|
HC DUPLEX ABD PELVIS SCROTAL CONTENTS AND OR RETROPERI ORGANS LIMITED
|
Facility
IP
|
$1,914.00
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
906601559
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$459.36 |
| Max. Negotiated Rate |
$1,626.90 |
| Rate for Payer: Cash Price |
$861.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$765.60
|
| Rate for Payer: Galaxy Health WC |
$1,626.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,148.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,276.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$459.36
|
| Rate for Payer: Multiplan Commercial |
$1,531.20
|
| Rate for Payer: Networks By Design Commercial |
$1,244.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,626.90
|
|
|
HC DUPLEX ABD PELVIS SCROTAL CONTENTS AND OR RETROPERI ORGANS LIMITED
|
Facility
OP
|
$1,914.00
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
906601559
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,626.90 |
| Rate for Payer: BCBS Transplant Transplant |
$1,148.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,053.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,140.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1,131.17
|
| Rate for Payer: Blue Shield of California EPN |
$897.67
|
| Rate for Payer: Cash Price |
$861.30
|
| Rate for Payer: Cash Price |
$861.30
|
| Rate for Payer: Cash Price |
$861.30
|
| Rate for Payer: Cigna of CA HMO |
$1,224.96
|
| Rate for Payer: Cigna of CA PPO |
$1,416.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,626.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,148.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,435.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: IEHP Medi-Cal |
$222.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$222.52
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,276.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$459.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,531.20
|
| Rate for Payer: Networks By Design Commercial |
$1,244.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,626.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,148.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,148.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,148.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC DUPLEX SCAN AORTA/VENA CAVA
|
Facility
OP
|
$2,211.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
906601159
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$1,879.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,055.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,317.31
|
| Rate for Payer: BCBS Transplant Transplant |
$1,326.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,306.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,036.96
|
| Rate for Payer: Cash Price |
$994.95
|
| Rate for Payer: Cash Price |
$994.95
|
| Rate for Payer: Cash Price |
$994.95
|
| Rate for Payer: Cigna of CA HMO |
$1,415.04
|
| Rate for Payer: Cigna of CA PPO |
$1,636.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$1,879.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,326.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,658.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: IEHP Medi-Cal |
$495.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$495.98
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,474.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$530.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$1,768.80
|
| Rate for Payer: Networks By Design Commercial |
$1,437.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,879.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,326.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,326.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,326.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC DUPLEX SCAN AORTA/VENA CAVA
|
Facility
IP
|
$2,211.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
906601159
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$530.64 |
| Max. Negotiated Rate |
$1,879.35 |
| Rate for Payer: Cash Price |
$994.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$884.40
|
| Rate for Payer: Galaxy Health WC |
$1,879.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,326.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,474.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$842.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$530.64
|
| Rate for Payer: Multiplan Commercial |
$1,768.80
|
| Rate for Payer: Networks By Design Commercial |
$1,437.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,879.35
|
|
|
HC DUPLX EXT VEIN BILAT
|
Facility
OP
|
$2,854.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
908100110
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$2,425.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,055.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,700.41
|
| Rate for Payer: BCBS Transplant Transplant |
$1,712.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,686.71
|
| Rate for Payer: Blue Shield of California EPN |
$1,338.53
|
| Rate for Payer: Cash Price |
$1,284.30
|
| Rate for Payer: Cash Price |
$1,284.30
|
| Rate for Payer: Cash Price |
$1,284.30
|
| Rate for Payer: Cigna of CA HMO |
$1,826.56
|
| Rate for Payer: Cigna of CA PPO |
$2,111.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$2,425.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,712.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,140.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: IEHP Medi-Cal |
$495.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$495.98
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,903.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$684.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$2,283.20
|
| Rate for Payer: Networks By Design Commercial |
$1,855.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,425.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,712.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,712.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,712.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC DUPLX EXT VEIN BILAT
|
Facility
IP
|
$2,854.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
908100110
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$684.96 |
| Max. Negotiated Rate |
$2,425.90 |
| Rate for Payer: Cash Price |
$1,284.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,141.60
|
| Rate for Payer: Galaxy Health WC |
$2,425.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,712.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,903.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,087.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$684.96
|
| Rate for Payer: Multiplan Commercial |
$2,283.20
|
| Rate for Payer: Networks By Design Commercial |
$1,855.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,425.90
|
|
|
HC DUPLX EXT VEIN UNILAT
|
Facility
OP
|
$1,796.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
908100124
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,526.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$664.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,070.06
|
| Rate for Payer: BCBS Transplant Transplant |
$1,077.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,061.44
|
| Rate for Payer: Blue Shield of California EPN |
$842.32
|
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Cigna of CA HMO |
$1,149.44
|
| Rate for Payer: Cigna of CA PPO |
$1,329.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,526.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,077.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,347.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: IEHP Medi-Cal |
$222.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$222.52
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,197.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$431.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,436.80
|
| Rate for Payer: Networks By Design Commercial |
$1,167.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,526.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,077.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,077.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,077.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC DUPLX EXT VEIN UNILAT
|
Facility
IP
|
$1,796.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
908100124
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$431.04 |
| Max. Negotiated Rate |
$1,526.60 |
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$718.40
|
| Rate for Payer: Galaxy Health WC |
$1,526.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,077.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,197.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$684.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$431.04
|
| Rate for Payer: Multiplan Commercial |
$1,436.80
|
| Rate for Payer: Networks By Design Commercial |
$1,167.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,526.60
|
|
|
HC DUPLX LO EXT ARTERY BILAT
|
Facility
OP
|
$2,595.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
908100106
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$184.05 |
| Max. Negotiated Rate |
$2,205.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,054.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,546.10
|
| Rate for Payer: BCBS Transplant Transplant |
$1,557.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,533.64
|
| Rate for Payer: Blue Shield of California EPN |
$1,217.06
|
| Rate for Payer: Cash Price |
$1,167.75
|
| Rate for Payer: Cash Price |
$1,167.75
|
| Rate for Payer: Cash Price |
$1,167.75
|
| Rate for Payer: Cigna of CA HMO |
$1,660.80
|
| Rate for Payer: Cigna of CA PPO |
$1,920.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$2,205.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,557.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,946.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: IEHP Medi-Cal |
$495.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$495.98
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,730.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$622.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$2,076.00
|
| Rate for Payer: Networks By Design Commercial |
$1,686.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,205.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,557.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,557.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,557.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC DUPLX LO EXT ARTERY BILAT
|
Facility
IP
|
$2,595.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
908100106
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$622.80 |
| Max. Negotiated Rate |
$2,205.75 |
| Rate for Payer: Cash Price |
$1,167.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Galaxy Health WC |
$2,205.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,557.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,730.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$988.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$622.80
|
| Rate for Payer: Multiplan Commercial |
$2,076.00
|
| Rate for Payer: Networks By Design Commercial |
$1,686.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,205.75
|
|
|
HC DUPLX LO EXT ARTERY UNI
|
Facility
IP
|
$1,863.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
908100123
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$447.12 |
| Max. Negotiated Rate |
$1,583.55 |
| Rate for Payer: Cash Price |
$838.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$745.20
|
| Rate for Payer: Galaxy Health WC |
$1,583.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,117.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,242.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$709.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$447.12
|
| Rate for Payer: Multiplan Commercial |
$1,490.40
|
| Rate for Payer: Networks By Design Commercial |
$1,210.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,583.55
|
|
|
HC DUPLX LO EXT ARTERY UNI
|
Facility
OP
|
$1,863.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
908100123
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,583.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$664.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,109.98
|
| Rate for Payer: BCBS Transplant Transplant |
$1,117.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,101.03
|
| Rate for Payer: Blue Shield of California EPN |
$873.75
|
| Rate for Payer: Cash Price |
$838.35
|
| Rate for Payer: Cash Price |
$838.35
|
| Rate for Payer: Cash Price |
$838.35
|
| Rate for Payer: Cigna of CA HMO |
$1,192.32
|
| Rate for Payer: Cigna of CA PPO |
$1,378.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,583.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,117.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,397.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: IEHP Medi-Cal |
$222.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$222.52
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,242.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$447.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,490.40
|
| Rate for Payer: Networks By Design Commercial |
$1,210.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,583.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,117.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,117.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,117.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC DUPLX UP EXT ARTERY BILAT
|
Facility
IP
|
$2,464.00
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
908100105
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$591.36 |
| Max. Negotiated Rate |
$2,094.40 |
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$985.60
|
| Rate for Payer: Galaxy Health WC |
$2,094.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,478.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,643.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$938.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$591.36
|
| Rate for Payer: Multiplan Commercial |
$1,971.20
|
| Rate for Payer: Networks By Design Commercial |
$1,601.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,094.40
|
|
|
HC DUPLX UP EXT ARTERY BILAT
|
Facility
OP
|
$2,464.00
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
908100105
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$176.72 |
| Max. Negotiated Rate |
$2,094.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,055.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,468.05
|
| Rate for Payer: BCBS Transplant Transplant |
$1,478.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,456.22
|
| Rate for Payer: Blue Shield of California EPN |
$1,155.62
|
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: Cigna of CA HMO |
$1,576.96
|
| Rate for Payer: Cigna of CA PPO |
$1,823.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$2,094.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,478.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,848.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: IEHP Medi-Cal |
$495.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$495.98
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,643.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$591.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$1,971.20
|
| Rate for Payer: Networks By Design Commercial |
$1,601.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,094.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,478.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,478.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,478.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC DUPLX UP EXT ARTERY UNI
|
Facility
IP
|
$2,067.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
908100120
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$496.08 |
| Max. Negotiated Rate |
$1,756.95 |
| Rate for Payer: Cash Price |
$930.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$826.80
|
| Rate for Payer: Galaxy Health WC |
$1,756.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,240.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,378.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$787.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.08
|
| Rate for Payer: Multiplan Commercial |
$1,653.60
|
| Rate for Payer: Networks By Design Commercial |
$1,343.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,756.95
|
|
|
HC DUPLX UP EXT ARTERY UNI
|
Facility
OP
|
$2,067.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
908100120
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,756.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$664.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,231.52
|
| Rate for Payer: BCBS Transplant Transplant |
$1,240.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,221.60
|
| Rate for Payer: Blue Shield of California EPN |
$969.42
|
| Rate for Payer: Cash Price |
$930.15
|
| Rate for Payer: Cash Price |
$930.15
|
| Rate for Payer: Cash Price |
$930.15
|
| Rate for Payer: Cigna of CA HMO |
$1,322.88
|
| Rate for Payer: Cigna of CA PPO |
$1,529.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,756.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,240.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,550.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: IEHP Medi-Cal |
$222.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$222.52
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,378.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,653.60
|
| Rate for Payer: Networks By Design Commercial |
$1,343.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,756.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,240.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,240.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,240.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC DUP SCAN EXTRACRANIAL ART COMPLEX
|
Facility
IP
|
$2,452.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
908100102
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$588.48 |
| Max. Negotiated Rate |
$2,084.20 |
| Rate for Payer: Cash Price |
$1,103.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$980.80
|
| Rate for Payer: Galaxy Health WC |
$2,084.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,471.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,635.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$934.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$588.48
|
| Rate for Payer: Multiplan Commercial |
$1,961.60
|
| Rate for Payer: Networks By Design Commercial |
$1,593.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,084.20
|
|
|
HC DUP SCAN EXTRACRANIAL ART COMPLEX
|
Facility
OP
|
$2,452.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
908100102
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$297.62 |
| Max. Negotiated Rate |
$2,084.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,055.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,460.90
|
| Rate for Payer: BCBS Transplant Transplant |
$1,471.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,449.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,149.99
|
| Rate for Payer: Cash Price |
$1,103.40
|
| Rate for Payer: Cash Price |
$1,103.40
|
| Rate for Payer: Cash Price |
$1,103.40
|
| Rate for Payer: Cigna of CA HMO |
$1,569.28
|
| Rate for Payer: Cigna of CA PPO |
$1,814.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$2,084.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,471.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,839.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: IEHP Medi-Cal |
$495.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$495.98
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,635.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$588.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$1,961.60
|
| Rate for Payer: Networks By Design Commercial |
$1,593.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,084.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,471.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,471.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,471.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC DUP SCAN EXTRACRANIAL ART LIMITED
|
Facility
IP
|
$1,192.00
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
908100116
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$286.08 |
| Max. Negotiated Rate |
$1,013.20 |
| Rate for Payer: Cash Price |
$536.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$476.80
|
| Rate for Payer: Galaxy Health WC |
$1,013.20
|
| Rate for Payer: Global Benefits Group Commercial |
$715.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$795.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$454.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.08
|
| Rate for Payer: Multiplan Commercial |
$953.60
|
| Rate for Payer: Networks By Design Commercial |
$774.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,013.20
|
|
|
HC DUP SCAN EXTRACRANIAL ART LIMITED
|
Facility
OP
|
$1,192.00
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
908100116
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,507.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,053.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$710.19
|
| Rate for Payer: BCBS Transplant Transplant |
$715.20
|
| Rate for Payer: Blue Shield of California Commercial |
$704.47
|
| Rate for Payer: Blue Shield of California EPN |
$559.05
|
| Rate for Payer: Cash Price |
$536.40
|
| Rate for Payer: Cash Price |
$536.40
|
| Rate for Payer: Cash Price |
$536.40
|
| Rate for Payer: Cigna of CA HMO |
$762.88
|
| Rate for Payer: Cigna of CA PPO |
$882.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,013.20
|
| Rate for Payer: Global Benefits Group Commercial |
$715.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$894.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: IEHP Medi-Cal |
$222.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$222.52
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$795.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$953.60
|
| Rate for Payer: Networks By Design Commercial |
$774.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,013.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$715.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$715.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$715.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC DVC BERLIN HEART DRIVING UNIT
|
Facility
IP
|
$18,596.00
|
|
| Hospital Charge Code |
901692008
|
|
Hospital Revenue Code
|
291
|
| Min. Negotiated Rate |
$4,463.04 |
| Max. Negotiated Rate |
$15,806.60 |
| Rate for Payer: Cash Price |
$8,368.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,438.40
|
| Rate for Payer: Galaxy Health WC |
$15,806.60
|
| Rate for Payer: Global Benefits Group Commercial |
$11,157.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,403.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,085.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,463.04
|
| Rate for Payer: Multiplan Commercial |
$14,876.80
|
| Rate for Payer: Networks By Design Commercial |
$12,087.40
|
| Rate for Payer: Prime Health Services Commercial |
$15,806.60
|
|
|
HC DVC BERLIN HEART DRIVING UNIT
|
Facility
OP
|
$18,596.00
|
|
| Hospital Charge Code |
901692008
|
|
Hospital Revenue Code
|
291
|
| Min. Negotiated Rate |
$4,463.04 |
| Max. Negotiated Rate |
$15,806.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,197.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15,806.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10,227.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10,227.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,079.50
|
| Rate for Payer: BCBS Transplant Transplant |
$11,157.60
|
| Rate for Payer: Blue Shield of California Commercial |
$13,705.25
|
| Rate for Payer: Blue Shield of California EPN |
$10,860.06
|
| Rate for Payer: Cash Price |
$8,368.20
|
| Rate for Payer: Cigna of CA HMO |
$11,901.44
|
| Rate for Payer: Cigna of CA PPO |
$13,761.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,806.60
|
| Rate for Payer: Dignity Health Media |
$15,806.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,806.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,438.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,438.40
|
| Rate for Payer: Galaxy Health WC |
$15,806.60
|
| Rate for Payer: Global Benefits Group Commercial |
$11,157.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13,947.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,403.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,085.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,463.04
|
| Rate for Payer: Multiplan Commercial |
$14,876.80
|
| Rate for Payer: Networks By Design Commercial |
$12,087.40
|
| Rate for Payer: Prime Health Services Commercial |
$15,806.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11,157.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,157.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,157.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,298.00
|
| Rate for Payer: United Healthcare All Other HMO |
$9,298.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,298.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,806.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,806.60
|
| Rate for Payer: Vantage Medical Group Senior |
$15,806.60
|
|
|
HC DVC PELVIC ORTHOTIC TPOD
|
Facility
OP
|
$580.00
|
|
|
Service Code
|
CPT E0944
|
| Hospital Charge Code |
901605152
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$59.28 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$136.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$319.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$345.56
|
| Rate for Payer: BCBS Transplant Transplant |
$348.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.46
|
| Rate for Payer: Blue Shield of California EPN |
$338.72
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Media |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$435.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC DVC PELVIC ORTHOTIC TPOD
|
Facility
IP
|
$580.00
|
|
|
Service Code
|
CPT E0944
|
| Hospital Charge Code |
901605152
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$139.20 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC DVLP TEST PHYS/QHP PT 1ST HR
|
Facility
OP
|
$1,042.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
900400020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$885.70 |
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$852.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$625.20
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cigna of CA HMO |
$666.88
|
| Rate for Payer: Cigna of CA PPO |
$771.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$885.70
|
| Rate for Payer: Global Benefits Group Commercial |
$625.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$781.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.08
|
| Rate for Payer: Heritage Provider Network Transplant |
$320.08
|
| Rate for Payer: IEHP Medi-Cal |
$316.18
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$316.18
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$695.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$833.60
|
| Rate for Payer: Networks By Design Commercial |
$677.30
|
| Rate for Payer: Prime Health Services Commercial |
$885.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$625.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$234.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
