|
HC DRVVT
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
900912008
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.76 |
| Max. Negotiated Rate |
$151.30 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.49
|
| Rate for Payer: Blue Shield of California Commercial |
$119.08
|
| Rate for Payer: Blue Shield of California EPN |
$78.68
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Cigna of CA HMO |
$113.92
|
| Rate for Payer: Cigna of CA PPO |
$131.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.93
|
| Rate for Payer: EPIC Health Plan Senior |
$9.58
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.84
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.76
|
| Rate for Payer: United Healthcare All Other HMO |
$7.76
|
| Rate for Payer: United Healthcare HMO Rider |
$7.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.76
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.54
|
| Rate for Payer: Vantage Medical Group Senior |
$9.58
|
|
|
HC DRVVT
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
900912008
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$151.30 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.72
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
|
|
HC DSCHG RCP EDU TRAINING EA 30MN
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
900898960
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$46.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC DSCHG RCP EDU TRAINING EA 30MN
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
900898960
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC D-STAT HEMOSTAT
|
Facility
|
IP
|
$483.00
|
|
| Hospital Charge Code |
906812352
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$410.55 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Cash Price |
$265.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.92
|
| Rate for Payer: Multiplan Commercial |
$386.40
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
|
|
HC D-STAT HEMOSTAT
|
Facility
|
OP
|
$483.00
|
|
| Hospital Charge Code |
906812352
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$410.55 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$316.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$362.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$296.61
|
| Rate for Payer: Cash Price |
$265.65
|
| Rate for Payer: Cigna of CA HMO |
$309.12
|
| Rate for Payer: Cigna of CA PPO |
$357.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$410.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$410.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.10
|
| Rate for Payer: Multiplan Commercial |
$386.40
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$241.50
|
| Rate for Payer: United Healthcare All Other HMO |
$241.50
|
| Rate for Payer: United Healthcare HMO Rider |
$241.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$410.55
|
| Rate for Payer: Vantage Medical Group Senior |
$410.55
|
|
|
HC D TEST
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912427
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.03
|
| Rate for Payer: Blue Shield of California Commercial |
$104.36
|
| Rate for Payer: Blue Shield of California EPN |
$68.95
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.10
|
| Rate for Payer: EPIC Health Plan Senior |
$7.48
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.02
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.06
|
| Rate for Payer: United Healthcare All Other HMO |
$6.06
|
| Rate for Payer: United Healthcare HMO Rider |
$6.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Vantage Medical Group Senior |
$7.48
|
|
|
HC D TEST
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912427
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.44
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
|
|
HC DT TOXOIDS PEDS ADMIN
|
Facility
|
IP
|
$39.00
|
|
| Hospital Charge Code |
908603028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| 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
|
|
|
HC DT TOXOIDS PEDS ADMIN
|
Facility
|
OP
|
$39.00
|
|
| Hospital Charge Code |
908603028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.95
|
| Rate for Payer: Cash Price |
$21.45
|
| 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 |
$33.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.30
|
| 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 |
$19.50
|
| Rate for Payer: United Healthcare All Other HMO |
$19.50
|
| Rate for Payer: United Healthcare HMO Rider |
$19.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.15
|
| Rate for Payer: Vantage Medical Group Senior |
$33.15
|
|
|
HC DT VACCINE IM LT 7 YRS
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 90702
|
| Hospital Charge Code |
900501449
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$178.85 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$178.85
|
| Rate for Payer: Cash Price |
$29.15
|
| Rate for Payer: Cash Price |
$29.15
|
| Rate for Payer: Cigna of CA HMO |
$33.92
|
| Rate for Payer: Cigna of CA PPO |
$39.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.20
|
| Rate for Payer: EPIC Health Plan Senior |
$21.20
|
| Rate for Payer: Galaxy Health WC |
$45.05
|
| Rate for Payer: Global Benefits Group Commercial |
$31.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$116.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.10
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: Networks By Design Commercial |
$34.45
|
| Rate for Payer: Prime Health Services Commercial |
$45.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.50
|
| Rate for Payer: United Healthcare All Other HMO |
$26.50
|
| Rate for Payer: United Healthcare HMO Rider |
$26.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.05
|
| Rate for Payer: Vantage Medical Group Senior |
$45.05
|
|
|
HC DT VACCINE IM LT 7 YRS
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 90702
|
| Hospital Charge Code |
900501449
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$45.05 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Blue Shield of California Commercial |
$39.11
|
| Rate for Payer: Blue Shield of California EPN |
$25.76
|
| Rate for Payer: Cash Price |
$29.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.20
|
| Rate for Payer: EPIC Health Plan Senior |
$21.20
|
| Rate for Payer: Galaxy Health WC |
$45.05
|
| Rate for Payer: Global Benefits Group Commercial |
$31.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.72
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: Networks By Design Commercial |
$34.45
|
| Rate for Payer: Prime Health Services Commercial |
$45.05
|
|
|
HC DUCTOGRAM/ASPIRATION-2 OR MORE
|
Facility
|
OP
|
$964.00
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
909001446
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.12 |
| Max. Negotiated Rate |
$1,035.09 |
| Rate for Payer: Adventist Health Commercial |
$192.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$632.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,035.09
|
| Rate for Payer: Blue Shield of California Commercial |
$589.97
|
| Rate for Payer: Blue Shield of California EPN |
$389.46
|
| Rate for Payer: Cash Price |
$530.20
|
| Rate for Payer: Cash Price |
$530.20
|
| Rate for Payer: Cigna of CA HMO |
$616.96
|
| Rate for Payer: Cigna of CA PPO |
$713.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$819.40
|
| Rate for Payer: Global Benefits Group Commercial |
$578.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$107.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$642.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$771.20
|
| Rate for Payer: Networks By Design Commercial |
$626.60
|
| Rate for Payer: Prime Health Services Commercial |
$819.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$578.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$578.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC DUCTOGRAM/ASPIRATION-2 OR MORE
|
Facility
|
IP
|
$964.00
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
909001446
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$192.80 |
| Max. Negotiated Rate |
$819.40 |
| Rate for Payer: Adventist Health Commercial |
$192.80
|
| Rate for Payer: Cash Price |
$530.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.60
|
| Rate for Payer: EPIC Health Plan Senior |
$385.60
|
| Rate for Payer: Galaxy Health WC |
$819.40
|
| Rate for Payer: Global Benefits Group Commercial |
$578.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$642.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$596.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.36
|
| Rate for Payer: Multiplan Commercial |
$771.20
|
| Rate for Payer: Networks By Design Commercial |
$626.60
|
| Rate for Payer: Prime Health Services Commercial |
$819.40
|
|
|
HC DUCTOGRAM/ASPIRATION- SINGLE
|
Facility
|
OP
|
$879.00
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
909001433
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.86 |
| Max. Negotiated Rate |
$747.15 |
| Rate for Payer: Adventist Health Commercial |
$175.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$576.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$743.84
|
| Rate for Payer: Blue Shield of California Commercial |
$537.95
|
| Rate for Payer: Blue Shield of California EPN |
$355.12
|
| Rate for Payer: Cash Price |
$483.45
|
| Rate for Payer: Cash Price |
$483.45
|
| Rate for Payer: Cigna of CA HMO |
$562.56
|
| Rate for Payer: Cigna of CA PPO |
$650.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$747.15
|
| Rate for Payer: Global Benefits Group Commercial |
$527.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$82.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$586.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$703.20
|
| Rate for Payer: Networks By Design Commercial |
$571.35
|
| Rate for Payer: Prime Health Services Commercial |
$747.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$527.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$527.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC DUCTOGRAM/ASPIRATION- SINGLE
|
Facility
|
IP
|
$879.00
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
909001433
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.80 |
| Max. Negotiated Rate |
$747.15 |
| Rate for Payer: Adventist Health Commercial |
$175.80
|
| Rate for Payer: Cash Price |
$483.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$351.60
|
| Rate for Payer: EPIC Health Plan Senior |
$351.60
|
| Rate for Payer: Galaxy Health WC |
$747.15
|
| Rate for Payer: Global Benefits Group Commercial |
$527.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$586.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$334.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$544.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.96
|
| Rate for Payer: Multiplan Commercial |
$703.20
|
| Rate for Payer: Networks By Design Commercial |
$571.35
|
| Rate for Payer: Prime Health Services Commercial |
$747.15
|
|
|
HC DUPLEX ABD PELVIS SCROTAL CONTENTS AND OR RETROPERI ORGANS LIMITED
|
Facility
|
IP
|
$2,090.00
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
906601559
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$418.00 |
| Max. Negotiated Rate |
$1,776.50 |
| Rate for Payer: Adventist Health Commercial |
$418.00
|
| Rate for Payer: Cash Price |
$1,149.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$836.00
|
| Rate for Payer: EPIC Health Plan Senior |
$836.00
|
| Rate for Payer: Galaxy Health WC |
$1,776.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,254.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,394.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$796.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,293.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.60
|
| Rate for Payer: Multiplan Commercial |
$1,672.00
|
| Rate for Payer: Networks By Design Commercial |
$1,358.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,776.50
|
|
|
HC DUPLEX ABD PELVIS SCROTAL CONTENTS AND OR RETROPERI ORGANS LIMITED
|
Facility
|
OP
|
$2,090.00
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
906601559
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$1,776.50 |
| Rate for Payer: Adventist Health Commercial |
$418.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,370.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,283.47
|
| Rate for Payer: Blue Shield of California Commercial |
$1,279.08
|
| Rate for Payer: Blue Shield of California EPN |
$844.36
|
| Rate for Payer: Cash Price |
$1,149.50
|
| Rate for Payer: Cash Price |
$1,149.50
|
| Rate for Payer: Cash Price |
$1,149.50
|
| Rate for Payer: Cigna of CA HMO |
$1,337.60
|
| Rate for Payer: Cigna of CA PPO |
$1,546.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,776.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,254.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$259.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,394.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,672.00
|
| Rate for Payer: Networks By Design Commercial |
$1,358.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,776.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,254.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,254.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC DUPLEX SCAN AORTA/VENA CAVA
|
Facility
|
IP
|
$2,414.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
906601159
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$482.80 |
| Max. Negotiated Rate |
$2,051.90 |
| Rate for Payer: Adventist Health Commercial |
$482.80
|
| Rate for Payer: Cash Price |
$1,327.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$965.60
|
| Rate for Payer: EPIC Health Plan Senior |
$965.60
|
| Rate for Payer: Galaxy Health WC |
$2,051.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,448.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,610.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$919.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,494.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$579.36
|
| Rate for Payer: Multiplan Commercial |
$1,931.20
|
| Rate for Payer: Networks By Design Commercial |
$1,569.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,051.90
|
|
|
HC DUPLEX SCAN AORTA/VENA CAVA
|
Facility
|
OP
|
$2,414.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
906601159
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$275.77 |
| Max. Negotiated Rate |
$2,051.90 |
| Rate for Payer: Adventist Health Commercial |
$482.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,583.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,482.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1,477.37
|
| Rate for Payer: Blue Shield of California EPN |
$975.26
|
| Rate for Payer: Cash Price |
$1,327.70
|
| Rate for Payer: Cash Price |
$1,327.70
|
| Rate for Payer: Cash Price |
$1,327.70
|
| Rate for Payer: Cigna of CA HMO |
$1,544.96
|
| Rate for Payer: Cigna of CA PPO |
$1,786.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$2,051.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,448.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$275.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,610.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$579.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$1,931.20
|
| Rate for Payer: Networks By Design Commercial |
$1,569.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,051.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,448.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,448.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC DUPLX EXT VEIN BILAT
|
Facility
|
OP
|
$3,116.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
908100110
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$282.64 |
| Max. Negotiated Rate |
$2,648.60 |
| Rate for Payer: Adventist Health Commercial |
$623.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,043.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,913.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,906.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,258.86
|
| Rate for Payer: Cash Price |
$1,713.80
|
| Rate for Payer: Cash Price |
$1,713.80
|
| Rate for Payer: Cash Price |
$1,713.80
|
| Rate for Payer: Cigna of CA HMO |
$1,994.24
|
| Rate for Payer: Cigna of CA PPO |
$2,305.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$2,648.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,869.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$282.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,078.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$747.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$2,492.80
|
| Rate for Payer: Networks By Design Commercial |
$2,025.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,648.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,869.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,869.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC DUPLX EXT VEIN BILAT
|
Facility
|
IP
|
$3,116.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
908100110
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$623.20 |
| Max. Negotiated Rate |
$2,648.60 |
| Rate for Payer: Adventist Health Commercial |
$623.20
|
| Rate for Payer: Cash Price |
$1,713.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,246.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,246.40
|
| Rate for Payer: Galaxy Health WC |
$2,648.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,869.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,078.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,187.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,928.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$747.84
|
| Rate for Payer: Multiplan Commercial |
$2,492.80
|
| Rate for Payer: Networks By Design Commercial |
$2,025.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,648.60
|
|
|
HC DUPLX EXT VEIN UNILAT
|
Facility
|
OP
|
$1,961.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
908100124
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$1,666.85 |
| Rate for Payer: Adventist Health Commercial |
$392.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,286.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,204.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,200.13
|
| Rate for Payer: Blue Shield of California EPN |
$792.24
|
| Rate for Payer: Cash Price |
$1,078.55
|
| Rate for Payer: Cash Price |
$1,078.55
|
| Rate for Payer: Cash Price |
$1,078.55
|
| Rate for Payer: Cigna of CA HMO |
$1,255.04
|
| Rate for Payer: Cigna of CA PPO |
$1,451.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,666.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,176.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$142.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,307.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$470.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,568.80
|
| Rate for Payer: Networks By Design Commercial |
$1,274.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,666.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,176.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,176.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC DUPLX EXT VEIN UNILAT
|
Facility
|
IP
|
$1,961.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
908100124
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$392.20 |
| Max. Negotiated Rate |
$1,666.85 |
| Rate for Payer: Adventist Health Commercial |
$392.20
|
| Rate for Payer: Cash Price |
$1,078.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$784.40
|
| Rate for Payer: EPIC Health Plan Senior |
$784.40
|
| Rate for Payer: Galaxy Health WC |
$1,666.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,176.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,307.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$747.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,213.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$470.64
|
| Rate for Payer: Multiplan Commercial |
$1,568.80
|
| Rate for Payer: Networks By Design Commercial |
$1,274.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,666.85
|
|
|
HC DUPLX LO EXT ARTERY BILAT
|
Facility
|
IP
|
$2,833.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
908100106
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$566.60 |
| Max. Negotiated Rate |
$2,408.05 |
| Rate for Payer: Adventist Health Commercial |
$566.60
|
| Rate for Payer: Cash Price |
$1,558.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,133.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,133.20
|
| Rate for Payer: Galaxy Health WC |
$2,408.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,699.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,889.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,079.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,753.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$679.92
|
| Rate for Payer: Multiplan Commercial |
$2,266.40
|
| Rate for Payer: Networks By Design Commercial |
$1,841.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,408.05
|
|
