|
HC US GUIDE VISCERAL TISS ABLATN
|
Facility
|
OP
|
$12,885.00
|
|
|
Service Code
|
CPT 76940
|
| Hospital Charge Code |
909001920
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$265.43 |
| Max. Negotiated Rate |
$10,952.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$402.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,952.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,086.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,086.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,676.88
|
| Rate for Payer: Blue Distinction Transplant |
$7,731.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,615.04
|
| Rate for Payer: Blue Shield of California EPN |
$6,043.06
|
| Rate for Payer: Cash Price |
$5,798.25
|
| Rate for Payer: Cash Price |
$5,798.25
|
| Rate for Payer: Cigna of CA HMO |
$8,246.40
|
| Rate for Payer: Cigna of CA PPO |
$9,534.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,952.25
|
| Rate for Payer: Dignity Health Media |
$10,952.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,952.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,154.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,154.00
|
| Rate for Payer: Galaxy Health WC |
$10,952.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,731.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,663.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,594.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,092.40
|
| Rate for Payer: Multiplan Commercial |
$10,308.00
|
| Rate for Payer: Networks By Design Commercial |
$8,375.25
|
| Rate for Payer: Prime Health Services Commercial |
$10,952.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,731.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,731.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,442.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,442.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,442.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,442.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,952.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,952.25
|
| Rate for Payer: Vantage Medical Group Senior |
$10,952.25
|
|
|
HC US GUIDE VISCERAL TISS ABLATN
|
Facility
|
IP
|
$12,885.00
|
|
|
Service Code
|
CPT 76940
|
| Hospital Charge Code |
909001920
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$3,092.40 |
| Max. Negotiated Rate |
$10,952.25 |
| Rate for Payer: Cash Price |
$5,798.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,154.00
|
| Rate for Payer: Galaxy Health WC |
$10,952.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,731.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,594.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,909.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,092.40
|
| Rate for Payer: Multiplan Commercial |
$10,308.00
|
| Rate for Payer: Networks By Design Commercial |
$8,375.25
|
| Rate for Payer: Prime Health Services Commercial |
$10,952.25
|
|
|
HC US INFANT HIP W/MD MANIPUL.
|
Facility
|
OP
|
$2,484.00
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
906601413
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$113.54 |
| Max. Negotiated Rate |
$2,111.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$397.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,479.97
|
| Rate for Payer: Blue Distinction Transplant |
$1,490.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,468.04
|
| Rate for Payer: Blue Shield of California EPN |
$1,165.00
|
| Rate for Payer: Cash Price |
$1,117.80
|
| Rate for Payer: Cash Price |
$1,117.80
|
| Rate for Payer: Cigna of CA HMO |
$1,589.76
|
| Rate for Payer: Cigna of CA PPO |
$1,838.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$2,111.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,490.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,863.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,656.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$596.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$1,987.20
|
| Rate for Payer: Networks By Design Commercial |
$1,614.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,111.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,490.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,490.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC US INFANT HIP W/MD MANIPUL.
|
Facility
|
IP
|
$2,484.00
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
906601413
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$596.16 |
| Max. Negotiated Rate |
$2,111.40 |
| Rate for Payer: Cash Price |
$1,117.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$993.60
|
| Rate for Payer: Galaxy Health WC |
$2,111.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,490.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,656.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$946.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$596.16
|
| Rate for Payer: Multiplan Commercial |
$1,987.20
|
| Rate for Payer: Networks By Design Commercial |
$1,614.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,111.40
|
|
|
HC US INFANT HIP W/O MANIPULATION
|
Facility
|
IP
|
$2,009.00
|
|
|
Service Code
|
CPT 76886
|
| Hospital Charge Code |
906601414
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$482.16 |
| Max. Negotiated Rate |
$1,707.65 |
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$803.60
|
| Rate for Payer: Galaxy Health WC |
$1,707.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,205.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,340.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$765.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.16
|
| Rate for Payer: Multiplan Commercial |
$1,607.20
|
| Rate for Payer: Networks By Design Commercial |
$1,305.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,707.65
|
|
|
HC US INFANT HIP W/O MANIPULATION
|
Facility
|
OP
|
$2,009.00
|
|
|
Service Code
|
CPT 76886
|
| Hospital Charge Code |
906601414
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$113.54 |
| Max. Negotiated Rate |
$1,707.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$395.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,196.96
|
| Rate for Payer: Blue Distinction Transplant |
$1,205.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,187.32
|
| Rate for Payer: Blue Shield of California EPN |
$942.22
|
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: Cigna of CA HMO |
$1,285.76
|
| Rate for Payer: Cigna of CA PPO |
$1,486.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$1,707.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,205.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,506.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,340.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$1,607.20
|
| Rate for Payer: Networks By Design Commercial |
$1,305.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,707.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,205.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,205.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC US SOFT TISS EXT COMP
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
906601419
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$479.76 |
| Max. Negotiated Rate |
$1,699.15 |
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$799.60
|
| Rate for Payer: Galaxy Health WC |
$1,699.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,199.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,333.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$761.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.76
|
| Rate for Payer: Multiplan Commercial |
$1,599.20
|
| Rate for Payer: Networks By Design Commercial |
$1,299.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,699.15
|
|
|
HC US SOFT TISS EXT COMP
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
906601419
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$101.25 |
| Max. Negotiated Rate |
$1,699.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$548.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,191.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,199.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,181.41
|
| Rate for Payer: Blue Shield of California EPN |
$937.53
|
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: Cigna of CA HMO |
$1,279.36
|
| Rate for Payer: Cigna of CA PPO |
$1,479.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,699.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,199.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,499.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,333.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,599.20
|
| Rate for Payer: Networks By Design Commercial |
$1,299.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,699.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,199.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,199.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US SOFT TISS EXT LMTD
|
Facility
|
IP
|
$1,786.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
906601421
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$428.64 |
| Max. Negotiated Rate |
$1,518.10 |
| Rate for Payer: Cash Price |
$803.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$714.40
|
| Rate for Payer: Galaxy Health WC |
$1,518.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,071.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$680.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.64
|
| Rate for Payer: Multiplan Commercial |
$1,428.80
|
| Rate for Payer: Networks By Design Commercial |
$1,160.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,518.10
|
|
|
HC US SOFT TISS EXT LMTD
|
Facility
|
OP
|
$1,786.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
906601421
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$49.88 |
| Max. Negotiated Rate |
$1,518.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$63.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,064.10
|
| Rate for Payer: Blue Distinction Transplant |
$1,071.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,055.53
|
| Rate for Payer: Blue Shield of California EPN |
$837.63
|
| Rate for Payer: Cash Price |
$803.70
|
| Rate for Payer: Cash Price |
$803.70
|
| Rate for Payer: Cigna of CA HMO |
$1,143.04
|
| Rate for Payer: Cigna of CA PPO |
$1,321.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,518.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,071.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,339.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,428.80
|
| Rate for Payer: Networks By Design Commercial |
$1,160.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,518.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,071.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,071.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US SOFT TISSUE MASS,HEAD/NECK
|
Facility
|
OP
|
$1,629.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
906601405
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$113.51 |
| Max. Negotiated Rate |
$1,384.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$578.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$970.56
|
| Rate for Payer: Blue Distinction Transplant |
$977.40
|
| Rate for Payer: Blue Shield of California Commercial |
$962.74
|
| Rate for Payer: Blue Shield of California EPN |
$764.00
|
| Rate for Payer: Cash Price |
$733.05
|
| Rate for Payer: Cash Price |
$733.05
|
| Rate for Payer: Cigna of CA HMO |
$1,042.56
|
| Rate for Payer: Cigna of CA PPO |
$1,205.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,384.65
|
| Rate for Payer: Global Benefits Group Commercial |
$977.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,221.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,086.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,303.20
|
| Rate for Payer: Networks By Design Commercial |
$1,058.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,384.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$977.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$977.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US SOFT TISSUE MASS,HEAD/NECK
|
Facility
|
IP
|
$1,629.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
906601405
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$390.96 |
| Max. Negotiated Rate |
$1,384.65 |
| Rate for Payer: Cash Price |
$733.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.60
|
| Rate for Payer: Galaxy Health WC |
$1,384.65
|
| Rate for Payer: Global Benefits Group Commercial |
$977.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,086.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$620.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.96
|
| Rate for Payer: Multiplan Commercial |
$1,303.20
|
| Rate for Payer: Networks By Design Commercial |
$1,058.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,384.65
|
|
|
HC US TRANSRECTAL
|
Facility
|
IP
|
$2,062.00
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
906601408
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$494.88 |
| Max. Negotiated Rate |
$1,752.70 |
| Rate for Payer: Cash Price |
$927.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$824.80
|
| Rate for Payer: Galaxy Health WC |
$1,752.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,237.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,375.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$785.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$494.88
|
| Rate for Payer: Multiplan Commercial |
$1,649.60
|
| Rate for Payer: Networks By Design Commercial |
$1,340.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,752.70
|
|
|
HC US TRANSRECTAL
|
Facility
|
OP
|
$2,062.00
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
906601408
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$1,752.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$611.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,228.54
|
| Rate for Payer: Blue Distinction Transplant |
$1,237.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,218.64
|
| Rate for Payer: Blue Shield of California EPN |
$967.08
|
| Rate for Payer: Cash Price |
$927.90
|
| Rate for Payer: Cash Price |
$927.90
|
| Rate for Payer: Cigna of CA HMO |
$1,319.68
|
| Rate for Payer: Cigna of CA PPO |
$1,525.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,752.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,237.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,546.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,375.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$494.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,649.60
|
| Rate for Payer: Networks By Design Commercial |
$1,340.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,752.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,237.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,237.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US TRGT DYN MBUBB 1ST LSN
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 76978
|
| Hospital Charge Code |
906676978
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$139.20 |
| Max. Negotiated Rate |
$1,572.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,572.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$345.56
|
| Rate for Payer: Blue Distinction Transplant |
$348.00
|
| Rate for Payer: Blue Shield of California Commercial |
$342.78
|
| Rate for Payer: Blue Shield of California EPN |
$272.02
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$435.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$530.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$516.45
|
| Rate for Payer: United Healthcare All Other HMO |
$516.45
|
| Rate for Payer: United Healthcare HMO Rider |
$516.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$516.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC US TRGT DYN MBUBB 1ST LSN
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 76978
|
| Hospital Charge Code |
906676978
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$139.20 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC US TRGT DYN MBUBB EA ADD LSN
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT 76979
|
| Hospital Charge Code |
906676979
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$246.50 |
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.60
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: Networks By Design Commercial |
$188.50
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
|
|
HC US TRGT DYN MBUBB EA ADD LSN
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT 76979
|
| Hospital Charge Code |
906676979
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$1,148.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,148.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$172.78
|
| Rate for Payer: Blue Distinction Transplant |
$174.00
|
| Rate for Payer: Blue Shield of California Commercial |
$171.39
|
| Rate for Payer: Blue Shield of California EPN |
$136.01
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna of CA HMO |
$185.60
|
| Rate for Payer: Cigna of CA PPO |
$214.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.50
|
| Rate for Payer: Dignity Health Media |
$246.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$217.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.60
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: Networks By Design Commercial |
$188.50
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$145.00
|
| Rate for Payer: United Healthcare All Other HMO |
$145.00
|
| Rate for Payer: United Healthcare HMO Rider |
$145.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.50
|
| Rate for Payer: Vantage Medical Group Senior |
$246.50
|
|
|
HC US ULTRA GUIDE/PSEU.AVFISTULA
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
CPT 76936
|
| Hospital Charge Code |
909001485
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$273.06 |
| Max. Negotiated Rate |
$1,487.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$678.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,042.65
|
| Rate for Payer: Blue Distinction Transplant |
$1,050.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,034.25
|
| Rate for Payer: Blue Shield of California EPN |
$820.75
|
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: Cigna of CA HMO |
$1,120.00
|
| Rate for Payer: Cigna of CA PPO |
$1,295.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$1,487.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,050.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,312.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,167.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$666.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$1,400.00
|
| Rate for Payer: Networks By Design Commercial |
$1,137.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,487.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,050.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,050.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$273.06
|
| Rate for Payer: United Healthcare All Other HMO |
$273.06
|
| Rate for Payer: United Healthcare HMO Rider |
$273.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$273.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC US ULTRA GUIDE/PSEU.AVFISTULA
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
CPT 76936
|
| Hospital Charge Code |
909001485
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,487.50 |
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.00
|
| Rate for Payer: Galaxy Health WC |
$1,487.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,050.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,167.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$666.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.00
|
| Rate for Payer: Multiplan Commercial |
$1,400.00
|
| Rate for Payer: Networks By Design Commercial |
$1,137.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,487.50
|
|
|
HC US VENOUS DUPLX SCAN BILAT
|
Facility
|
OP
|
$719.00
|
|
|
Service Code
|
CPT 93985
|
| Hospital Charge Code |
908100985
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$172.56 |
| Max. Negotiated Rate |
$1,607.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,607.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$428.38
|
| Rate for Payer: Blue Distinction Transplant |
$431.40
|
| Rate for Payer: Blue Shield of California Commercial |
$424.93
|
| Rate for Payer: Blue Shield of California EPN |
$337.21
|
| Rate for Payer: Cash Price |
$323.55
|
| Rate for Payer: Cash Price |
$323.55
|
| Rate for Payer: Cash Price |
$323.55
|
| Rate for Payer: Cigna of CA HMO |
$460.16
|
| Rate for Payer: Cigna of CA PPO |
$532.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$611.15
|
| Rate for Payer: Global Benefits Group Commercial |
$431.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$539.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$479.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$575.20
|
| Rate for Payer: Networks By Design Commercial |
$467.35
|
| Rate for Payer: Prime Health Services Commercial |
$611.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$431.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$431.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC US VENOUS DUPLX SCAN BILAT
|
Facility
|
IP
|
$719.00
|
|
|
Service Code
|
CPT 93985
|
| Hospital Charge Code |
908100985
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$172.56 |
| Max. Negotiated Rate |
$611.15 |
| Rate for Payer: Cash Price |
$323.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$287.60
|
| Rate for Payer: Galaxy Health WC |
$611.15
|
| Rate for Payer: Global Benefits Group Commercial |
$431.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$479.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$273.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.56
|
| Rate for Payer: Multiplan Commercial |
$575.20
|
| Rate for Payer: Networks By Design Commercial |
$467.35
|
| Rate for Payer: Prime Health Services Commercial |
$611.15
|
|
|
HC US VENOUS DUPLX SCAN UNILAT
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
CPT 93986
|
| Hospital Charge Code |
908100986
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$83.04 |
| Max. Negotiated Rate |
$1,507.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$776.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.15
|
| Rate for Payer: Blue Distinction Transplant |
$207.60
|
| Rate for Payer: Blue Shield of California Commercial |
$204.49
|
| Rate for Payer: Blue Shield of California EPN |
$162.27
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna of CA HMO |
$221.44
|
| Rate for Payer: Cigna of CA PPO |
$256.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$294.10
|
| Rate for Payer: Global Benefits Group Commercial |
$207.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$259.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$230.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$271.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$276.80
|
| Rate for Payer: Networks By Design Commercial |
$224.90
|
| Rate for Payer: Prime Health Services Commercial |
$294.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$207.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$207.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US VENOUS DUPLX SCAN UNILAT
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
CPT 93986
|
| Hospital Charge Code |
908100986
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$83.04 |
| Max. Negotiated Rate |
$294.10 |
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.40
|
| Rate for Payer: Galaxy Health WC |
$294.10
|
| Rate for Payer: Global Benefits Group Commercial |
$207.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$230.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.04
|
| Rate for Payer: Multiplan Commercial |
$276.80
|
| Rate for Payer: Networks By Design Commercial |
$224.90
|
| Rate for Payer: Prime Health Services Commercial |
$294.10
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
|
IP
|
$1,608.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$385.92 |
| Max. Negotiated Rate |
$1,366.80 |
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$643.20
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$612.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.92
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
|
