|
HC LYMPHANGIOGRAPHY INJECTION
|
Facility
|
OP
|
$659.00
|
|
|
Service Code
|
CPT 38790
|
| Hospital Charge Code |
909000131
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$158.16 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$560.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$362.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$362.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$395.40
|
| 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 |
$296.55
|
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: Cigna of CA PPO |
$487.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$560.15
|
| Rate for Payer: Dignity Health Media |
$560.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$560.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$263.60
|
| Rate for Payer: Galaxy Health WC |
$560.15
|
| Rate for Payer: Global Benefits Group Commercial |
$395.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$494.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$439.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$859.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.16
|
| Rate for Payer: Multiplan Commercial |
$527.20
|
| Rate for Payer: Networks By Design Commercial |
$428.35
|
| Rate for Payer: Prime Health Services Commercial |
$560.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$395.40
|
| 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 |
$560.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$560.15
|
| Rate for Payer: Vantage Medical Group Senior |
$560.15
|
|
|
HC LYMPHANGIOGRAPHY INJECTION
|
Facility
|
IP
|
$659.00
|
|
|
Service Code
|
CPT 38790
|
| Hospital Charge Code |
909000131
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$158.16 |
| Max. Negotiated Rate |
$560.15 |
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.60
|
| Rate for Payer: Galaxy Health WC |
$560.15
|
| Rate for Payer: Global Benefits Group Commercial |
$395.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$439.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.16
|
| Rate for Payer: Multiplan Commercial |
$527.20
|
| Rate for Payer: Networks By Design Commercial |
$428.35
|
| Rate for Payer: Prime Health Services Commercial |
$560.15
|
|
|
HC LYMPHAT/ANTIMONY SCA
|
Facility
|
IP
|
$3,523.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
909301341
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$845.52 |
| Max. Negotiated Rate |
$2,994.55 |
| Rate for Payer: Cash Price |
$1,585.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,409.20
|
| Rate for Payer: Galaxy Health WC |
$2,994.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,113.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,349.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,342.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$2,818.40
|
| Rate for Payer: Networks By Design Commercial |
$2,289.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,994.55
|
|
|
HC LYMPHAT/ANTIMONY SCA
|
Facility
|
OP
|
$3,523.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
909301341
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$360.14 |
| Max. Negotiated Rate |
$2,994.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,635.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,099.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,113.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,082.09
|
| Rate for Payer: Blue Shield of California EPN |
$1,652.29
|
| Rate for Payer: Cash Price |
$1,585.35
|
| Rate for Payer: Cash Price |
$1,585.35
|
| Rate for Payer: Cigna of CA HMO |
$2,254.72
|
| Rate for Payer: Cigna of CA PPO |
$2,607.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Media |
$675.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$675.33
|
| Rate for Payer: Galaxy Health WC |
$2,994.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,113.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,642.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,107.54
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,107.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,094.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,094.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$675.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,349.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$845.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$850.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.94
|
| Rate for Payer: Multiplan Commercial |
$2,818.40
|
| Rate for Payer: Networks By Design Commercial |
$2,289.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,994.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,113.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,113.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$654.98
|
| Rate for Payer: United Healthcare All Other HMO |
$654.98
|
| Rate for Payer: United Healthcare HMO Rider |
$654.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$654.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC LYMPH NODE NDLE BPSY, DP AX
|
Facility
|
OP
|
$6,990.00
|
|
|
Service Code
|
CPT 38525
|
| Hospital Charge Code |
909000129
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$280.82 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,762.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,194.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$3,145.50
|
| Rate for Payer: Cash Price |
$3,145.50
|
| Rate for Payer: Cigna of CA PPO |
$5,172.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Dignity Health Media |
$4,762.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,238.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,429.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,762.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,762.51
|
| Rate for Payer: Galaxy Health WC |
$5,941.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,194.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,242.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,810.52
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,810.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,715.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7,715.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,762.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,662.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,762.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,677.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,000.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,381.76
|
| Rate for Payer: Multiplan Commercial |
$5,592.00
|
| Rate for Payer: Networks By Design Commercial |
$4,543.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,941.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,194.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4,762.51
|
|
|
HC LYMPH NODE NDLE BPSY, DP AX
|
Facility
|
IP
|
$6,990.00
|
|
|
Service Code
|
CPT 38525
|
| Hospital Charge Code |
909000129
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,677.60 |
| Max. Negotiated Rate |
$5,941.50 |
| Rate for Payer: Cash Price |
$3,145.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,796.00
|
| Rate for Payer: Galaxy Health WC |
$5,941.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,194.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,662.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,663.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,677.60
|
| Rate for Payer: Multiplan Commercial |
$5,592.00
|
| Rate for Payer: Networks By Design Commercial |
$4,543.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,941.50
|
|
|
HC LYMPH NODE NDLE BPSY, DP CE
|
Facility
|
OP
|
$8,533.00
|
|
|
Service Code
|
CPT 38510
|
| Hospital Charge Code |
909000128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$274.46 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,762.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,119.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$3,839.85
|
| Rate for Payer: Cash Price |
$3,839.85
|
| Rate for Payer: Cigna of CA PPO |
$6,314.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Dignity Health Media |
$4,762.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,238.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,429.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,762.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,762.51
|
| Rate for Payer: Galaxy Health WC |
$7,253.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,119.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,399.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,810.52
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,810.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,715.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7,715.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,762.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,691.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,762.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,047.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,000.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,381.76
|
| Rate for Payer: Multiplan Commercial |
$6,826.40
|
| Rate for Payer: Networks By Design Commercial |
$5,546.45
|
| Rate for Payer: Prime Health Services Commercial |
$7,253.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,119.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4,762.51
|
|
|
HC LYMPH NODE NDLE BPSY, DP CE
|
Facility
|
IP
|
$8,533.00
|
|
|
Service Code
|
CPT 38510
|
| Hospital Charge Code |
909000128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,047.92 |
| Max. Negotiated Rate |
$7,253.05 |
| Rate for Payer: Cash Price |
$3,839.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,413.20
|
| Rate for Payer: Galaxy Health WC |
$7,253.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,119.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,691.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,251.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,047.92
|
| Rate for Payer: Multiplan Commercial |
$6,826.40
|
| Rate for Payer: Networks By Design Commercial |
$5,546.45
|
| Rate for Payer: Prime Health Services Commercial |
$7,253.05
|
|
|
HC LYMPH NODE NDLE BPSY, INT M
|
Facility
|
IP
|
$8,855.00
|
|
|
Service Code
|
CPT 38530
|
| Hospital Charge Code |
909000130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,125.20 |
| Max. Negotiated Rate |
$7,526.75 |
| Rate for Payer: Cash Price |
$3,984.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,542.00
|
| Rate for Payer: Galaxy Health WC |
$7,526.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,313.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,906.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,373.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,125.20
|
| Rate for Payer: Multiplan Commercial |
$7,084.00
|
| Rate for Payer: Networks By Design Commercial |
$5,755.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,526.75
|
|
|
HC LYMPH NODE NDLE BPSY, INT M
|
Facility
|
OP
|
$8,855.00
|
|
|
Service Code
|
CPT 38530
|
| Hospital Charge Code |
909000130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$112.48 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,762.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,313.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$3,984.75
|
| Rate for Payer: Cash Price |
$3,984.75
|
| Rate for Payer: Cigna of CA PPO |
$6,552.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Dignity Health Media |
$4,762.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,238.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,429.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,762.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,762.51
|
| Rate for Payer: Galaxy Health WC |
$7,526.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,313.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,641.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,810.52
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,810.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,715.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7,715.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,762.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,906.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,762.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,125.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,000.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,381.76
|
| Rate for Payer: Multiplan Commercial |
$7,084.00
|
| Rate for Payer: Networks By Design Commercial |
$5,755.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,526.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,313.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4,762.51
|
|
|
HC LYMPH NODE NDLE BPSY,SUPFCL
|
Facility
|
OP
|
$3,800.00
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
909000127
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$134.41 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,280.00
|
| 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 |
$1,710.00
|
| Rate for Payer: Cash Price |
$1,710.00
|
| Rate for Payer: Cigna of CA PPO |
$2,812.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$3,230.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,280.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,850.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,534.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$912.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$3,040.00
|
| Rate for Payer: Networks By Design Commercial |
$2,470.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,230.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,280.00
|
| 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 |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC LYMPH NODE NDLE BPSY,SUPFCL
|
Facility
|
IP
|
$3,800.00
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
909000127
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$912.00 |
| Max. Negotiated Rate |
$3,230.00 |
| Rate for Payer: Cash Price |
$1,710.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,520.00
|
| Rate for Payer: Galaxy Health WC |
$3,230.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,280.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,534.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,447.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$912.00
|
| Rate for Payer: Multiplan Commercial |
$3,040.00
|
| Rate for Payer: Networks By Design Commercial |
$2,470.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,230.00
|
|
|
HC LYMPHOCYTE SUBSET, EA CELL MAR
|
Facility
|
OP
|
$773.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
903901952
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$80.14 |
| Max. Negotiated Rate |
$736.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$533.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$449.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$355.89
|
| Rate for Payer: Blue Distinction Transplant |
$463.80
|
| Rate for Payer: Blue Shield of California Commercial |
$499.36
|
| Rate for Payer: Blue Shield of California EPN |
$395.78
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cigna of CA HMO |
$494.72
|
| Rate for Payer: Cigna of CA PPO |
$572.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.66
|
| Rate for Payer: Dignity Health Media |
$449.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$494.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$449.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$449.11
|
| Rate for Payer: Galaxy Health WC |
$657.05
|
| Rate for Payer: Global Benefits Group Commercial |
$463.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$579.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$736.54
|
| Rate for Payer: Heritage Provider Network Transplant |
$736.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$727.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$727.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$449.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$515.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$449.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.81
|
| Rate for Payer: Multiplan Commercial |
$618.40
|
| Rate for Payer: Networks By Design Commercial |
$502.45
|
| Rate for Payer: Prime Health Services Commercial |
$657.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$463.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$463.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Vantage Medical Group Senior |
$449.11
|
|
|
HC LYMPHOCYTE SUBSET, EA CELL MAR
|
Facility
|
IP
|
$773.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
903901952
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$185.52 |
| Max. Negotiated Rate |
$657.05 |
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.20
|
| Rate for Payer: Galaxy Health WC |
$657.05
|
| Rate for Payer: Global Benefits Group Commercial |
$463.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$515.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.52
|
| Rate for Payer: Multiplan Commercial |
$618.40
|
| Rate for Payer: Networks By Design Commercial |
$502.45
|
| Rate for Payer: Prime Health Services Commercial |
$657.05
|
|
|
HC LYSIS OF LABIAL ADHESIONS
|
Facility
|
IP
|
$7,938.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
902400744
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,905.12 |
| Max. Negotiated Rate |
$6,747.30 |
| Rate for Payer: Cash Price |
$3,572.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,175.20
|
| Rate for Payer: Galaxy Health WC |
$6,747.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,762.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,294.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,024.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,905.12
|
| Rate for Payer: Multiplan Commercial |
$6,350.40
|
| Rate for Payer: Networks By Design Commercial |
$5,159.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,747.30
|
|
|
HC LYSIS OF LABIAL ADHESIONS
|
Facility
|
IP
|
$7,938.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
902400744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,905.12 |
| Max. Negotiated Rate |
$6,747.30 |
| Rate for Payer: Cash Price |
$3,572.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,175.20
|
| Rate for Payer: Galaxy Health WC |
$6,747.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,762.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,294.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,024.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,905.12
|
| Rate for Payer: Multiplan Commercial |
$6,350.40
|
| Rate for Payer: Networks By Design Commercial |
$5,159.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,747.30
|
|
|
HC LYSIS OF LABIAL ADHESIONS
|
Facility
|
OP
|
$7,938.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
902400744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$321.10 |
| Max. Negotiated Rate |
$6,747.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,762.80
|
| Rate for Payer: Cash Price |
$3,572.10
|
| Rate for Payer: Cash Price |
$3,572.10
|
| Rate for Payer: Cash Price |
$3,572.10
|
| Rate for Payer: Cigna of CA PPO |
$5,874.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$6,747.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,762.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,953.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,406.14
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,406.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,294.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,905.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$6,350.40
|
| Rate for Payer: Networks By Design Commercial |
$5,159.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,747.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,762.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,969.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,969.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,969.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,969.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC LYSIS OF LABIAL ADHESIONS
|
Facility
|
OP
|
$7,938.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
902400744
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$321.10 |
| Max. Negotiated Rate |
$6,747.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,762.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,850.31
|
| Rate for Payer: Blue Shield of California EPN |
$4,635.79
|
| Rate for Payer: Cash Price |
$3,572.10
|
| Rate for Payer: Cash Price |
$3,572.10
|
| Rate for Payer: Cash Price |
$3,572.10
|
| Rate for Payer: Cigna of CA HMO |
$5,080.32
|
| Rate for Payer: Cigna of CA PPO |
$5,874.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$6,747.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,762.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,953.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,406.14
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,406.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,328.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,328.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,294.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,905.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$6,350.40
|
| Rate for Payer: Networks By Design Commercial |
$5,159.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,747.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,762.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,762.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC MAGNESIUM
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900910230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$60.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.75
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.92
|
| Rate for Payer: Blue Shield of California EPN |
$10.24
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.05
|
| Rate for Payer: Dignity Health Media |
$6.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.70
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.99
|
| Rate for Payer: Heritage Provider Network Transplant |
$10.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$10.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.98
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.43
|
| Rate for Payer: United Healthcare All Other HMO |
$5.43
|
| Rate for Payer: United Healthcare HMO Rider |
$5.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Vantage Medical Group Senior |
$6.70
|
|
|
HC MALARIA QUANTITAT
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911640
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$54.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.67
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Media |
$5.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.09
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.99
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.82
|
| Rate for Payer: Heritage Provider Network Transplant |
$9.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$9.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.03
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
|
|
HC MALARIA SCREEN AG TEST
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
900912441
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.25 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.00
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.10
|
| Rate for Payer: Dignity Health Media |
$16.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.07
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$26.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$26.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.53
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO |
$13.01
|
| Rate for Payer: United Healthcare HMO Rider |
$13.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
|
|
HC MALARIA SMEARS
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911686
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$54.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.67
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Media |
$5.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.09
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.99
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.82
|
| Rate for Payer: Heritage Provider Network Transplant |
$9.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$9.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.03
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
|
|
HC MAMMARY DUCTOGRAM
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
CPT 19030
|
| Hospital Charge Code |
909000103
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.08 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$481.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$311.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$311.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$340.20
|
| 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 |
$255.15
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Cigna of CA PPO |
$419.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$481.95
|
| Rate for Payer: Dignity Health Media |
$481.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$481.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$226.80
|
| Rate for Payer: Galaxy Health WC |
$481.95
|
| Rate for Payer: Global Benefits Group Commercial |
$340.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$425.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$378.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.08
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: Networks By Design Commercial |
$368.55
|
| Rate for Payer: Prime Health Services Commercial |
$481.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$340.20
|
| 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 |
$481.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$481.95
|
| Rate for Payer: Vantage Medical Group Senior |
$481.95
|
|
|
HC MAMMARY DUCTOGRAM
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
CPT 19030
|
| Hospital Charge Code |
909000103
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.08 |
| Max. Negotiated Rate |
$481.95 |
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.80
|
| Rate for Payer: Galaxy Health WC |
$481.95
|
| Rate for Payer: Global Benefits Group Commercial |
$340.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$378.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.08
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: Networks By Design Commercial |
$368.55
|
| Rate for Payer: Prime Health Services Commercial |
$481.95
|
|
|
HC MAMMOGRAPHY DIGITAL BILAT
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
CPT 77066
|
| Hospital Charge Code |
909002011
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.00
|
| Rate for Payer: Galaxy Health WC |
$850.00
|
| Rate for Payer: Global Benefits Group Commercial |
$600.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$667.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.00
|
| Rate for Payer: Multiplan Commercial |
$800.00
|
| Rate for Payer: Networks By Design Commercial |
$650.00
|
| Rate for Payer: Prime Health Services Commercial |
$850.00
|
|
