$318.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$984.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$756.67
|
| Rate for Payer: Blue Shield of California EPN |
$602.15
|
| Rate for Payer: Cash Price |
$716.85
|
| Rate for Payer: Cash Price |
$716.85
|
| Rate for Payer: Cash Price |
$716.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,035.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$567.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,078.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,078.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$759.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$288.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$652.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$760.34
|
| Rate for Payer: Multiplan Commercial |
$1,194.75
|
| Rate for Payer: Multiplan WC |
$885.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$955.80
|
| Rate for Payer: TriValley Medical Group Senior |
$955.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
IP
|
$1,593.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
906536430
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$288.33 |
| Max. Negotiated Rate |
$1,194.75 |
| Rate for Payer: Adventist Health Commercial |
$318.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,025.89
|
| Rate for Payer: Cash Price |
$716.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,078.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,078.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$288.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.25
|
| Rate for Payer: Multiplan Commercial |
$1,194.75
|
|
