|
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 |
$70.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$99.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.04
|
| 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 DTP-HIB COMBO ADMIN
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
902890231
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC DTP-HIB COMBO ADMIN
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
902890231
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$9.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC DT TOXOIDS PEDS ADMIN
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
902890233
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC DT TOXOIDS PEDS ADMIN
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
902890233
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$9.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
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 |
$17.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$24.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.01
|
| 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 |
$25.03
|
| 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 |
$33.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$24.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.01
|
| 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
|
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 |
$26.87
|
| Rate for Payer: Blue Shield of California Commercial |
$40.76
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$33.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.27
|
| 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 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 |
$466.91 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$466.91
|
| 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 |
$32.93
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cash Price |
$23.85
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$33.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$131.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.27
|
| 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 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 |
$1,081.67 |
| Rate for Payer: Adventist Health Commercial |
$192.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$498.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,081.67
|
| Rate for Payer: Blue Shield of California Commercial |
$405.84
|
| Rate for Payer: Blue Shield of California Commercial |
$615.03
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Cash Price |
$433.80
|
| 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 |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$674.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$819.40
|
| Rate for Payer: Global Benefits Group Commercial |
$578.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$107.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$612.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$121.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$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 |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC 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 |
$433.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$674.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$612.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$568.76
|
| 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
|
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 |
$395.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$615.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$558.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$518.61
|
| 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 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 |
$777.30 |
| Rate for Payer: Adventist Health Commercial |
$175.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$361.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$777.30
|
| Rate for Payer: Blue Shield of California Commercial |
$370.06
|
| Rate for Payer: Blue Shield of California Commercial |
$560.80
|
| Rate for Payer: Cash Price |
$395.55
|
| Rate for Payer: Cash Price |
$395.55
|
| 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 |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$615.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$747.15
|
| Rate for Payer: Global Benefits Group Commercial |
$527.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$82.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$558.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$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 |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC 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 |
$940.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,463.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,327.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,233.10
|
| 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 |
$134.46 |
| Max. Negotiated Rate |
$1,776.50 |
| Rate for Payer: Adventist Health Commercial |
$418.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,127.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,341.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1,333.42
|
| Rate for Payer: Blue Shield of California Commercial |
$879.89
|
| Rate for Payer: Cash Price |
$940.50
|
| Rate for Payer: Cash Price |
$940.50
|
| Rate for Payer: Cash Price |
$940.50
|
| 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 |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,463.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,776.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,254.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$259.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,327.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$293.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,672.00
|
| 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 |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC 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 |
$1,086.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,689.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,532.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,424.26
|
| 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 |
$1,129.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,549.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,016.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1,540.13
|
| Rate for Payer: Cash Price |
$1,086.30
|
| Rate for Payer: Cash Price |
$1,086.30
|
| Rate for Payer: Cash Price |
$1,086.30
|
| 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 |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,689.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| 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/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$275.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,532.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$311.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$579.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$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 |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC 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 |
$1,402.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,181.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,978.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,838.44
|
| 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 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 |
$1,129.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,999.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,311.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,988.01
|
| Rate for Payer: Cash Price |
$1,402.20
|
| Rate for Payer: Cash Price |
$1,402.20
|
| Rate for Payer: Cash Price |
$1,402.20
|
| 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 |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,181.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| 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/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$282.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,978.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$319.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$747.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$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 |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC DUPLX EXT VEIN UNILAT
|
Facility
|
OP
|
$1,961.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
908100124
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,666.85 |
| Rate for Payer: Adventist Health Commercial |
$392.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$711.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,258.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1,251.12
|
| Rate for Payer: Blue Shield of California Commercial |
$825.58
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Cash Price |
$882.45
|
| 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 |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,372.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,666.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,176.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$142.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,245.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$470.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,568.80
|
| 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 |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC 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 |
$882.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,372.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,245.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,156.99
|
| 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 |
$1,274.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,983.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,798.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,671.47
|
| 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
|
|
|
HC DUPLX LO EXT ARTERY BILAT
|
Facility
|
OP
|
$2,833.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
908100106
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$162.74 |
| Max. Negotiated Rate |
$2,408.05 |
| Rate for Payer: Adventist Health Commercial |
$566.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,128.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,817.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1,192.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,807.45
|
| Rate for Payer: Cash Price |
$1,274.85
|
| Rate for Payer: Cash Price |
$1,274.85
|
| Rate for Payer: Cash Price |
$1,274.85
|
| Rate for Payer: Cigna of CA HMO |
$1,813.12
|
| Rate for Payer: Cigna of CA PPO |
$2,096.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,983.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$2,408.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,699.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$162.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,798.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$184.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$679.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$2,266.40
|
| Rate for Payer: Networks By Design Commercial |
$1,841.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,408.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,699.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,699.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC DUPLX LO EXT ARTERY UNI
|
Facility
|
OP
|
$2,034.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
908100123
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,728.90 |
| Rate for Payer: Adventist Health Commercial |
$406.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$711.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,305.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,297.69
|
| Rate for Payer: Blue Shield of California Commercial |
$856.31
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Cigna of CA HMO |
$1,301.76
|
| Rate for Payer: Cigna of CA PPO |
$1,505.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,423.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,728.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,220.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$142.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,291.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$161.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,627.20
|
| Rate for Payer: Networks By Design Commercial |
$1,322.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,728.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,220.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,220.40
|
| 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 |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC DUPLX LO EXT ARTERY UNI
|
Facility
|
IP
|
$2,034.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
908100123
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$406.80 |
| Max. Negotiated Rate |
$1,728.90 |
| Rate for Payer: Adventist Health Commercial |
$406.80
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,423.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$813.60
|
| Rate for Payer: EPIC Health Plan Senior |
$813.60
|
| Rate for Payer: Galaxy Health WC |
$1,728.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,220.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,291.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,200.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.16
|
| Rate for Payer: Multiplan Commercial |
$1,627.20
|
| Rate for Payer: Networks By Design Commercial |
$1,322.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,728.90
|
|
