|
HC ANORECTAL MANOMETRY
|
Facility
OP
|
$1,842.00
|
|
|
Service Code
|
CPT 91122
|
| Hospital Charge Code |
906791122
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$114.70 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$956.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,097.46
|
| Rate for Payer: BCBS Transplant Transplant |
$1,105.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$828.90
|
| Rate for Payer: Cash Price |
$828.90
|
| Rate for Payer: Cash Price |
$828.90
|
| Rate for Payer: Cigna of CA PPO |
$1,363.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$1,565.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,105.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,381.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: IEHP Medi-Cal |
$635.32
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$635.32
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,228.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$1,473.60
|
| Rate for Payer: Networks By Design Commercial |
$1,197.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,565.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$431.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,105.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$470.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC ANORECTAL MANOMETRY
|
Facility
IP
|
$2,534.00
|
|
|
Service Code
|
CPT 91122
|
| Hospital Charge Code |
906791122
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$608.16 |
| Max. Negotiated Rate |
$2,153.90 |
| Rate for Payer: Cash Price |
$1,140.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,013.60
|
| Rate for Payer: Galaxy Health WC |
$2,153.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,520.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,690.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.16
|
| Rate for Payer: Multiplan Commercial |
$2,027.20
|
| Rate for Payer: Networks By Design Commercial |
$1,647.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,153.90
|
|
|
HC ANOSCOPY DIAGNOSTIC W WO SPEC COLLECT
|
Facility
OP
|
$466.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
900501159
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.74 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$279.60
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Cigna of CA PPO |
$344.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$396.10
|
| Rate for Payer: Global Benefits Group Commercial |
$279.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$349.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$261.74
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$310.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$372.80
|
| Rate for Payer: Networks By Design Commercial |
$302.90
|
| Rate for Payer: Prime Health Services Commercial |
$396.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$279.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.00
|
| Rate for Payer: United Healthcare All Other HMO |
$233.00
|
| Rate for Payer: United Healthcare HMO Rider |
$233.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$233.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC ANOSCOPY DIAGNOSTIC W WO SPEC COLLECT
|
Facility
IP
|
$466.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
900501159
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.84 |
| Max. Negotiated Rate |
$396.10 |
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$186.40
|
| Rate for Payer: Galaxy Health WC |
$396.10
|
| Rate for Payer: Global Benefits Group Commercial |
$279.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$310.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.84
|
| Rate for Payer: Multiplan Commercial |
$372.80
|
| Rate for Payer: Networks By Design Commercial |
$302.90
|
| Rate for Payer: Prime Health Services Commercial |
$396.10
|
|
|
HC ANOSCOPY DIAG W/RMVL FB
|
Facility
OP
|
$3,726.00
|
|
|
Service Code
|
CPT 46608
|
| Hospital Charge Code |
900501160
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$205.14 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,235.60
|
| Rate for Payer: Cash Price |
$1,676.70
|
| Rate for Payer: Cash Price |
$1,676.70
|
| Rate for Payer: Cash Price |
$1,676.70
|
| Rate for Payer: Cigna of CA PPO |
$2,757.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Media |
$1,141.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,141.93
|
| Rate for Payer: Galaxy Health WC |
$3,167.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,235.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,794.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,872.77
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,872.77
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,141.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,485.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,141.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$894.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,438.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,530.19
|
| Rate for Payer: Multiplan Commercial |
$2,980.80
|
| Rate for Payer: Networks By Design Commercial |
$2,421.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,167.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,235.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,235.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,863.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,863.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,863.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,863.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
HC ANOSCOPY DIAG W/RMVL FB
|
Facility
IP
|
$3,726.00
|
|
|
Service Code
|
CPT 46608
|
| Hospital Charge Code |
900501160
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$894.24 |
| Max. Negotiated Rate |
$3,167.10 |
| Rate for Payer: Cash Price |
$1,676.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,490.40
|
| Rate for Payer: Galaxy Health WC |
$3,167.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,235.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,485.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,419.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$894.24
|
| Rate for Payer: Multiplan Commercial |
$2,980.80
|
| Rate for Payer: Networks By Design Commercial |
$2,421.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,167.10
|
|
|
HC ANOSCOPY W CONTRL OF BLEEDNG
|
Facility
IP
|
$2,844.00
|
|
|
Service Code
|
CPT 46614
|
| Hospital Charge Code |
906746614
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$682.56 |
| Max. Negotiated Rate |
$2,417.40 |
| Rate for Payer: Cash Price |
$1,279.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,137.60
|
| Rate for Payer: Galaxy Health WC |
$2,417.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,706.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,896.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,083.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$682.56
|
| Rate for Payer: Multiplan Commercial |
$2,275.20
|
| Rate for Payer: Networks By Design Commercial |
$1,848.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,417.40
|
|
|
HC ANOSCOPY W CONTRL OF BLEEDNG
|
Facility
OP
|
$2,844.00
|
|
|
Service Code
|
CPT 46614
|
| Hospital Charge Code |
906746614
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$227.07 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,706.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,279.80
|
| Rate for Payer: Cash Price |
$1,279.80
|
| Rate for Payer: Cigna of CA PPO |
$2,104.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Dignity Health Media |
$1,474.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,621.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,990.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,474.42
|
| Rate for Payer: Galaxy Health WC |
$2,417.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,706.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,133.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,418.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,418.05
|
| Rate for Payer: IEHP Medi-Cal |
$2,388.56
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2,388.56
|
| Rate for Payer: IEHP Medicare Advantage |
$1,474.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,896.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,474.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$682.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,857.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,975.72
|
| Rate for Payer: Multiplan Commercial |
$2,275.20
|
| Rate for Payer: Networks By Design Commercial |
$1,848.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,417.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,621.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,706.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,769.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
HC ANS PARASYMP & SYMP W TILT
|
Facility
IP
|
$728.00
|
|
|
Service Code
|
CPT 95924
|
| Hospital Charge Code |
900600331
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$174.72 |
| Max. Negotiated Rate |
$618.80 |
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.20
|
| Rate for Payer: Galaxy Health WC |
$618.80
|
| Rate for Payer: Global Benefits Group Commercial |
$436.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$485.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$277.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.72
|
| Rate for Payer: Multiplan Commercial |
$582.40
|
| Rate for Payer: Networks By Design Commercial |
$473.20
|
| Rate for Payer: Prime Health Services Commercial |
$618.80
|
|
|
HC ANS PARASYMP & SYMP W TILT
|
Facility
OP
|
$728.00
|
|
|
Service Code
|
CPT 95924
|
| Hospital Charge Code |
900600331
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$174.72 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$421.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$433.74
|
| Rate for Payer: BCBS Transplant Transplant |
$436.80
|
| Rate for Payer: Blue Shield of California Commercial |
$430.25
|
| Rate for Payer: Blue Shield of California EPN |
$341.43
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cigna of CA HMO |
$465.92
|
| Rate for Payer: Cigna of CA PPO |
$538.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$618.80
|
| Rate for Payer: Global Benefits Group Commercial |
$436.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$546.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: IEHP Medi-Cal |
$635.32
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$635.32
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$485.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$582.40
|
| Rate for Payer: Networks By Design Commercial |
$473.20
|
| Rate for Payer: Prime Health Services Commercial |
$618.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$436.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$436.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$436.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$969.00
|
| Rate for Payer: United Healthcare All Other HMO |
$765.00
|
| Rate for Payer: United Healthcare HMO Rider |
$579.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC ANTIMICROB SUSCEPTIBILITY TEST
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900911660
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$20.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.58
|
| Rate for Payer: BCBS Transplant Transplant |
$10.80
|
| Rate for Payer: Blue Shield of California Commercial |
$11.63
|
| Rate for Payer: Blue Shield of California EPN |
$9.22
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Media |
$4.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.41
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.75
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.79
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.79
|
| Rate for Payer: IEHP Medi-Cal |
$7.70
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$7.70
|
| Rate for Payer: IEHP Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.36
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC ANTINUCLEAR ANTIBODIES (ANA)
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
900910969
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$110.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$100.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.26
|
| Rate for Payer: BCBS Transplant Transplant |
$21.60
|
| Rate for Payer: Blue Shield of California Commercial |
$23.26
|
| Rate for Payer: Blue Shield of California EPN |
$18.43
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.14
|
| Rate for Payer: Dignity Health Media |
$12.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.09
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.83
|
| Rate for Payer: Heritage Provider Network Transplant |
$19.83
|
| Rate for Payer: IEHP Medi-Cal |
$19.59
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$19.59
|
| Rate for Payer: IEHP Medicare Advantage |
$12.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.79
|
| Rate for Payer: United Healthcare All Other HMO |
$9.79
|
| Rate for Payer: United Healthcare HMO Rider |
$9.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: Vantage Medical Group Senior |
$12.09
|
|
|
HC ANTISTREPTOLYSIN O
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900910881
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$113.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.20
|
| Rate for Payer: BCBS Transplant Transplant |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$29.07
|
| Rate for Payer: Blue Shield of California EPN |
$23.04
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Media |
$13.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$33.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.30
|
| Rate for Payer: Heritage Provider Network Transplant |
$22.30
|
| Rate for Payer: IEHP Medi-Cal |
$22.03
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$22.03
|
| Rate for Payer: IEHP Medicare Advantage |
$13.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.22
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.02
|
| Rate for Payer: United Healthcare All Other HMO |
$11.02
|
| Rate for Payer: United Healthcare HMO Rider |
$11.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Vantage Medical Group Senior |
$13.60
|
|
|
HC ANTITHROMBIN III ACTIVITY
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
900912010
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$108.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$98.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.11
|
| Rate for Payer: BCBS Transplant Transplant |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$29.07
|
| Rate for Payer: Blue Shield of California EPN |
$23.04
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.78
|
| Rate for Payer: Dignity Health Media |
$11.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.85
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$33.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.43
|
| Rate for Payer: Heritage Provider Network Transplant |
$19.43
|
| Rate for Payer: IEHP Medi-Cal |
$19.20
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$19.20
|
| Rate for Payer: IEHP Medicare Advantage |
$11.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.88
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.60
|
| Rate for Payer: United Healthcare All Other HMO |
$9.60
|
| Rate for Payer: United Healthcare HMO Rider |
$9.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.04
|
| Rate for Payer: Vantage Medical Group Senior |
$11.85
|
|
|
HC ANTITHROMBIN III ANTIGEN
|
Facility
OP
|
$41.00
|
|
|
Service Code
|
CPT 85301
|
| Hospital Charge Code |
900912011
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$98.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$89.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.65
|
| Rate for Payer: BCBS Transplant Transplant |
$24.60
|
| Rate for Payer: Blue Shield of California Commercial |
$26.49
|
| Rate for Payer: Blue Shield of California EPN |
$20.99
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cigna of CA HMO |
$26.24
|
| Rate for Payer: Cigna of CA PPO |
$30.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.22
|
| Rate for Payer: Dignity Health Media |
$10.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.59
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$10.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.81
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$30.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.73
|
| Rate for Payer: Heritage Provider Network Transplant |
$17.73
|
| Rate for Payer: IEHP Medi-Cal |
$17.51
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$17.51
|
| Rate for Payer: IEHP Medicare Advantage |
$10.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.49
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.76
|
| Rate for Payer: United Healthcare All Other HMO |
$8.76
|
| Rate for Payer: United Healthcare HMO Rider |
$8.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.89
|
| Rate for Payer: Vantage Medical Group Senior |
$10.81
|
|
|
HC ANTI-XA APIXABAN
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900912042
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$108.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$108.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.47
|
| Rate for Payer: BCBS Transplant Transplant |
$15.00
|
| Rate for Payer: Blue Shield of California Commercial |
$16.15
|
| Rate for Payer: Blue Shield of California EPN |
$12.80
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.64
|
| Rate for Payer: Dignity Health Media |
$13.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.67
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.09
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.47
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.47
|
| Rate for Payer: IEHP Medi-Cal |
$21.21
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$21.21
|
| Rate for Payer: IEHP Medicare Advantage |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.54
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.60
|
| Rate for Payer: United Healthcare All Other HMO |
$10.60
|
| Rate for Payer: United Healthcare HMO Rider |
$10.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Vantage Medical Group Senior |
$13.09
|
|
|
HC ANTI-XA UNFRACTIONATED HEPARIN
|
Facility
OP
|
$73.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900912030
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$108.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$108.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.47
|
| Rate for Payer: BCBS Transplant Transplant |
$43.80
|
| Rate for Payer: Blue Shield of California Commercial |
$47.16
|
| Rate for Payer: Blue Shield of California EPN |
$37.38
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cigna of CA HMO |
$46.72
|
| Rate for Payer: Cigna of CA PPO |
$54.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.64
|
| Rate for Payer: Dignity Health Media |
$13.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.67
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.09
|
| Rate for Payer: Galaxy Health WC |
$62.05
|
| Rate for Payer: Global Benefits Group Commercial |
$43.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$54.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.47
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.47
|
| Rate for Payer: IEHP Medi-Cal |
$21.21
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$21.21
|
| Rate for Payer: IEHP Medicare Advantage |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.54
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: Networks By Design Commercial |
$47.45
|
| Rate for Payer: Prime Health Services Commercial |
$62.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$43.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.60
|
| Rate for Payer: United Healthcare All Other HMO |
$10.60
|
| Rate for Payer: United Healthcare HMO Rider |
$10.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Vantage Medical Group Senior |
$13.09
|
|
|
HC AORTA CATHETER (FEMORAL/AX
|
Facility
OP
|
$1,416.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
909081318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,203.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$778.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$778.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: BCBS Transplant Transplant |
$849.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cigna of CA PPO |
$1,047.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,203.60
|
| Rate for Payer: Dignity Health Media |
$1,203.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,203.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$566.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$566.40
|
| Rate for Payer: Galaxy Health WC |
$1,203.60
|
| Rate for Payer: Global Benefits Group Commercial |
$849.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,062.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$944.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.84
|
| Rate for Payer: Multiplan Commercial |
$1,132.80
|
| Rate for Payer: Networks By Design Commercial |
$920.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,203.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$849.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$849.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,203.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,203.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,203.60
|
|
|
HC AORTA CATHETER (FEMORAL/AX
|
Facility
IP
|
$1,416.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
909081318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$339.84 |
| Max. Negotiated Rate |
$1,203.60 |
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$566.40
|
| Rate for Payer: Galaxy Health WC |
$1,203.60
|
| Rate for Payer: Global Benefits Group Commercial |
$849.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$944.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$539.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.84
|
| Rate for Payer: Multiplan Commercial |
$1,132.80
|
| Rate for Payer: Networks By Design Commercial |
$920.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,203.60
|
|
|
HC AORTOGRAM/SUPRAVALVULAR
|
Facility
OP
|
$2,530.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
906811416
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$177.08 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,627.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,150.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,391.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,391.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,518.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Cigna of CA PPO |
$1,872.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,150.50
|
| Rate for Payer: Dignity Health Media |
$2,150.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,012.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,012.00
|
| Rate for Payer: Galaxy Health WC |
$2,150.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,518.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,897.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,687.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$607.20
|
| Rate for Payer: Multiplan Commercial |
$2,024.00
|
| Rate for Payer: Networks By Design Commercial |
$1,644.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,150.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,518.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,518.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,518.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,150.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,150.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,150.50
|
|
|
HC AORTOGRAM/SUPRAVALVULAR
|
Facility
IP
|
$2,530.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
906811416
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$607.20 |
| Max. Negotiated Rate |
$2,150.50 |
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,012.00
|
| Rate for Payer: Galaxy Health WC |
$2,150.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,518.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,687.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$963.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$607.20
|
| Rate for Payer: Multiplan Commercial |
$2,024.00
|
| Rate for Payer: Networks By Design Commercial |
$1,644.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,150.50
|
|
|
HC AORTOGRAPH ABDOMINAL
|
Facility
OP
|
$12,988.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
909081602
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$218.46 |
| Max. Negotiated Rate |
$11,039.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,005.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,271.14
|
| Rate for Payer: BCBS Transplant Transplant |
$7,792.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,675.91
|
| Rate for Payer: Blue Shield of California EPN |
$6,091.37
|
| Rate for Payer: Cash Price |
$5,844.60
|
| Rate for Payer: Cash Price |
$5,844.60
|
| Rate for Payer: Cigna of CA HMO |
$8,312.32
|
| Rate for Payer: Cigna of CA PPO |
$9,611.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$11,039.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,792.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9,741.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: IEHP Medi-Cal |
$6,451.73
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,663.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,117.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$10,390.40
|
| Rate for Payer: Networks By Design Commercial |
$8,442.20
|
| Rate for Payer: Prime Health Services Commercial |
$11,039.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,792.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,792.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,792.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC AORTOGRAPH ABDOMINAL
|
Facility
IP
|
$12,988.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
909081602
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,117.12 |
| Max. Negotiated Rate |
$11,039.80 |
| Rate for Payer: Cash Price |
$5,844.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,195.20
|
| Rate for Payer: Galaxy Health WC |
$11,039.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,792.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,663.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,948.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,117.12
|
| Rate for Payer: Multiplan Commercial |
$10,390.40
|
| Rate for Payer: Networks By Design Commercial |
$8,442.20
|
| Rate for Payer: Prime Health Services Commercial |
$11,039.80
|
|
|
HC AORTOGRAPH ABDOMINAL AIF
|
Facility
IP
|
$14,336.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
909081603
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$3,440.64 |
| Max. Negotiated Rate |
$12,185.60 |
| Rate for Payer: Cash Price |
$6,451.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,734.40
|
| Rate for Payer: Galaxy Health WC |
$12,185.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,601.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,562.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,462.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,440.64
|
| Rate for Payer: Multiplan Commercial |
$11,468.80
|
| Rate for Payer: Networks By Design Commercial |
$9,318.40
|
| Rate for Payer: Prime Health Services Commercial |
$12,185.60
|
|
|
HC AORTOGRAPH ABDOMINAL AIF
|
Facility
IP
|
$14,336.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
909081603
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,440.64 |
| Max. Negotiated Rate |
$12,185.60 |
| Rate for Payer: Cash Price |
$6,451.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,734.40
|
| Rate for Payer: Galaxy Health WC |
$12,185.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,601.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,562.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,462.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,440.64
|
| Rate for Payer: Multiplan Commercial |
$11,468.80
|
| Rate for Payer: Networks By Design Commercial |
$9,318.40
|
| Rate for Payer: Prime Health Services Commercial |
$12,185.60
|
|
