|
HC US GUID CHOR VILUS SAMPLING
|
Facility
|
OP
|
$1,341.00
|
|
|
Service Code
|
CPT 76945
|
| Hospital Charge Code |
910400115
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$268.20 |
| Max. Negotiated Rate |
$1,139.85 |
| Rate for Payer: Adventist Health Commercial |
$268.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$427.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,139.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$737.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,005.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$860.52
|
| Rate for Payer: Blue Shield of California Commercial |
$564.56
|
| Rate for Payer: Blue Shield of California Commercial |
$855.56
|
| Rate for Payer: Cash Price |
$603.45
|
| Rate for Payer: Cash Price |
$603.45
|
| Rate for Payer: Cigna of CA HMO |
$858.24
|
| Rate for Payer: Cigna of CA PPO |
$992.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,139.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,139.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$938.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$536.40
|
| Rate for Payer: EPIC Health Plan Senior |
$536.40
|
| Rate for Payer: Galaxy Health WC |
$1,139.85
|
| Rate for Payer: Global Benefits Group Commercial |
$804.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$851.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$486.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$791.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$938.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$938.70
|
| Rate for Payer: Multiplan Commercial |
$1,072.80
|
| Rate for Payer: Networks By Design Commercial |
$871.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,139.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$804.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$804.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$670.50
|
| Rate for Payer: United Healthcare All Other HMO |
$670.50
|
| Rate for Payer: United Healthcare HMO Rider |
$670.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$670.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,139.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,139.85
|
|
|
HC US GUID CHOR VILUS SAMP TWIN
|
Facility
|
IP
|
$1,341.00
|
|
|
Service Code
|
CPT 76945
|
| Hospital Charge Code |
910400116
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$268.20 |
| Max. Negotiated Rate |
$1,139.85 |
| Rate for Payer: Adventist Health Commercial |
$268.20
|
| Rate for Payer: Cash Price |
$603.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$938.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$536.40
|
| Rate for Payer: EPIC Health Plan Senior |
$536.40
|
| Rate for Payer: Galaxy Health WC |
$1,139.85
|
| Rate for Payer: Global Benefits Group Commercial |
$804.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$851.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$791.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.84
|
| Rate for Payer: Multiplan Commercial |
$1,072.80
|
| Rate for Payer: Networks By Design Commercial |
$871.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,139.85
|
|
|
HC US GUID CHOR VILUS SAMP TWIN
|
Facility
|
OP
|
$1,341.00
|
|
|
Service Code
|
CPT 76945
|
| Hospital Charge Code |
910400116
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$268.20 |
| Max. Negotiated Rate |
$1,139.85 |
| Rate for Payer: Adventist Health Commercial |
$268.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$427.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,139.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$737.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,005.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$860.52
|
| Rate for Payer: Blue Shield of California Commercial |
$564.56
|
| Rate for Payer: Blue Shield of California Commercial |
$855.56
|
| Rate for Payer: Cash Price |
$603.45
|
| Rate for Payer: Cash Price |
$603.45
|
| Rate for Payer: Cigna of CA HMO |
$858.24
|
| Rate for Payer: Cigna of CA PPO |
$992.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,139.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,139.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$938.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$536.40
|
| Rate for Payer: EPIC Health Plan Senior |
$536.40
|
| Rate for Payer: Galaxy Health WC |
$1,139.85
|
| Rate for Payer: Global Benefits Group Commercial |
$804.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$851.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$486.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$791.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$938.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$938.70
|
| Rate for Payer: Multiplan Commercial |
$1,072.80
|
| Rate for Payer: Networks By Design Commercial |
$871.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,139.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$804.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$804.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$670.50
|
| Rate for Payer: United Healthcare All Other HMO |
$670.50
|
| Rate for Payer: United Healthcare HMO Rider |
$670.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$670.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,139.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,139.85
|
|
|
HC US GUIDE AMNIOCENTESIS
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
910400117
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$48.13 |
| Max. Negotiated Rate |
$1,330.25 |
| Rate for Payer: Adventist Health Commercial |
$313.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,330.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$860.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,173.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,004.26
|
| Rate for Payer: Blue Shield of California Commercial |
$998.47
|
| Rate for Payer: Blue Shield of California Commercial |
$658.87
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: Cigna of CA HMO |
$1,001.60
|
| Rate for Payer: Cigna of CA PPO |
$1,158.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,330.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,330.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,330.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,095.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$626.00
|
| Rate for Payer: EPIC Health Plan Senior |
$626.00
|
| Rate for Payer: Galaxy Health WC |
$1,330.25
|
| Rate for Payer: Global Benefits Group Commercial |
$939.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$993.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$923.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,095.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,095.50
|
| Rate for Payer: Multiplan Commercial |
$1,252.00
|
| Rate for Payer: Networks By Design Commercial |
$1,017.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,330.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$939.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$939.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$782.50
|
| Rate for Payer: United Healthcare All Other HMO |
$782.50
|
| Rate for Payer: United Healthcare HMO Rider |
$782.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$782.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,330.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,330.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,330.25
|
|
|
HC US GUIDE AMNIOCENTESIS
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
910400117
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$313.00 |
| Max. Negotiated Rate |
$1,330.25 |
| Rate for Payer: Adventist Health Commercial |
$313.00
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,095.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$626.00
|
| Rate for Payer: EPIC Health Plan Senior |
$626.00
|
| Rate for Payer: Galaxy Health WC |
$1,330.25
|
| Rate for Payer: Global Benefits Group Commercial |
$939.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$993.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$923.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.60
|
| Rate for Payer: Multiplan Commercial |
$1,252.00
|
| Rate for Payer: Networks By Design Commercial |
$1,017.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,330.25
|
|
|
HC US GUIDE AMNIOCENTESIS TWIN
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
910400118
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$48.13 |
| Max. Negotiated Rate |
$1,330.25 |
| Rate for Payer: Adventist Health Commercial |
$313.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,330.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$860.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,173.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,004.26
|
| Rate for Payer: Blue Shield of California Commercial |
$998.47
|
| Rate for Payer: Blue Shield of California Commercial |
$658.87
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: Cigna of CA HMO |
$1,001.60
|
| Rate for Payer: Cigna of CA PPO |
$1,158.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,330.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,330.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,330.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,095.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$626.00
|
| Rate for Payer: EPIC Health Plan Senior |
$626.00
|
| Rate for Payer: Galaxy Health WC |
$1,330.25
|
| Rate for Payer: Global Benefits Group Commercial |
$939.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$993.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$923.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,095.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,095.50
|
| Rate for Payer: Multiplan Commercial |
$1,252.00
|
| Rate for Payer: Networks By Design Commercial |
$1,017.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,330.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$939.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$939.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$782.50
|
| Rate for Payer: United Healthcare All Other HMO |
$782.50
|
| Rate for Payer: United Healthcare HMO Rider |
$782.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$782.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,330.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,330.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,330.25
|
|
|
HC US GUIDE AMNIOCENTESIS TWIN
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
910400118
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$313.00 |
| Max. Negotiated Rate |
$1,330.25 |
| Rate for Payer: Adventist Health Commercial |
$313.00
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,095.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$626.00
|
| Rate for Payer: EPIC Health Plan Senior |
$626.00
|
| Rate for Payer: Galaxy Health WC |
$1,330.25
|
| Rate for Payer: Global Benefits Group Commercial |
$939.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$993.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$923.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.60
|
| Rate for Payer: Multiplan Commercial |
$1,252.00
|
| Rate for Payer: Networks By Design Commercial |
$1,017.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,330.25
|
|
|
HC US GUIDE FETAL TRANSFUSION
|
Facility
|
OP
|
$1,104.00
|
|
|
Service Code
|
CPT 76941
|
| Hospital Charge Code |
906601995
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$189.77 |
| Max. Negotiated Rate |
$938.40 |
| Rate for Payer: Adventist Health Commercial |
$220.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$414.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$938.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$607.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$828.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$708.44
|
| Rate for Payer: Blue Shield of California Commercial |
$704.35
|
| Rate for Payer: Blue Shield of California Commercial |
$464.78
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cigna of CA HMO |
$706.56
|
| Rate for Payer: Cigna of CA PPO |
$816.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$938.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$938.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$938.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$772.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$441.60
|
| Rate for Payer: EPIC Health Plan Senior |
$441.60
|
| Rate for Payer: Galaxy Health WC |
$938.40
|
| Rate for Payer: Global Benefits Group Commercial |
$662.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$189.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$701.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$214.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$651.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$772.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$772.80
|
| Rate for Payer: Multiplan Commercial |
$883.20
|
| Rate for Payer: Networks By Design Commercial |
$717.60
|
| Rate for Payer: Prime Health Services Commercial |
$938.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$662.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$662.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$552.00
|
| Rate for Payer: United Healthcare All Other HMO |
$552.00
|
| Rate for Payer: United Healthcare HMO Rider |
$552.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$938.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$938.40
|
| Rate for Payer: Vantage Medical Group Senior |
$938.40
|
|
|
HC US GUIDE FETAL TRANSFUSION
|
Facility
|
IP
|
$1,104.00
|
|
|
Service Code
|
CPT 76941
|
| Hospital Charge Code |
906601995
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$220.80 |
| Max. Negotiated Rate |
$938.40 |
| Rate for Payer: Adventist Health Commercial |
$220.80
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$772.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$441.60
|
| Rate for Payer: EPIC Health Plan Senior |
$441.60
|
| Rate for Payer: Galaxy Health WC |
$938.40
|
| Rate for Payer: Global Benefits Group Commercial |
$662.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$701.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$651.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.96
|
| Rate for Payer: Multiplan Commercial |
$883.20
|
| Rate for Payer: Networks By Design Commercial |
$717.60
|
| Rate for Payer: Prime Health Services Commercial |
$938.40
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
IP
|
$2,535.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
900501576
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,154.75 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,609.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,495.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.40
|
| Rate for Payer: Multiplan Commercial |
$2,028.00
|
| Rate for Payer: Networks By Design Commercial |
$1,647.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
OP
|
$2,535.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
900501576
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.04 |
| Max. Negotiated Rate |
$2,154.75 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,184.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,394.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,901.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,626.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,617.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1,067.23
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Cigna of CA HMO |
$1,622.40
|
| Rate for Payer: Cigna of CA PPO |
$1,875.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,154.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,154.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$85.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,609.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,495.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,774.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,774.50
|
| Rate for Payer: Multiplan Commercial |
$2,028.00
|
| Rate for Payer: Networks By Design Commercial |
$1,647.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,521.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,521.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,267.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,267.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,267.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,267.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,154.75
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
IP
|
$2,535.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
901200046
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,154.75 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,609.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,495.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.40
|
| Rate for Payer: Multiplan Commercial |
$2,028.00
|
| Rate for Payer: Networks By Design Commercial |
$1,647.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
OP
|
$2,535.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
901200046
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.04 |
| Max. Negotiated Rate |
$2,154.75 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,184.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,394.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,901.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,626.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,617.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1,067.23
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Cigna of CA HMO |
$1,622.40
|
| Rate for Payer: Cigna of CA PPO |
$1,875.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,154.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,154.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$85.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,609.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,495.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,774.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,774.50
|
| Rate for Payer: Multiplan Commercial |
$2,028.00
|
| Rate for Payer: Networks By Design Commercial |
$1,647.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,521.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,521.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,267.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,267.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,267.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,267.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,154.75
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
OP
|
$2,535.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
906601444
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.04 |
| Max. Negotiated Rate |
$2,154.75 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,184.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,394.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,901.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,626.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,617.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1,067.23
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Cigna of CA HMO |
$1,622.40
|
| Rate for Payer: Cigna of CA PPO |
$1,875.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,154.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,154.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$85.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,609.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,495.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,774.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,774.50
|
| Rate for Payer: Multiplan Commercial |
$2,028.00
|
| Rate for Payer: Networks By Design Commercial |
$1,647.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,521.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,521.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,267.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,267.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,267.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,267.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,154.75
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
IP
|
$2,535.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
906601444
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,154.75 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,609.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,495.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.40
|
| Rate for Payer: Multiplan Commercial |
$2,028.00
|
| Rate for Payer: Networks By Design Commercial |
$1,647.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
|
|
HC US GUIDE VASCULAR ACCESS
|
Facility
|
OP
|
$2,340.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
901200114
|
|
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 |
$141.06
|
| 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 |
$1,501.58
|
| Rate for Payer: Blue Shield of California Commercial |
$985.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,492.92
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cash Price |
$1,053.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,638.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,485.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,380.60
|
| 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 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 |
$1,053.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,638.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,485.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,380.60
|
| 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
|
IP
|
$2,340.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
909001488
|
|
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 |
$1,053.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,638.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,485.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,380.60
|
| 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 |
$141.06
|
| 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 |
$1,501.58
|
| Rate for Payer: Blue Shield of California Commercial |
$985.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,492.92
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cash Price |
$1,053.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,638.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,485.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,380.60
|
| 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 |
$6,330.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,847.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$8,933.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,300.12
|
| 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: Adventist Health Commercial |
$2,813.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$457.87
|
| 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 |
$9,027.44
|
| Rate for Payer: Blue Shield of California Commercial |
$8,975.38
|
| Rate for Payer: Blue Shield of California Commercial |
$5,922.63
|
| Rate for Payer: Cash Price |
$6,330.60
|
| Rate for Payer: Cash Price |
$6,330.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,847.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$8,933.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$265.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,300.12
|
| 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: Networks By Design Commercial |
$9,144.20
|
| 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
|
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 |
$1,220.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,898.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,722.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,600.08
|
| 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/MD MANIPUL.
|
Facility
|
OP
|
$2,712.00
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
906601413
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$111.93 |
| Max. Negotiated Rate |
$2,305.20 |
| Rate for Payer: Adventist Health Commercial |
$542.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,740.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1,730.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,141.75
|
| Rate for Payer: Cash Price |
$1,220.40
|
| Rate for Payer: Cash Price |
$1,220.40
|
| 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 |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,898.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| 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/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$127.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,722.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$650.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| 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 |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
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 |
$986.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,535.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,392.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,293.87
|
| 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 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 |
$111.93 |
| Max. Negotiated Rate |
$1,864.05 |
| Rate for Payer: Adventist Health Commercial |
$438.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$447.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,407.25
|
| Rate for Payer: Blue Shield of California Commercial |
$923.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,399.13
|
| Rate for Payer: Cash Price |
$986.85
|
| Rate for Payer: Cash Price |
$986.85
|
| 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 |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,535.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| 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/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$113.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,392.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| 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 |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
