|
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 |
$142.65
|
| Rate for Payer: Cash Price |
$142.65
|
| 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 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 |
$669.60
|
| 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 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 |
$669.60
|
| Rate for Payer: Cash Price |
$669.60
|
| 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 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 |
$315.90
|
| 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
|
|
|
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 |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| 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 UNILAT
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 93986
|
| Hospital Charge Code |
908100986
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$67.40 |
| Max. Negotiated Rate |
$1,588.00 |
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
| Rate for Payer: Adventist Health Commercial |
$67.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$221.04
|
| 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 |
$206.95
|
| Rate for Payer: Blue Shield of California Commercial |
$206.24
|
| Rate for Payer: Blue Shield of California EPN |
$136.15
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cigna of CA HMO |
$215.68
|
| Rate for Payer: Cigna of CA PPO |
$249.38
|
| 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 |
$286.45
|
| Rate for Payer: Global Benefits Group Commercial |
$202.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$240.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$271.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.88
|
| 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 |
$269.60
|
| Rate for Payer: Networks By Design Commercial |
$219.05
|
| Rate for Payer: Prime Health Services Commercial |
$286.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$202.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$202.20
|
| 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 |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
|
|
HC US VENOUS DUPLX SCAN UNILAT
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 93986
|
| Hospital Charge Code |
908100986
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$67.40 |
| Max. Negotiated Rate |
$286.45 |
| Rate for Payer: Adventist Health Commercial |
$67.40
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.80
|
| Rate for Payer: EPIC Health Plan Senior |
$134.80
|
| Rate for Payer: Galaxy Health WC |
$286.45
|
| Rate for Payer: Global Benefits Group Commercial |
$202.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$208.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.88
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: Networks By Design Commercial |
$219.05
|
| Rate for Payer: Prime Health Services Commercial |
$286.45
|
|
|
HC UTRAVERSE BALLOON
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909000018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$684.25 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$442.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$603.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$466.26
|
| Rate for Payer: Blue Shield of California Commercial |
$594.09
|
| Rate for Payer: Blue Shield of California EPN |
$391.23
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cigna of CA HMO |
$563.50
|
| Rate for Payer: Cigna of CA PPO |
$563.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$684.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$684.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$684.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.00
|
| Rate for Payer: EPIC Health Plan Senior |
$322.00
|
| Rate for Payer: Galaxy Health WC |
$684.25
|
| Rate for Payer: Global Benefits Group Commercial |
$483.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$563.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$563.50
|
| Rate for Payer: Multiplan Commercial |
$644.00
|
| Rate for Payer: Networks By Design Commercial |
$402.50
|
| Rate for Payer: Prime Health Services Commercial |
$684.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$483.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$483.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.12
|
| Rate for Payer: United Healthcare All Other HMO |
$294.07
|
| Rate for Payer: United Healthcare HMO Rider |
$287.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$684.25
|
| Rate for Payer: Vantage Medical Group Senior |
$684.25
|
|
|
HC UTRAVERSE BALLOON
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909000018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Cigna of CA HMO |
$563.50
|
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cigna of CA PPO |
$563.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.00
|
| Rate for Payer: EPIC Health Plan Senior |
$322.00
|
| Rate for Payer: Galaxy Health WC |
$684.25
|
| Rate for Payer: Global Benefits Group Commercial |
$483.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$644.00
|
| Rate for Payer: Networks By Design Commercial |
$402.50
|
| Rate for Payer: Prime Health Services Commercial |
$684.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.12
|
| Rate for Payer: United Healthcare All Other HMO |
$294.07
|
| Rate for Payer: United Healthcare HMO Rider |
$287.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.64
|
|
|
HC VACCINE HEPATITIS B
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT 90747
|
| Hospital Charge Code |
941000003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Blue Shield of California Commercial |
$247.97
|
| Rate for Payer: Blue Shield of California EPN |
$163.30
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$235.20
|
| Rate for Payer: Cigna of CA PPO |
$235.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.64
|
| Rate for Payer: Multiplan Commercial |
$268.80
|
| Rate for Payer: Networks By Design Commercial |
$168.00
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.10
|
| Rate for Payer: United Healthcare All Other HMO |
$122.74
|
| Rate for Payer: United Healthcare HMO Rider |
$120.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.04
|
|
|
HC VACCINE HEPATITIS B
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT 90747
|
| Hospital Charge Code |
941000003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$391.80 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$220.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$184.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$391.80
|
| Rate for Payer: Blue Shield of California Commercial |
$166.48
|
| Rate for Payer: Blue Shield of California EPN |
$166.48
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$235.20
|
| Rate for Payer: Cigna of CA PPO |
$235.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$285.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$285.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$140.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$275.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.20
|
| Rate for Payer: Multiplan Commercial |
$268.80
|
| Rate for Payer: Networks By Design Commercial |
$168.00
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.10
|
| Rate for Payer: United Healthcare All Other HMO |
$122.74
|
| Rate for Payer: United Healthcare HMO Rider |
$120.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$285.60
|
| Rate for Payer: Vantage Medical Group Senior |
$285.60
|
|
|
HC VACCINE HEPATITIS B
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT 90747
|
| Hospital Charge Code |
942100003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Blue Shield of California Commercial |
$247.97
|
| Rate for Payer: Blue Shield of California EPN |
$163.30
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$235.20
|
| Rate for Payer: Cigna of CA PPO |
$235.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.64
|
| Rate for Payer: Multiplan Commercial |
$268.80
|
| Rate for Payer: Networks By Design Commercial |
$168.00
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.10
|
| Rate for Payer: United Healthcare All Other HMO |
$122.74
|
| Rate for Payer: United Healthcare HMO Rider |
$120.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.04
|
|
|
HC VACCINE HEPATITIS B
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT 90747
|
| Hospital Charge Code |
942100003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$391.80 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$220.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$184.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$391.80
|
| Rate for Payer: Blue Shield of California Commercial |
$166.48
|
| Rate for Payer: Blue Shield of California EPN |
$166.48
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$235.20
|
| Rate for Payer: Cigna of CA PPO |
$235.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$285.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$285.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$140.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$275.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.20
|
| Rate for Payer: Multiplan Commercial |
$268.80
|
| Rate for Payer: Networks By Design Commercial |
$168.00
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.10
|
| Rate for Payer: United Healthcare All Other HMO |
$122.74
|
| Rate for Payer: United Healthcare HMO Rider |
$120.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$285.60
|
| Rate for Payer: Vantage Medical Group Senior |
$285.60
|
|
|
HC VACCINE INFLUENZA GT 3 YR
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
941002039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$51.85 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Blue Shield of California Commercial |
$45.02
|
| Rate for Payer: Blue Shield of California EPN |
$29.65
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cigna of CA HMO |
$42.70
|
| Rate for Payer: Cigna of CA PPO |
$42.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Senior |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.64
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: Networks By Design Commercial |
$30.50
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.89
|
| Rate for Payer: United Healthcare All Other HMO |
$22.28
|
| Rate for Payer: United Healthcare HMO Rider |
$21.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.98
|
|
|
HC VACCINE INFLUENZA GT 3 YR
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
941002039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$53.26 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.26
|
| Rate for Payer: Blue Shield of California Commercial |
$23.53
|
| Rate for Payer: Blue Shield of California EPN |
$23.53
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cigna of CA HMO |
$42.70
|
| Rate for Payer: Cigna of CA PPO |
$42.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Senior |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.70
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: Networks By Design Commercial |
$30.50
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.89
|
| Rate for Payer: United Healthcare All Other HMO |
$22.28
|
| Rate for Payer: United Healthcare HMO Rider |
$21.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.85
|
| Rate for Payer: Vantage Medical Group Senior |
$51.85
|
|
|
HC VACCINE INFLUENZA VACCINE GT 3 YR
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
910400052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$51.85 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Blue Shield of California Commercial |
$45.02
|
| Rate for Payer: Blue Shield of California EPN |
$29.65
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cigna of CA HMO |
$42.70
|
| Rate for Payer: Cigna of CA PPO |
$42.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Senior |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.64
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: Networks By Design Commercial |
$30.50
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.89
|
| Rate for Payer: United Healthcare All Other HMO |
$22.28
|
| Rate for Payer: United Healthcare HMO Rider |
$21.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.98
|
|
|
HC VACCINE INFLUENZA VACCINE GT 3 YR
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
910400052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$53.26 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.26
|
| Rate for Payer: Blue Shield of California Commercial |
$23.53
|
| Rate for Payer: Blue Shield of California EPN |
$23.53
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cigna of CA HMO |
$42.70
|
| Rate for Payer: Cigna of CA PPO |
$42.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Senior |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.70
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: Networks By Design Commercial |
$30.50
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.89
|
| Rate for Payer: United Healthcare All Other HMO |
$22.28
|
| Rate for Payer: United Healthcare HMO Rider |
$21.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.85
|
| Rate for Payer: Vantage Medical Group Senior |
$51.85
|
|
|
HC VACCINE PNEUMOCOCCAL 23 SDV
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
941000405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$171.70 |
| Rate for Payer: Adventist Health Commercial |
$40.40
|
| Rate for Payer: Blue Shield of California Commercial |
$149.08
|
| Rate for Payer: Blue Shield of California EPN |
$98.17
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna of CA HMO |
$141.40
|
| Rate for Payer: Cigna of CA PPO |
$141.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Senior |
$80.80
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$125.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.48
|
| Rate for Payer: Multiplan Commercial |
$161.60
|
| Rate for Payer: Networks By Design Commercial |
$101.00
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.81
|
| Rate for Payer: United Healthcare All Other HMO |
$73.79
|
| Rate for Payer: United Healthcare HMO Rider |
$72.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.16
|
|
|
HC VACCINE PNEUMOCOCCAL 23 SDV
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
942100405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$318.05 |
| Rate for Payer: Adventist Health Commercial |
$40.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$171.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$111.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$151.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$318.05
|
| Rate for Payer: Blue Shield of California Commercial |
$140.50
|
| Rate for Payer: Blue Shield of California EPN |
$140.50
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna of CA HMO |
$141.40
|
| Rate for Payer: Cigna of CA PPO |
$141.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$171.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$171.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Senior |
$80.80
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$133.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$125.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$141.40
|
| Rate for Payer: Multiplan Commercial |
$161.60
|
| Rate for Payer: Networks By Design Commercial |
$101.00
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$121.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$121.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.81
|
| Rate for Payer: United Healthcare All Other HMO |
$73.79
|
| Rate for Payer: United Healthcare HMO Rider |
$72.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$171.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$171.70
|
| Rate for Payer: Vantage Medical Group Senior |
$171.70
|
|
|
HC VACCINE PNEUMOCOCCAL 23 SDV
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
942100405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$171.70 |
| Rate for Payer: Adventist Health Commercial |
$40.40
|
| Rate for Payer: Blue Shield of California Commercial |
$149.08
|
| Rate for Payer: Blue Shield of California EPN |
$98.17
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna of CA HMO |
$141.40
|
| Rate for Payer: Cigna of CA PPO |
$141.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Senior |
$80.80
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$125.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.48
|
| Rate for Payer: Multiplan Commercial |
$161.60
|
| Rate for Payer: Networks By Design Commercial |
$101.00
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.81
|
| Rate for Payer: United Healthcare All Other HMO |
$73.79
|
| Rate for Payer: United Healthcare HMO Rider |
$72.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.16
|
|
|
HC VACCINE PNEUMOCOCCAL 23 SDV
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
941000405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$318.05 |
| Rate for Payer: Adventist Health Commercial |
$40.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$171.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$111.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$151.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$318.05
|
| Rate for Payer: Blue Shield of California Commercial |
$140.50
|
| Rate for Payer: Blue Shield of California EPN |
$140.50
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna of CA HMO |
$141.40
|
| Rate for Payer: Cigna of CA PPO |
$141.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$171.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$171.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Senior |
$80.80
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$133.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$125.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$141.40
|
| Rate for Payer: Multiplan Commercial |
$161.60
|
| Rate for Payer: Networks By Design Commercial |
$101.00
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$121.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$121.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.81
|
| Rate for Payer: United Healthcare All Other HMO |
$73.79
|
| Rate for Payer: United Healthcare HMO Rider |
$72.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$171.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$171.70
|
| Rate for Payer: Vantage Medical Group Senior |
$171.70
|
|
|
HC VACCINIA VRS VAC 0.3 ML PERQ
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 90622
|
| Hospital Charge Code |
948000201
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC VACCINIA VRS VAC 0.3 ML PERQ
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 90622
|
| Hospital Charge Code |
948000201
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
|
|
HC VAD ABIOMED IMPELLA 2.5 CATH
|
Facility
|
IP
|
$37,500.00
|
|
| Hospital Charge Code |
906812386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,500.00 |
| Max. Negotiated Rate |
$31,875.00 |
| Rate for Payer: Adventist Health Commercial |
$7,500.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$16,875.00
|
| Rate for Payer: Cash Price |
$16,875.00
|
| Rate for Payer: Cigna of CA HMO |
$26,250.00
|
| Rate for Payer: Cigna of CA PPO |
$26,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$15,000.00
|
| Rate for Payer: Galaxy Health WC |
$31,875.00
|
| Rate for Payer: Global Benefits Group Commercial |
$22,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,012.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,287.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,212.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,000.00
|
| Rate for Payer: Multiplan Commercial |
$30,000.00
|
| Rate for Payer: Networks By Design Commercial |
$18,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$31,875.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,073.75
|
| Rate for Payer: United Healthcare All Other HMO |
$13,698.75
|
| Rate for Payer: United Healthcare HMO Rider |
$13,402.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,281.25
|
|
|
HC VAD ABIOMED IMPELLA 2.5 CATH
|
Facility
|
OP
|
$37,500.00
|
|
| Hospital Charge Code |
906812386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,500.00 |
| Max. Negotiated Rate |
$31,875.00 |
| Rate for Payer: Adventist Health Commercial |
$7,500.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31,875.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,625.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,125.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21,720.00
|
| Rate for Payer: Blue Shield of California Commercial |
$27,675.00
|
| Rate for Payer: Blue Shield of California EPN |
$18,225.00
|
| Rate for Payer: Cash Price |
$16,875.00
|
| Rate for Payer: Cigna of CA HMO |
$26,250.00
|
| Rate for Payer: Cigna of CA PPO |
$26,250.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31,875.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,875.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31,875.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$15,000.00
|
| Rate for Payer: Galaxy Health WC |
$31,875.00
|
| Rate for Payer: Global Benefits Group Commercial |
$22,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,012.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,287.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,212.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,250.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26,250.00
|
| Rate for Payer: Multiplan Commercial |
$30,000.00
|
| Rate for Payer: Networks By Design Commercial |
$18,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$31,875.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,500.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,073.75
|
| Rate for Payer: United Healthcare All Other HMO |
$13,698.75
|
| Rate for Payer: United Healthcare HMO Rider |
$13,402.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,281.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31,875.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,875.00
|
| Rate for Payer: Vantage Medical Group Senior |
$31,875.00
|
|
