|
HC US GUIDE AMNIOCENTESIS
|
Facility
IP
|
$1,433.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
910400117
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$343.92 |
| Max. Negotiated Rate |
$1,218.05 |
| Rate for Payer: Cash Price |
$644.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$573.20
|
| Rate for Payer: Galaxy Health WC |
$1,218.05
|
| Rate for Payer: Global Benefits Group Commercial |
$859.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$955.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$545.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.92
|
| Rate for Payer: Multiplan Commercial |
$1,146.40
|
| Rate for Payer: Networks By Design Commercial |
$931.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,218.05
|
|
|
HC US GUIDE AMNIOCENTESIS
|
Facility
OP
|
$1,433.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
910400117
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.44 |
| Max. Negotiated Rate |
$1,218.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$122.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,218.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$788.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$788.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$853.78
|
| Rate for Payer: BCBS Transplant Transplant |
$859.80
|
| Rate for Payer: Blue Shield of California Commercial |
$846.90
|
| Rate for Payer: Blue Shield of California EPN |
$672.08
|
| Rate for Payer: Cash Price |
$644.85
|
| Rate for Payer: Cash Price |
$644.85
|
| Rate for Payer: Cigna of CA HMO |
$917.12
|
| Rate for Payer: Cigna of CA PPO |
$1,060.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,218.05
|
| Rate for Payer: Dignity Health Media |
$1,218.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,218.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$573.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$573.20
|
| Rate for Payer: Galaxy Health WC |
$1,218.05
|
| Rate for Payer: Global Benefits Group Commercial |
$859.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,074.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$955.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.92
|
| Rate for Payer: Multiplan Commercial |
$1,146.40
|
| Rate for Payer: Networks By Design Commercial |
$931.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,218.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$859.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$859.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$859.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$716.50
|
| Rate for Payer: United Healthcare All Other HMO |
$716.50
|
| Rate for Payer: United Healthcare HMO Rider |
$716.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$716.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,218.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,218.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,218.05
|
|
|
HC US GUIDE AMNIOCENTESIS TWIN
|
Facility
OP
|
$1,433.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
910400118
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.44 |
| Max. Negotiated Rate |
$1,218.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$122.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,218.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$788.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$788.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$853.78
|
| Rate for Payer: BCBS Transplant Transplant |
$859.80
|
| Rate for Payer: Blue Shield of California Commercial |
$846.90
|
| Rate for Payer: Blue Shield of California EPN |
$672.08
|
| Rate for Payer: Cash Price |
$644.85
|
| Rate for Payer: Cash Price |
$644.85
|
| Rate for Payer: Cigna of CA HMO |
$917.12
|
| Rate for Payer: Cigna of CA PPO |
$1,060.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,218.05
|
| Rate for Payer: Dignity Health Media |
$1,218.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,218.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$573.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$573.20
|
| Rate for Payer: Galaxy Health WC |
$1,218.05
|
| Rate for Payer: Global Benefits Group Commercial |
$859.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,074.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$955.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.92
|
| Rate for Payer: Multiplan Commercial |
$1,146.40
|
| Rate for Payer: Networks By Design Commercial |
$931.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,218.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$859.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$859.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$859.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$716.50
|
| Rate for Payer: United Healthcare All Other HMO |
$716.50
|
| Rate for Payer: United Healthcare HMO Rider |
$716.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$716.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,218.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,218.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,218.05
|
|
|
HC US GUIDE AMNIOCENTESIS TWIN
|
Facility
IP
|
$1,433.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
910400118
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$343.92 |
| Max. Negotiated Rate |
$1,218.05 |
| Rate for Payer: Cash Price |
$644.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$573.20
|
| Rate for Payer: Galaxy Health WC |
$1,218.05
|
| Rate for Payer: Global Benefits Group Commercial |
$859.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$955.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$545.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.92
|
| Rate for Payer: Multiplan Commercial |
$1,146.40
|
| Rate for Payer: Networks By Design Commercial |
$931.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,218.05
|
|
|
HC US GUIDE FETAL TRANSFUSION
|
Facility
IP
|
$1,011.00
|
|
|
Service Code
|
CPT 76941
|
| Hospital Charge Code |
906601995
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$242.64 |
| Max. Negotiated Rate |
$859.35 |
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.40
|
| Rate for Payer: Galaxy Health WC |
$859.35
|
| Rate for Payer: Global Benefits Group Commercial |
$606.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$674.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.64
|
| Rate for Payer: Multiplan Commercial |
$808.80
|
| Rate for Payer: Networks By Design Commercial |
$657.15
|
| Rate for Payer: Prime Health Services Commercial |
$859.35
|
|
|
HC US GUIDE FETAL TRANSFUSION
|
Facility
OP
|
$1,011.00
|
|
|
Service Code
|
CPT 76941
|
| Hospital Charge Code |
906601995
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$214.62 |
| Max. Negotiated Rate |
$859.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$364.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$859.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$556.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$556.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$602.35
|
| Rate for Payer: BCBS Transplant Transplant |
$606.60
|
| Rate for Payer: Blue Shield of California Commercial |
$597.50
|
| Rate for Payer: Blue Shield of California EPN |
$474.16
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Cigna of CA HMO |
$647.04
|
| Rate for Payer: Cigna of CA PPO |
$748.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$859.35
|
| Rate for Payer: Dignity Health Media |
$859.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$859.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$404.40
|
| Rate for Payer: Galaxy Health WC |
$859.35
|
| Rate for Payer: Global Benefits Group Commercial |
$606.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$758.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$674.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.64
|
| Rate for Payer: Multiplan Commercial |
$808.80
|
| Rate for Payer: Networks By Design Commercial |
$657.15
|
| Rate for Payer: Prime Health Services Commercial |
$859.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$606.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$606.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$606.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$505.50
|
| Rate for Payer: United Healthcare All Other HMO |
$505.50
|
| Rate for Payer: United Healthcare HMO Rider |
$505.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$505.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$859.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$859.35
|
| Rate for Payer: Vantage Medical Group Senior |
$859.35
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
OP
|
$2,322.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
901200046
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$96.18 |
| Max. Negotiated Rate |
$1,973.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,046.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,973.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,277.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,277.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,383.45
|
| Rate for Payer: BCBS Transplant Transplant |
$1,393.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,372.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,089.02
|
| Rate for Payer: Cash Price |
$1,044.90
|
| Rate for Payer: Cash Price |
$1,044.90
|
| Rate for Payer: Cigna of CA HMO |
$1,486.08
|
| Rate for Payer: Cigna of CA PPO |
$1,718.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,973.70
|
| Rate for Payer: Dignity Health Media |
$1,973.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,973.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$928.80
|
| Rate for Payer: Galaxy Health WC |
$1,973.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,393.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,741.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,548.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$557.28
|
| Rate for Payer: Multiplan Commercial |
$1,857.60
|
| Rate for Payer: Networks By Design Commercial |
$1,509.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,973.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,393.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,393.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,393.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,161.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,161.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,161.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,973.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,973.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.70
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
OP
|
$2,322.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
900501576
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$96.18 |
| Max. Negotiated Rate |
$1,973.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,046.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,973.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,277.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,277.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,383.45
|
| Rate for Payer: BCBS Transplant Transplant |
$1,393.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,372.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,089.02
|
| Rate for Payer: Cash Price |
$1,044.90
|
| Rate for Payer: Cash Price |
$1,044.90
|
| Rate for Payer: Cigna of CA HMO |
$1,486.08
|
| Rate for Payer: Cigna of CA PPO |
$1,718.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,973.70
|
| Rate for Payer: Dignity Health Media |
$1,973.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,973.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$928.80
|
| Rate for Payer: Galaxy Health WC |
$1,973.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,393.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,741.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,548.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$557.28
|
| Rate for Payer: Multiplan Commercial |
$1,857.60
|
| Rate for Payer: Networks By Design Commercial |
$1,509.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,973.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,393.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,393.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,393.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,161.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,161.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,161.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,973.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,973.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.70
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
IP
|
$2,322.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
906601444
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$557.28 |
| Max. Negotiated Rate |
$1,973.70 |
| Rate for Payer: Cash Price |
$1,044.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.80
|
| Rate for Payer: Galaxy Health WC |
$1,973.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,393.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,548.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$884.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$557.28
|
| Rate for Payer: Multiplan Commercial |
$1,857.60
|
| Rate for Payer: Networks By Design Commercial |
$1,509.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,973.70
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
OP
|
$2,322.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
906601444
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$96.18 |
| Max. Negotiated Rate |
$1,973.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,046.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,973.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,277.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,277.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,383.45
|
| Rate for Payer: BCBS Transplant Transplant |
$1,393.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,372.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,089.02
|
| Rate for Payer: Cash Price |
$1,044.90
|
| Rate for Payer: Cash Price |
$1,044.90
|
| Rate for Payer: Cigna of CA HMO |
$1,486.08
|
| Rate for Payer: Cigna of CA PPO |
$1,718.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,973.70
|
| Rate for Payer: Dignity Health Media |
$1,973.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,973.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$928.80
|
| Rate for Payer: Galaxy Health WC |
$1,973.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,393.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,741.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,548.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$557.28
|
| Rate for Payer: Multiplan Commercial |
$1,857.60
|
| Rate for Payer: Networks By Design Commercial |
$1,509.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,973.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,393.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,393.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,393.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,161.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,161.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,161.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,973.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,973.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.70
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
IP
|
$2,322.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
901200046
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$557.28 |
| Max. Negotiated Rate |
$1,973.70 |
| Rate for Payer: Cash Price |
$1,044.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.80
|
| Rate for Payer: Galaxy Health WC |
$1,973.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,393.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,548.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$884.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$557.28
|
| Rate for Payer: Multiplan Commercial |
$1,857.60
|
| Rate for Payer: Networks By Design Commercial |
$1,509.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,973.70
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
IP
|
$2,322.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
900501576
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$557.28 |
| Max. Negotiated Rate |
$1,973.70 |
| Rate for Payer: Cash Price |
$1,044.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.80
|
| Rate for Payer: Galaxy Health WC |
$1,973.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,393.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,548.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$884.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$557.28
|
| Rate for Payer: Multiplan Commercial |
$1,857.60
|
| Rate for Payer: Networks By Design Commercial |
$1,509.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,973.70
|
|
|
HC US GUIDE VASCULAR ACCESS
|
Facility
OP
|
$2,143.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
909001488
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.48 |
| Max. Negotiated Rate |
$1,821.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,821.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,178.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,178.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,276.80
|
| Rate for Payer: BCBS Transplant Transplant |
$1,285.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,266.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,005.07
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Cigna of CA HMO |
$1,371.52
|
| Rate for Payer: Cigna of CA PPO |
$1,585.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,821.55
|
| Rate for Payer: Dignity Health Media |
$1,821.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,821.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$857.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$857.20
|
| Rate for Payer: Galaxy Health WC |
$1,821.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,285.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,607.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,429.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$514.32
|
| Rate for Payer: Multiplan Commercial |
$1,714.40
|
| Rate for Payer: Networks By Design Commercial |
$1,392.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,821.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,285.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,285.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,285.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,071.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,071.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,071.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,071.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,821.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,821.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,821.55
|
|
|
HC US GUIDE VASCULAR ACCESS
|
Facility
IP
|
$2,143.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
909001488
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$514.32 |
| Max. Negotiated Rate |
$1,821.55 |
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$857.20
|
| Rate for Payer: Galaxy Health WC |
$1,821.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,285.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,429.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$816.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$514.32
|
| Rate for Payer: Multiplan Commercial |
$1,714.40
|
| Rate for Payer: Networks By Design Commercial |
$1,392.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,821.55
|
|
|
HC US GUIDE VASCULAR ACCESS
|
Facility
OP
|
$2,143.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
901200114
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.48 |
| Max. Negotiated Rate |
$1,821.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,821.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,178.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,178.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,276.80
|
| Rate for Payer: BCBS Transplant Transplant |
$1,285.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,266.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,005.07
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Cigna of CA HMO |
$1,371.52
|
| Rate for Payer: Cigna of CA PPO |
$1,585.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,821.55
|
| Rate for Payer: Dignity Health Media |
$1,821.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,821.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$857.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$857.20
|
| Rate for Payer: Galaxy Health WC |
$1,821.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,285.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,607.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,429.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$514.32
|
| Rate for Payer: Multiplan Commercial |
$1,714.40
|
| Rate for Payer: Networks By Design Commercial |
$1,392.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,821.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,285.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,285.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,285.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,071.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,071.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,071.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,071.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,821.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,821.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,821.55
|
|
|
HC US GUIDE VASCULAR ACCESS
|
Facility
IP
|
$2,143.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
901200114
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$514.32 |
| Max. Negotiated Rate |
$1,821.55 |
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$857.20
|
| Rate for Payer: Galaxy Health WC |
$1,821.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,285.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,429.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$816.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$514.32
|
| Rate for Payer: Multiplan Commercial |
$1,714.40
|
| Rate for Payer: Networks By Design Commercial |
$1,392.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,821.55
|
|
|
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 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: AlphaCare Medical Group Commercial/Exchange |
$10,952.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,086.75
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$7,731.00
|
| 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 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: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,479.97
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$183.93
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$183.93
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$1,490.40
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,196.96
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$183.93
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$183.93
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$1,205.40
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,191.00
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$222.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$222.52
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$1,199.40
|
| 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
|
|
