|
HC FETAL NON-STRESS TEST SINGLE FETUS
|
Facility
|
IP
|
$1,360.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
910400086
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$272.00 |
| Max. Negotiated Rate |
$1,156.00 |
| Rate for Payer: Adventist Health Commercial |
$272.00
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$544.00
|
| Rate for Payer: EPIC Health Plan Senior |
$544.00
|
| Rate for Payer: Galaxy Health WC |
$1,156.00
|
| Rate for Payer: Global Benefits Group Commercial |
$816.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$907.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$518.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$841.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.40
|
| Rate for Payer: Multiplan Commercial |
$1,088.00
|
| Rate for Payer: Networks By Design Commercial |
$884.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,156.00
|
|
|
HC FETAL SHUNT PLACEMENT
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 59076
|
| Hospital Charge Code |
910400092
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$101.80 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Cigna of CA HMO |
$325.76
|
| Rate for Payer: Cigna of CA PPO |
$376.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$742.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$839.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: Networks By Design Commercial |
$330.85
|
| Rate for Payer: Prime Health Services Commercial |
$432.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$305.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$305.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC FETAL SHUNT PLACEMENT
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 59076
|
| Hospital Charge Code |
910400092
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$101.80 |
| Max. Negotiated Rate |
$432.65 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.60
|
| Rate for Payer: EPIC Health Plan Senior |
$203.60
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.16
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: Networks By Design Commercial |
$330.85
|
| Rate for Payer: Prime Health Services Commercial |
$432.65
|
|
|
HC FETAL SHUNT PLACMNT ADDL FETUS
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 59076
|
| Hospital Charge Code |
910400093
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.80 |
| Max. Negotiated Rate |
$432.65 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.60
|
| Rate for Payer: EPIC Health Plan Senior |
$203.60
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.16
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: Networks By Design Commercial |
$330.85
|
| Rate for Payer: Prime Health Services Commercial |
$432.65
|
|
|
HC FETAL SHUNT PLACMNT ADDL FETUS
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 59076
|
| Hospital Charge Code |
910400093
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.80 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Cigna of CA HMO |
$325.76
|
| Rate for Payer: Cigna of CA PPO |
$376.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$742.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$839.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: Networks By Design Commercial |
$330.85
|
| Rate for Payer: Prime Health Services Commercial |
$432.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$305.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$305.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$254.50
|
| Rate for Payer: United Healthcare All Other HMO |
$254.50
|
| Rate for Payer: United Healthcare HMO Rider |
$254.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$254.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC FFP PED PAK ALIQUOT
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904530
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$590.75 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.00
|
| Rate for Payer: EPIC Health Plan Senior |
$278.00
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$430.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.80
|
| Rate for Payer: Multiplan Commercial |
$556.00
|
| Rate for Payer: Networks By Design Commercial |
$451.75
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
|
|
HC FFP PED PAK ALIQUOT
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904530
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$455.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$426.80
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: Cigna of CA HMO |
$444.80
|
| Rate for Payer: Cigna of CA PPO |
$514.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.23
|
| Rate for Payer: EPIC Health Plan Senior |
$180.17
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$295.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$250.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$180.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$241.43
|
| Rate for Payer: Multiplan Commercial |
$556.00
|
| Rate for Payer: Networks By Design Commercial |
$451.75
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$417.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$417.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$180.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Vantage Medical Group Senior |
$180.17
|
|
|
HC FFP SPLIT UNIT GT 150 ML
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904533
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$66.20 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$217.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.27
|
| Rate for Payer: Cash Price |
$182.05
|
| Rate for Payer: Cash Price |
$182.05
|
| Rate for Payer: Cash Price |
$182.05
|
| Rate for Payer: Cigna of CA HMO |
$211.84
|
| Rate for Payer: Cigna of CA PPO |
$244.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.23
|
| Rate for Payer: EPIC Health Plan Senior |
$180.17
|
| Rate for Payer: Galaxy Health WC |
$281.35
|
| Rate for Payer: Global Benefits Group Commercial |
$198.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$295.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$250.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$180.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$241.43
|
| Rate for Payer: Multiplan Commercial |
$264.80
|
| Rate for Payer: Networks By Design Commercial |
$215.15
|
| Rate for Payer: Prime Health Services Commercial |
$281.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$198.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$180.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Vantage Medical Group Senior |
$180.17
|
|
|
HC FFP SPLIT UNIT GT 150 ML
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904533
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$66.20 |
| Max. Negotiated Rate |
$281.35 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Cash Price |
$182.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.40
|
| Rate for Payer: EPIC Health Plan Senior |
$132.40
|
| Rate for Payer: Galaxy Health WC |
$281.35
|
| Rate for Payer: Global Benefits Group Commercial |
$198.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.44
|
| Rate for Payer: Multiplan Commercial |
$264.80
|
| Rate for Payer: Networks By Design Commercial |
$215.15
|
| Rate for Payer: Prime Health Services Commercial |
$281.35
|
|
|
HC FIBRIN DEGRAD SPLIT PRODUCTS
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
CPT 85362
|
| Hospital Charge Code |
900910069
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$222.70 |
| Rate for Payer: Adventist Health Commercial |
$52.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$171.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.96
|
| Rate for Payer: Blue Shield of California Commercial |
$175.28
|
| Rate for Payer: Blue Shield of California EPN |
$115.80
|
| Rate for Payer: Cash Price |
$144.10
|
| Rate for Payer: Cash Price |
$144.10
|
| Rate for Payer: Cigna of CA HMO |
$167.68
|
| Rate for Payer: Cigna of CA PPO |
$193.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.30
|
| Rate for Payer: EPIC Health Plan Senior |
$6.89
|
| Rate for Payer: Galaxy Health WC |
$222.70
|
| Rate for Payer: Global Benefits Group Commercial |
$157.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$174.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.23
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: Networks By Design Commercial |
$170.30
|
| Rate for Payer: Prime Health Services Commercial |
$222.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$157.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$157.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.58
|
| Rate for Payer: United Healthcare All Other HMO |
$5.58
|
| Rate for Payer: United Healthcare HMO Rider |
$5.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Vantage Medical Group Senior |
$6.89
|
|
|
HC FIBRIN DEGRAD SPLIT PRODUCTS
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
CPT 85362
|
| Hospital Charge Code |
900910069
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$222.70 |
| Rate for Payer: Adventist Health Commercial |
$52.40
|
| Rate for Payer: Cash Price |
$144.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.80
|
| Rate for Payer: EPIC Health Plan Senior |
$104.80
|
| Rate for Payer: Galaxy Health WC |
$222.70
|
| Rate for Payer: Global Benefits Group Commercial |
$157.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$174.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.88
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: Networks By Design Commercial |
$170.30
|
| Rate for Payer: Prime Health Services Commercial |
$222.70
|
|
|
HC FIBRINOGEN ASSAY
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
900910013
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$254.15 |
| Rate for Payer: Adventist Health Commercial |
$59.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$196.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.39
|
| Rate for Payer: Blue Shield of California Commercial |
$200.03
|
| Rate for Payer: Blue Shield of California EPN |
$132.16
|
| Rate for Payer: Cash Price |
$164.45
|
| Rate for Payer: Cash Price |
$164.45
|
| Rate for Payer: Cigna of CA HMO |
$191.36
|
| Rate for Payer: Cigna of CA PPO |
$221.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.12
|
| Rate for Payer: EPIC Health Plan Senior |
$9.72
|
| Rate for Payer: Galaxy Health WC |
$254.15
|
| Rate for Payer: Global Benefits Group Commercial |
$179.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$199.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.02
|
| Rate for Payer: Multiplan Commercial |
$239.20
|
| Rate for Payer: Networks By Design Commercial |
$194.35
|
| Rate for Payer: Prime Health Services Commercial |
$254.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$179.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$179.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.88
|
| Rate for Payer: United Healthcare All Other HMO |
$7.88
|
| Rate for Payer: United Healthcare HMO Rider |
$7.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.69
|
| Rate for Payer: Vantage Medical Group Senior |
$9.72
|
|
|
HC FIBRINOGEN ASSAY
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
900910013
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$254.15 |
| Rate for Payer: Adventist Health Commercial |
$59.80
|
| Rate for Payer: Cash Price |
$164.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.60
|
| Rate for Payer: EPIC Health Plan Senior |
$119.60
|
| Rate for Payer: Galaxy Health WC |
$254.15
|
| Rate for Payer: Global Benefits Group Commercial |
$179.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$199.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$239.20
|
| Rate for Payer: Networks By Design Commercial |
$194.35
|
| Rate for Payer: Prime Health Services Commercial |
$254.15
|
|
|
HC FINE NDLE ASPIR W/GUIDANCE
|
Facility
|
IP
|
$2,540.00
|
|
|
Service Code
|
CPT 62267
|
| Hospital Charge Code |
909000240
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$508.00 |
| Max. Negotiated Rate |
$2,159.00 |
| Rate for Payer: Adventist Health Commercial |
$508.00
|
| Rate for Payer: Cash Price |
$1,397.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,016.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,016.00
|
| Rate for Payer: Galaxy Health WC |
$2,159.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,524.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,694.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$967.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,572.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$609.60
|
| Rate for Payer: Multiplan Commercial |
$2,032.00
|
| Rate for Payer: Networks By Design Commercial |
$1,651.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,159.00
|
|
|
HC FINE NDLE ASPIR W/GUIDANCE
|
Facility
|
OP
|
$2,540.00
|
|
|
Service Code
|
CPT 62267
|
| Hospital Charge Code |
909000240
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$195.77 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$508.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,397.00
|
| Rate for Payer: Cash Price |
$1,397.00
|
| Rate for Payer: Cash Price |
$1,397.00
|
| Rate for Payer: Cigna of CA HMO |
$1,625.60
|
| Rate for Payer: Cigna of CA PPO |
$1,879.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$2,159.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,524.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$195.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,694.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$609.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$2,032.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,651.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,159.00
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,524.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC FINE NEEDLE ASPIRATION
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800007
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$151.00 |
| Max. Negotiated Rate |
$641.75 |
| Rate for Payer: Adventist Health Commercial |
$151.00
|
| Rate for Payer: Cash Price |
$415.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.00
|
| Rate for Payer: EPIC Health Plan Senior |
$302.00
|
| Rate for Payer: Galaxy Health WC |
$641.75
|
| Rate for Payer: Global Benefits Group Commercial |
$453.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$503.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$467.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.20
|
| Rate for Payer: Multiplan Commercial |
$604.00
|
| Rate for Payer: Networks By Design Commercial |
$490.75
|
| Rate for Payer: Prime Health Services Commercial |
$641.75
|
|
|
HC FINE NEEDLE ASPIRATION
|
Facility
|
OP
|
$755.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800007
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$641.75 |
| Rate for Payer: Adventist Health Commercial |
$151.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$495.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.99
|
| Rate for Payer: Blue Shield of California Commercial |
$505.10
|
| Rate for Payer: Blue Shield of California EPN |
$333.71
|
| Rate for Payer: Cash Price |
$415.25
|
| Rate for Payer: Cash Price |
$415.25
|
| Rate for Payer: Cigna of CA HMO |
$483.20
|
| Rate for Payer: Cigna of CA PPO |
$558.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.65
|
| Rate for Payer: EPIC Health Plan Senior |
$67.89
|
| Rate for Payer: Galaxy Health WC |
$641.75
|
| Rate for Payer: Global Benefits Group Commercial |
$453.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$87.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$503.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.97
|
| Rate for Payer: Multiplan Commercial |
$604.00
|
| Rate for Payer: Networks By Design Commercial |
$490.75
|
| Rate for Payer: Prime Health Services Commercial |
$641.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$453.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$453.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
|
HC FINE NEEDLE ASPIRATION PG
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800290
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$111.34 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.99
|
| Rate for Payer: Blue Shield of California Commercial |
$81.62
|
| Rate for Payer: Blue Shield of California EPN |
$53.92
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cigna of CA HMO |
$78.08
|
| Rate for Payer: Cigna of CA PPO |
$90.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.65
|
| Rate for Payer: EPIC Health Plan Senior |
$67.89
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$87.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.97
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
|
HC FINE NEEDLE ASPIRATION PG
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800290
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
|
|
HC FINE NEEDLE ASP W IMAGE
|
Facility
|
OP
|
$1,748.00
|
|
|
Service Code
|
CPT 10022
|
| Hospital Charge Code |
903800168
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$349.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$349.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,485.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$961.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,311.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,073.45
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$961.40
|
| Rate for Payer: Cash Price |
$961.40
|
| Rate for Payer: Cigna of CA HMO |
$1,118.72
|
| Rate for Payer: Cigna of CA PPO |
$1,293.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,485.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,485.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,485.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$699.20
|
| Rate for Payer: EPIC Health Plan Senior |
$699.20
|
| Rate for Payer: Galaxy Health WC |
$1,485.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,048.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,165.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$665.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,082.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$419.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,223.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,223.60
|
| Rate for Payer: Multiplan Commercial |
$1,398.40
|
| Rate for Payer: Networks By Design Commercial |
$1,136.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,485.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,048.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$874.00
|
| Rate for Payer: United Healthcare All Other HMO |
$874.00
|
| Rate for Payer: United Healthcare HMO Rider |
$874.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$874.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,485.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,485.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,485.80
|
|
|
HC FINE NEEDLE ASP W IMAGE
|
Facility
|
OP
|
$1,748.00
|
|
|
Service Code
|
CPT 10022
|
| Hospital Charge Code |
903800168
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$349.60 |
| Max. Negotiated Rate |
$1,485.80 |
| Rate for Payer: Adventist Health Commercial |
$349.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,146.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,485.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$961.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,311.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,073.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1,169.41
|
| Rate for Payer: Blue Shield of California EPN |
$772.62
|
| Rate for Payer: Cash Price |
$961.40
|
| Rate for Payer: Cigna of CA HMO |
$1,118.72
|
| Rate for Payer: Cigna of CA PPO |
$1,293.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,485.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,485.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,485.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$699.20
|
| Rate for Payer: EPIC Health Plan Senior |
$699.20
|
| Rate for Payer: Galaxy Health WC |
$1,485.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,048.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,165.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$665.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,082.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$419.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,223.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,223.60
|
| Rate for Payer: Multiplan Commercial |
$1,398.40
|
| Rate for Payer: Networks By Design Commercial |
$1,136.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,485.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,048.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,048.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$874.00
|
| Rate for Payer: United Healthcare All Other HMO |
$874.00
|
| Rate for Payer: United Healthcare HMO Rider |
$874.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$874.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,485.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,485.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,485.80
|
|
|
HC FINE NEEDLE ASP W IMAGE
|
Facility
|
IP
|
$1,748.00
|
|
|
Service Code
|
CPT 10022
|
| Hospital Charge Code |
903800168
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$349.60 |
| Max. Negotiated Rate |
$1,485.80 |
| Rate for Payer: Adventist Health Commercial |
$349.60
|
| Rate for Payer: Cash Price |
$961.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$699.20
|
| Rate for Payer: EPIC Health Plan Senior |
$699.20
|
| Rate for Payer: Galaxy Health WC |
$1,485.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,048.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,165.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$665.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,082.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$419.52
|
| Rate for Payer: Multiplan Commercial |
$1,398.40
|
| Rate for Payer: Networks By Design Commercial |
$1,136.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,485.80
|
|
|
HC FINE NEEDLE ASP W IMAGE
|
Facility
|
IP
|
$1,748.00
|
|
|
Service Code
|
CPT 10022
|
| Hospital Charge Code |
903800168
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$349.60 |
| Max. Negotiated Rate |
$1,485.80 |
| Rate for Payer: Adventist Health Commercial |
$349.60
|
| Rate for Payer: Cash Price |
$961.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$699.20
|
| Rate for Payer: EPIC Health Plan Senior |
$699.20
|
| Rate for Payer: Galaxy Health WC |
$1,485.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,048.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,165.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$665.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,082.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$419.52
|
| Rate for Payer: Multiplan Commercial |
$1,398.40
|
| Rate for Payer: Networks By Design Commercial |
$1,136.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,485.80
|
|
|
HC FINE NEEDLE ASP WO IMAGE
|
Facility
|
OP
|
$1,229.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
903800167
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$123.21 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$1,044.65
|
| Rate for Payer: Adventist Health Commercial |
$245.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$822.20
|
| Rate for Payer: Blue Shield of California EPN |
$543.22
|
| Rate for Payer: Cash Price |
$675.95
|
| Rate for Payer: Cash Price |
$675.95
|
| Rate for Payer: Cash Price |
$675.95
|
| Rate for Payer: Cigna of CA HMO |
$786.56
|
| Rate for Payer: Cigna of CA PPO |
$909.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: Global Benefits Group Commercial |
$737.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$819.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$983.20
|
| Rate for Payer: Networks By Design Commercial |
$798.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,044.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$737.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$737.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$614.50
|
| Rate for Payer: United Healthcare All Other HMO |
$614.50
|
| Rate for Payer: United Healthcare HMO Rider |
$614.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$614.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC FINE NEEDLE ASP WO IMAGE
|
Facility
|
IP
|
$1,229.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
903800167
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$245.80 |
| Max. Negotiated Rate |
$1,044.65 |
| Rate for Payer: Adventist Health Commercial |
$245.80
|
| Rate for Payer: Cash Price |
$675.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$491.60
|
| Rate for Payer: EPIC Health Plan Senior |
$491.60
|
| Rate for Payer: Galaxy Health WC |
$1,044.65
|
| Rate for Payer: Global Benefits Group Commercial |
$737.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$819.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$468.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$760.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.96
|
| Rate for Payer: Multiplan Commercial |
$983.20
|
| Rate for Payer: Networks By Design Commercial |
$798.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,044.65
|
|
