|
HC US GUIDE VASCULAR ACCESS
|
Facility
|
OP
|
$2,155.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
906820091
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$47.29 |
| Max. Negotiated Rate |
$1,831.75 |
| Rate for Payer: Adventist Health Commercial |
$431.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,413.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,831.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,185.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,616.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,323.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1,318.86
|
| Rate for Payer: Blue Shield of California EPN |
$870.62
|
| Rate for Payer: Cash Price |
$1,185.25
|
| Rate for Payer: Cash Price |
$1,185.25
|
| Rate for Payer: Cigna of CA HMO |
$1,379.20
|
| Rate for Payer: Cigna of CA PPO |
$1,594.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,831.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,831.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,831.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.00
|
| Rate for Payer: EPIC Health Plan Senior |
$862.00
|
| Rate for Payer: Galaxy Health WC |
$1,831.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,293.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,437.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,333.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,508.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,508.50
|
| Rate for Payer: Multiplan Commercial |
$1,724.00
|
| Rate for Payer: Networks By Design Commercial |
$1,400.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,831.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,293.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,293.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,077.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,077.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,077.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,077.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,831.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,831.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,831.75
|
|
|
HC US GUIDE VASCULAR ACCESS
|
Facility
|
IP
|
$2,340.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
901200114
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$1,989.00 |
| Rate for Payer: Adventist Health Commercial |
$468.00
|
| Rate for Payer: Cash Price |
$1,287.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.00
|
| Rate for Payer: EPIC Health Plan Senior |
$936.00
|
| Rate for Payer: Galaxy Health WC |
$1,989.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,560.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,448.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.60
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
| Rate for Payer: Networks By Design Commercial |
$1,521.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.00
|
|
|
HC US GUIDE VASCULAR ACCESS
|
Facility
|
OP
|
$2,340.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
909001488
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$47.29 |
| Max. Negotiated Rate |
$1,989.00 |
| Rate for Payer: Adventist Health Commercial |
$468.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,534.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,989.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,287.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,755.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,436.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1,432.08
|
| Rate for Payer: Blue Shield of California EPN |
$945.36
|
| Rate for Payer: Cash Price |
$1,287.00
|
| Rate for Payer: Cash Price |
$1,287.00
|
| Rate for Payer: Cigna of CA HMO |
$1,497.60
|
| Rate for Payer: Cigna of CA PPO |
$1,731.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,989.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,989.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,989.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.00
|
| Rate for Payer: EPIC Health Plan Senior |
$936.00
|
| Rate for Payer: Galaxy Health WC |
$1,989.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,560.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,448.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,638.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,638.00
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
| Rate for Payer: Networks By Design Commercial |
$1,521.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,404.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,404.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,170.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,170.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,170.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,170.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,989.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,989.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,989.00
|
|
|
HC US GUIDE VISCERAL TISS ABLATN
|
Facility
|
IP
|
$14,068.00
|
|
|
Service Code
|
CPT 76940
|
| Hospital Charge Code |
909001920
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$2,813.60 |
| Max. Negotiated Rate |
$11,957.80 |
| Rate for Payer: Adventist Health Commercial |
$2,813.60
|
| Rate for Payer: Cash Price |
$7,737.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,627.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,627.20
|
| Rate for Payer: Galaxy Health WC |
$11,957.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,440.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,383.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,359.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,708.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,376.32
|
| Rate for Payer: Multiplan Commercial |
$11,254.40
|
| Rate for Payer: Networks By Design Commercial |
$9,144.20
|
| Rate for Payer: Prime Health Services Commercial |
$11,957.80
|
|
|
HC US GUIDE VISCERAL TISS ABLATN
|
Facility
|
OP
|
$14,068.00
|
|
|
Service Code
|
CPT 76940
|
| Hospital Charge Code |
909001920
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$234.70 |
| Max. Negotiated Rate |
$11,957.80 |
| Rate for Payer: Networks By Design Commercial |
$9,144.20
|
| Rate for Payer: Adventist Health Commercial |
$2,813.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,227.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,957.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,737.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,551.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,639.16
|
| Rate for Payer: Blue Shield of California Commercial |
$8,609.62
|
| Rate for Payer: Blue Shield of California EPN |
$5,683.47
|
| Rate for Payer: Cash Price |
$7,737.40
|
| Rate for Payer: Cash Price |
$7,737.40
|
| Rate for Payer: Cigna of CA HMO |
$9,003.52
|
| Rate for Payer: Cigna of CA PPO |
$10,410.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,957.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,957.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,957.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,627.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,627.20
|
| Rate for Payer: Galaxy Health WC |
$11,957.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,440.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$234.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,383.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,708.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,376.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,847.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,847.60
|
| Rate for Payer: Multiplan Commercial |
$11,254.40
|
| Rate for Payer: Prime Health Services Commercial |
$11,957.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,440.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,440.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,034.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,034.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,034.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,034.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,957.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,957.80
|
| Rate for Payer: Vantage Medical Group Senior |
$11,957.80
|
|
|
HC US INFANT HIP W/MD MANIPUL.
|
Facility
|
OP
|
$2,712.00
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
906601413
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$2,305.20 |
| Rate for Payer: Adventist Health Commercial |
$542.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,778.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,665.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1,659.74
|
| Rate for Payer: Blue Shield of California EPN |
$1,095.65
|
| Rate for Payer: Cash Price |
$1,491.60
|
| Rate for Payer: Cash Price |
$1,491.60
|
| Rate for Payer: Cigna of CA HMO |
$1,735.68
|
| Rate for Payer: Cigna of CA PPO |
$2,006.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$2,305.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,627.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$127.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,808.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$650.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$2,169.60
|
| Rate for Payer: Networks By Design Commercial |
$1,762.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,305.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,627.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,627.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC US INFANT HIP W/MD MANIPUL.
|
Facility
|
IP
|
$2,712.00
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
906601413
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$542.40 |
| Max. Negotiated Rate |
$2,305.20 |
| Rate for Payer: Adventist Health Commercial |
$542.40
|
| Rate for Payer: Cash Price |
$1,491.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,084.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,084.80
|
| Rate for Payer: Galaxy Health WC |
$2,305.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,627.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,808.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,033.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,678.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$650.88
|
| Rate for Payer: Multiplan Commercial |
$2,169.60
|
| Rate for Payer: Networks By Design Commercial |
$1,762.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,305.20
|
|
|
HC US INFANT HIP W/O MANIPULATION
|
Facility
|
OP
|
$2,193.00
|
|
|
Service Code
|
CPT 76886
|
| Hospital Charge Code |
906601414
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$1,864.05 |
| Rate for Payer: Adventist Health Commercial |
$438.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,438.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,346.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,342.12
|
| Rate for Payer: Blue Shield of California EPN |
$885.97
|
| Rate for Payer: Cash Price |
$1,206.15
|
| Rate for Payer: Cash Price |
$1,206.15
|
| Rate for Payer: Cigna of CA HMO |
$1,403.52
|
| Rate for Payer: Cigna of CA PPO |
$1,622.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$1,864.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,315.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$113.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,462.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$1,754.40
|
| Rate for Payer: Networks By Design Commercial |
$1,425.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,864.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,315.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,315.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC US INFANT HIP W/O MANIPULATION
|
Facility
|
IP
|
$2,193.00
|
|
|
Service Code
|
CPT 76886
|
| Hospital Charge Code |
906601414
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$438.60 |
| Max. Negotiated Rate |
$1,864.05 |
| Rate for Payer: Adventist Health Commercial |
$438.60
|
| Rate for Payer: Cash Price |
$1,206.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$877.20
|
| Rate for Payer: EPIC Health Plan Senior |
$877.20
|
| Rate for Payer: Galaxy Health WC |
$1,864.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,315.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,462.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$835.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,357.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.32
|
| Rate for Payer: Multiplan Commercial |
$1,754.40
|
| Rate for Payer: Networks By Design Commercial |
$1,425.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,864.05
|
|
|
HC US SOFT TISS EXT COMP
|
Facility
|
IP
|
$2,183.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
906601419
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$436.60 |
| Max. Negotiated Rate |
$1,855.55 |
| Rate for Payer: Adventist Health Commercial |
$436.60
|
| Rate for Payer: Cash Price |
$1,200.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.20
|
| Rate for Payer: EPIC Health Plan Senior |
$873.20
|
| Rate for Payer: Galaxy Health WC |
$1,855.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,309.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,456.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$831.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,351.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.92
|
| Rate for Payer: Multiplan Commercial |
$1,746.40
|
| Rate for Payer: Networks By Design Commercial |
$1,418.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,855.55
|
|
|
HC US SOFT TISS EXT COMP
|
Facility
|
OP
|
$2,183.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
906601419
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$89.53 |
| Max. Negotiated Rate |
$1,855.55 |
| Rate for Payer: Adventist Health Commercial |
$436.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,431.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,340.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,336.00
|
| Rate for Payer: Blue Shield of California EPN |
$881.93
|
| Rate for Payer: Cash Price |
$1,200.65
|
| Rate for Payer: Cash Price |
$1,200.65
|
| Rate for Payer: Cigna of CA HMO |
$1,397.12
|
| Rate for Payer: Cigna of CA PPO |
$1,615.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,855.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,309.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$89.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,456.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,746.40
|
| Rate for Payer: Networks By Design Commercial |
$1,418.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,855.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,309.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,309.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC US SOFT TISS EXT LMTD
|
Facility
|
OP
|
$1,950.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
906601421
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$44.08 |
| Max. Negotiated Rate |
$1,657.50 |
| Rate for Payer: Adventist Health Commercial |
$390.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,279.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,197.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1,193.40
|
| Rate for Payer: Blue Shield of California EPN |
$787.80
|
| Rate for Payer: Cash Price |
$1,072.50
|
| Rate for Payer: Cash Price |
$1,072.50
|
| Rate for Payer: Cigna of CA HMO |
$1,248.00
|
| Rate for Payer: Cigna of CA PPO |
$1,443.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,657.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,170.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$44.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,300.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,657.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,170.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,170.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC US SOFT TISS EXT LMTD
|
Facility
|
IP
|
$1,950.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
906601421
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$1,657.50 |
| Rate for Payer: Adventist Health Commercial |
$390.00
|
| Rate for Payer: Cash Price |
$1,072.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$780.00
|
| Rate for Payer: EPIC Health Plan Senior |
$780.00
|
| Rate for Payer: Galaxy Health WC |
$1,657.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,170.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,300.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$742.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,207.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,657.50
|
|
|
HC US SOFT TISSUE MASS,HEAD/NECK
|
Facility
|
OP
|
$1,779.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
906601405
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$100.36 |
| Max. Negotiated Rate |
$1,512.15 |
| Rate for Payer: Adventist Health Commercial |
$355.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,166.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,092.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1,088.75
|
| Rate for Payer: Blue Shield of California EPN |
$718.72
|
| Rate for Payer: Cash Price |
$978.45
|
| Rate for Payer: Cash Price |
$978.45
|
| Rate for Payer: Cigna of CA HMO |
$1,138.56
|
| Rate for Payer: Cigna of CA PPO |
$1,316.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,512.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,067.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$100.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,186.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$426.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,423.20
|
| Rate for Payer: Networks By Design Commercial |
$1,156.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,512.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,067.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,067.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC US SOFT TISSUE MASS,HEAD/NECK
|
Facility
|
IP
|
$1,779.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
906601405
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$355.80 |
| Max. Negotiated Rate |
$1,512.15 |
| Rate for Payer: Adventist Health Commercial |
$355.80
|
| Rate for Payer: Cash Price |
$978.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.60
|
| Rate for Payer: EPIC Health Plan Senior |
$711.60
|
| Rate for Payer: Galaxy Health WC |
$1,512.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,067.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,186.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$677.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,101.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$426.96
|
| Rate for Payer: Multiplan Commercial |
$1,423.20
|
| Rate for Payer: Networks By Design Commercial |
$1,156.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,512.15
|
|
|
HC US TRANSRECTAL
|
Facility
|
OP
|
$2,251.00
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
906601408
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$113.65 |
| Max. Negotiated Rate |
$1,913.35 |
| Rate for Payer: Adventist Health Commercial |
$450.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,476.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,382.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1,377.61
|
| Rate for Payer: Blue Shield of California EPN |
$909.40
|
| Rate for Payer: Cash Price |
$1,238.05
|
| Rate for Payer: Cash Price |
$1,238.05
|
| Rate for Payer: Cigna of CA HMO |
$1,440.64
|
| Rate for Payer: Cigna of CA PPO |
$1,665.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,913.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,350.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$113.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,501.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,800.80
|
| Rate for Payer: Networks By Design Commercial |
$1,463.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,913.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,350.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,350.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC US TRANSRECTAL
|
Facility
|
IP
|
$2,251.00
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
906601408
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$450.20 |
| Max. Negotiated Rate |
$1,913.35 |
| Rate for Payer: Adventist Health Commercial |
$450.20
|
| Rate for Payer: Cash Price |
$1,238.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$900.40
|
| Rate for Payer: EPIC Health Plan Senior |
$900.40
|
| Rate for Payer: Galaxy Health WC |
$1,913.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,350.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,501.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$857.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,393.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.24
|
| Rate for Payer: Multiplan Commercial |
$1,800.80
|
| Rate for Payer: Networks By Design Commercial |
$1,463.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,913.35
|
|
|
HC US TRGT DYN MBUBB 1ST LSN
|
Facility
|
IP
|
$633.00
|
|
|
Service Code
|
CPT 76978
|
| Hospital Charge Code |
906676978
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$126.60 |
| Max. Negotiated Rate |
$538.05 |
| Rate for Payer: Adventist Health Commercial |
$126.60
|
| Rate for Payer: Cash Price |
$348.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.20
|
| Rate for Payer: EPIC Health Plan Senior |
$253.20
|
| Rate for Payer: Galaxy Health WC |
$538.05
|
| Rate for Payer: Global Benefits Group Commercial |
$379.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$422.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$391.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.92
|
| Rate for Payer: Multiplan Commercial |
$506.40
|
| Rate for Payer: Networks By Design Commercial |
$411.45
|
| Rate for Payer: Prime Health Services Commercial |
$538.05
|
|
|
HC US TRGT DYN MBUBB 1ST LSN
|
Facility
|
OP
|
$633.00
|
|
|
Service Code
|
CPT 76978
|
| Hospital Charge Code |
906676978
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$126.60 |
| Max. Negotiated Rate |
$538.05 |
| Rate for Payer: Adventist Health Commercial |
$126.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$415.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$388.73
|
| Rate for Payer: Blue Shield of California Commercial |
$387.40
|
| Rate for Payer: Blue Shield of California EPN |
$255.73
|
| Rate for Payer: Cash Price |
$348.15
|
| Rate for Payer: Cash Price |
$348.15
|
| Rate for Payer: Cigna of CA HMO |
$405.12
|
| Rate for Payer: Cigna of CA PPO |
$468.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$538.05
|
| Rate for Payer: Global Benefits Group Commercial |
$379.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$469.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$422.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$530.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$506.40
|
| Rate for Payer: Networks By Design Commercial |
$411.45
|
| Rate for Payer: Prime Health Services Commercial |
$538.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$379.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$379.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$516.45
|
| Rate for Payer: United Healthcare All Other HMO |
$516.45
|
| Rate for Payer: United Healthcare HMO Rider |
$516.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$516.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC US TRGT DYN MBUBB EA ADD LSN
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
CPT 76979
|
| Hospital Charge Code |
906676979
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$63.40 |
| Max. Negotiated Rate |
$353.40 |
| Rate for Payer: Adventist Health Commercial |
$63.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$207.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$269.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$174.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$237.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$194.67
|
| Rate for Payer: Blue Shield of California Commercial |
$194.00
|
| Rate for Payer: Blue Shield of California EPN |
$128.07
|
| Rate for Payer: Cash Price |
$174.35
|
| Rate for Payer: Cash Price |
$174.35
|
| Rate for Payer: Cigna of CA HMO |
$202.88
|
| Rate for Payer: Cigna of CA PPO |
$234.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$269.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$269.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$269.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.80
|
| Rate for Payer: EPIC Health Plan Senior |
$126.80
|
| Rate for Payer: Galaxy Health WC |
$269.45
|
| Rate for Payer: Global Benefits Group Commercial |
$190.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$312.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$211.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$221.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.90
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: Networks By Design Commercial |
$206.05
|
| Rate for Payer: Prime Health Services Commercial |
$269.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$190.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$190.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$158.50
|
| Rate for Payer: United Healthcare All Other HMO |
$158.50
|
| Rate for Payer: United Healthcare HMO Rider |
$158.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$158.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$269.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$269.45
|
| Rate for Payer: Vantage Medical Group Senior |
$269.45
|
|
|
HC US TRGT DYN MBUBB EA ADD LSN
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
CPT 76979
|
| Hospital Charge Code |
906676979
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$63.40 |
| Max. Negotiated Rate |
$269.45 |
| Rate for Payer: Adventist Health Commercial |
$63.40
|
| Rate for Payer: Cash Price |
$174.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.80
|
| Rate for Payer: EPIC Health Plan Senior |
$126.80
|
| Rate for Payer: Galaxy Health WC |
$269.45
|
| Rate for Payer: Global Benefits Group Commercial |
$190.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$211.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.08
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: Networks By Design Commercial |
$206.05
|
| Rate for Payer: Prime Health Services Commercial |
$269.45
|
|
|
HC US ULTRA GUIDE/PSEU.AVFISTULA
|
Facility
|
OP
|
$1,488.00
|
|
|
Service Code
|
CPT 76936
|
| Hospital Charge Code |
909001485
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$273.06 |
| Max. Negotiated Rate |
$1,264.80 |
| Rate for Payer: Adventist Health Commercial |
$297.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$975.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$913.78
|
| Rate for Payer: Blue Shield of California Commercial |
$910.66
|
| Rate for Payer: Blue Shield of California EPN |
$601.15
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cigna of CA HMO |
$952.32
|
| Rate for Payer: Cigna of CA PPO |
$1,101.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$1,264.80
|
| Rate for Payer: Global Benefits Group Commercial |
$892.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$992.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$566.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$1,190.40
|
| Rate for Payer: Networks By Design Commercial |
$967.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,264.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$892.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$892.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$273.06
|
| Rate for Payer: United Healthcare All Other HMO |
$273.06
|
| Rate for Payer: United Healthcare HMO Rider |
$273.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$273.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC US ULTRA GUIDE/PSEU.AVFISTULA
|
Facility
|
IP
|
$1,488.00
|
|
|
Service Code
|
CPT 76936
|
| Hospital Charge Code |
909001485
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$297.60 |
| Max. Negotiated Rate |
$1,264.80 |
| Rate for Payer: Adventist Health Commercial |
$297.60
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$595.20
|
| Rate for Payer: EPIC Health Plan Senior |
$595.20
|
| Rate for Payer: Galaxy Health WC |
$1,264.80
|
| Rate for Payer: Global Benefits Group Commercial |
$892.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$992.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$566.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$921.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.12
|
| Rate for Payer: Multiplan Commercial |
$1,190.40
|
| Rate for Payer: Networks By Design Commercial |
$967.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,264.80
|
|
|
HC US VENOUS DUPLX SCAN BILAT
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT 93985
|
| Hospital Charge Code |
908100985
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$1,588.00 |
| Rate for Payer: Adventist Health Commercial |
$140.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$460.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$431.10
|
| Rate for Payer: Blue Shield of California Commercial |
$429.62
|
| Rate for Payer: Blue Shield of California EPN |
$283.61
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cigna of CA HMO |
$449.28
|
| Rate for Payer: Cigna of CA PPO |
$519.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$415.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: Networks By Design Commercial |
$456.30
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$421.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC US VENOUS DUPLX SCAN BILAT
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT 93985
|
| Hospital Charge Code |
908100985
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: Adventist Health Commercial |
$140.40
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Senior |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$434.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.48
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: Networks By Design Commercial |
$456.30
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
|
