|
HC US SOFT TISS EXT COMP
|
Facility
|
IP
|
$2,183.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
906601419
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$436.60 |
| Max. Negotiated Rate |
$1,855.55 |
| Rate for Payer: Adventist Health Commercial |
$436.60
|
| Rate for Payer: Cash Price |
$982.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,528.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.20
|
| Rate for Payer: EPIC Health Plan Senior |
$873.20
|
| Rate for Payer: Galaxy Health WC |
$1,855.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,309.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,386.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,287.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.92
|
| Rate for Payer: Multiplan Commercial |
$1,746.40
|
| Rate for Payer: Networks By Design Commercial |
$1,418.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,855.55
|
|
|
HC US SOFT TISS EXT COMP
|
Facility
|
OP
|
$2,183.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
906601419
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$89.53 |
| Max. Negotiated Rate |
$1,855.55 |
| Rate for Payer: Adventist Health Commercial |
$436.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$621.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,400.83
|
| Rate for Payer: Blue Shield of California Commercial |
$919.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,392.75
|
| Rate for Payer: Cash Price |
$982.35
|
| Rate for Payer: Cash Price |
$982.35
|
| Rate for Payer: Cigna of CA HMO |
$1,397.12
|
| Rate for Payer: Cigna of CA PPO |
$1,615.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,528.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,855.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,309.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$89.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,386.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$101.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,746.40
|
| Rate for Payer: Networks By Design Commercial |
$1,418.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,855.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,309.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,309.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC US SOFT TISS EXT LMTD
|
Facility
|
IP
|
$1,950.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
906601421
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$1,657.50 |
| Rate for Payer: Adventist Health Commercial |
$390.00
|
| Rate for Payer: Cash Price |
$877.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,365.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$780.00
|
| Rate for Payer: EPIC Health Plan Senior |
$780.00
|
| Rate for Payer: Galaxy Health WC |
$1,657.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,170.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,238.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,150.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,657.50
|
|
|
HC US SOFT TISS EXT LMTD
|
Facility
|
OP
|
$1,950.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
906601421
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$44.08 |
| Max. Negotiated Rate |
$1,657.50 |
| Rate for Payer: Galaxy Health WC |
$1,657.50
|
| Rate for Payer: Adventist Health Commercial |
$390.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,251.32
|
| Rate for Payer: Blue Shield of California Commercial |
$820.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1,244.10
|
| Rate for Payer: Cash Price |
$877.50
|
| Rate for Payer: Cash Price |
$877.50
|
| Rate for Payer: Cigna of CA HMO |
$1,248.00
|
| Rate for Payer: Cigna of CA PPO |
$1,443.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,365.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Global Benefits Group Commercial |
$1,170.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$44.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,238.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,657.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,170.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,170.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC US SOFT TISSUE MASS,HEAD/NECK
|
Facility
|
IP
|
$1,779.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
906601405
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$355.80 |
| Max. Negotiated Rate |
$1,512.15 |
| Rate for Payer: Adventist Health Commercial |
$355.80
|
| Rate for Payer: Cash Price |
$800.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,245.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.60
|
| Rate for Payer: EPIC Health Plan Senior |
$711.60
|
| Rate for Payer: Galaxy Health WC |
$1,512.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,067.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,129.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,049.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$426.96
|
| Rate for Payer: Multiplan Commercial |
$1,423.20
|
| Rate for Payer: Networks By Design Commercial |
$1,156.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,512.15
|
|
|
HC US SOFT TISSUE MASS,HEAD/NECK
|
Facility
|
OP
|
$1,779.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
906601405
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$100.36 |
| Max. Negotiated Rate |
$1,512.15 |
| Rate for Payer: Adventist Health Commercial |
$355.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$655.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,141.58
|
| Rate for Payer: Blue Shield of California Commercial |
$748.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1,135.00
|
| Rate for Payer: Cash Price |
$800.55
|
| Rate for Payer: Cash Price |
$800.55
|
| Rate for Payer: Cigna of CA HMO |
$1,138.56
|
| Rate for Payer: Cigna of CA PPO |
$1,316.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,245.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,512.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,067.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$100.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,129.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$113.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$426.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,423.20
|
| Rate for Payer: Networks By Design Commercial |
$1,156.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,512.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,067.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,067.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC US TRANSRECTAL
|
Facility
|
IP
|
$2,251.00
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
906601408
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$450.20 |
| Max. Negotiated Rate |
$1,913.35 |
| Rate for Payer: Adventist Health Commercial |
$450.20
|
| Rate for Payer: Cash Price |
$1,012.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,575.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$900.40
|
| Rate for Payer: EPIC Health Plan Senior |
$900.40
|
| Rate for Payer: Galaxy Health WC |
$1,913.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,350.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,429.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,328.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.24
|
| Rate for Payer: Multiplan Commercial |
$1,800.80
|
| Rate for Payer: Networks By Design Commercial |
$1,463.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,913.35
|
|
|
HC US TRANSRECTAL
|
Facility
|
OP
|
$2,251.00
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
906601408
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$113.65 |
| Max. Negotiated Rate |
$1,913.35 |
| Rate for Payer: Adventist Health Commercial |
$450.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$692.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,444.47
|
| Rate for Payer: Blue Shield of California Commercial |
$947.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1,436.14
|
| Rate for Payer: Cash Price |
$1,012.95
|
| Rate for Payer: Cash Price |
$1,012.95
|
| Rate for Payer: Cigna of CA HMO |
$1,440.64
|
| Rate for Payer: Cigna of CA PPO |
$1,665.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,575.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,913.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,350.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$113.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,429.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,800.80
|
| Rate for Payer: Networks By Design Commercial |
$1,463.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,913.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,350.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,350.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC US TRGT DYN MBUBB 1ST LSN
|
Facility
|
IP
|
$633.00
|
|
|
Service Code
|
CPT 76978
|
| Hospital Charge Code |
906676978
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$126.60 |
| Max. Negotiated Rate |
$538.05 |
| Rate for Payer: Adventist Health Commercial |
$126.60
|
| Rate for Payer: Cash Price |
$284.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.20
|
| Rate for Payer: EPIC Health Plan Senior |
$253.20
|
| Rate for Payer: Galaxy Health WC |
$538.05
|
| Rate for Payer: Global Benefits Group Commercial |
$379.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$401.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$373.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.92
|
| Rate for Payer: Multiplan Commercial |
$506.40
|
| Rate for Payer: Networks By Design Commercial |
$411.45
|
| Rate for Payer: Prime Health Services Commercial |
$538.05
|
|
|
HC US TRGT DYN MBUBB 1ST LSN
|
Facility
|
OP
|
$633.00
|
|
|
Service Code
|
CPT 76978
|
| Hospital Charge Code |
906676978
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$126.60 |
| Max. Negotiated Rate |
$1,723.52 |
| Rate for Payer: Adventist Health Commercial |
$126.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,723.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$406.20
|
| Rate for Payer: Blue Shield of California Commercial |
$403.85
|
| Rate for Payer: Blue Shield of California Commercial |
$266.49
|
| Rate for Payer: Cash Price |
$284.85
|
| Rate for Payer: Cash Price |
$284.85
|
| Rate for Payer: Cigna of CA HMO |
$405.12
|
| Rate for Payer: Cigna of CA PPO |
$468.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: Galaxy Health WC |
$538.05
|
| Rate for Payer: Global Benefits Group Commercial |
$379.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$469.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$401.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$530.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$506.40
|
| Rate for Payer: Networks By Design Commercial |
$411.45
|
| Rate for Payer: Prime Health Services Commercial |
$538.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$379.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$379.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$516.45
|
| Rate for Payer: United Healthcare All Other HMO |
$516.45
|
| Rate for Payer: United Healthcare HMO Rider |
$516.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$516.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
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 |
$1,258.35 |
| Rate for Payer: Adventist Health Commercial |
$63.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,258.35
|
| 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 |
$203.42
|
| Rate for Payer: Blue Shield of California Commercial |
$202.25
|
| Rate for Payer: Blue Shield of California Commercial |
$133.46
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$221.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$201.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$353.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$187.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$221.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.90
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: Networks By Design Commercial |
$206.05
|
| Rate for Payer: Prime Health Services Commercial |
$269.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$190.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$190.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$158.50
|
| Rate for Payer: United Healthcare All Other HMO |
$158.50
|
| Rate for Payer: United Healthcare HMO Rider |
$158.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$158.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$269.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$269.45
|
| Rate for Payer: Vantage Medical Group Senior |
$269.45
|
|
|
HC US TRGT DYN MBUBB EA ADD LSN
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
CPT 76979
|
| Hospital Charge Code |
906676979
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$63.40 |
| Max. Negotiated Rate |
$269.45 |
| Rate for Payer: Adventist Health Commercial |
$63.40
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$221.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.80
|
| Rate for Payer: EPIC Health Plan Senior |
$126.80
|
| Rate for Payer: Galaxy Health WC |
$269.45
|
| Rate for Payer: Global Benefits Group Commercial |
$190.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$201.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$187.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.08
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: Networks By Design Commercial |
$206.05
|
| Rate for Payer: Prime Health Services Commercial |
$269.45
|
|
|
HC US ULTRA GUIDE/PSEU.AVFISTULA
|
Facility
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,041.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$944.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$877.92
|
| 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 |
$768.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$954.85
|
| Rate for Payer: Blue Shield of California Commercial |
$949.34
|
| Rate for Payer: Blue Shield of California Commercial |
$626.45
|
| 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 |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,041.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| 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/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$944.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$540.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$349.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$372.13
|
| 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 |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
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 |
$1,647.60 |
| Rate for Payer: Adventist Health Commercial |
$140.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,647.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$450.47
|
| Rate for Payer: Blue Shield of California Commercial |
$295.54
|
| Rate for Payer: Blue Shield of California Commercial |
$447.88
|
| 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 |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$491.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$415.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$445.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$469.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| 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 |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$491.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$445.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.18
|
| 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 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: Adventist Health Commercial |
$67.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$796.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$216.25
|
| Rate for Payer: Blue Shield of California Commercial |
$141.88
|
| Rate for Payer: Blue Shield of California Commercial |
$215.01
|
| 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 |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$286.45
|
| Rate for Payer: Global Benefits Group Commercial |
$202.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$240.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$214.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$271.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| 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 |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$214.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.83
|
| 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
|
IP
|
$805.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909000018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$362.25
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$511.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$474.95
|
| 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 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 |
$487.27
|
| Rate for Payer: Blue Shield of California Commercial |
$408.13
|
| Rate for Payer: Blue Shield of California Commercial |
$619.04
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$511.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$292.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$474.95
|
| 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 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 |
$170.35
|
| Rate for Payer: Blue Shield of California Commercial |
$258.38
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$213.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.24
|
| 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 |
$978.52 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$978.52
|
| 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 |
$500.47
|
| Rate for Payer: Blue Shield of California Commercial |
$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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$170.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$213.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.24
|
| 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
|
OP
|
$336.00
|
|
|
Service Code
|
CPT 90747
|
| Hospital Charge Code |
942100003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$978.52 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$285.60
|
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$978.52
|
| 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 |
$500.47
|
| Rate for Payer: Blue Shield of California Commercial |
$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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$170.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$213.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.24
|
| 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 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 |
$170.35
|
| Rate for Payer: Blue Shield of California Commercial |
$258.38
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$213.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.24
|
| 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 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 |
$30.93
|
| Rate for Payer: Blue Shield of California Commercial |
$46.91
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$38.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.99
|
| 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
|
|
