|
HC LUM SPINE COMP W/BENDING VIEWS
|
Facility
|
IP
|
$1,564.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
909001316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$312.80 |
| Max. Negotiated Rate |
$1,329.40 |
| Rate for Payer: Adventist Health Commercial |
$312.80
|
| Rate for Payer: Cash Price |
$860.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$625.60
|
| Rate for Payer: EPIC Health Plan Senior |
$625.60
|
| Rate for Payer: Galaxy Health WC |
$1,329.40
|
| Rate for Payer: Global Benefits Group Commercial |
$938.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,043.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$968.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.36
|
| Rate for Payer: Multiplan Commercial |
$1,251.20
|
| Rate for Payer: Networks By Design Commercial |
$1,016.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,329.40
|
|
|
HC LUM SPINE W/OBLIQUES
|
Facility
|
OP
|
$1,125.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
909001317
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.67 |
| Max. Negotiated Rate |
$956.25 |
| Rate for Payer: Adventist Health Commercial |
$225.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$737.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$258.67
|
| Rate for Payer: Blue Shield of California Commercial |
$688.50
|
| Rate for Payer: Blue Shield of California EPN |
$454.50
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Cigna of CA HMO |
$720.00
|
| Rate for Payer: Cigna of CA PPO |
$832.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$956.25
|
| Rate for Payer: Global Benefits Group Commercial |
$675.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$750.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$900.00
|
| Rate for Payer: Networks By Design Commercial |
$731.25
|
| Rate for Payer: Prime Health Services Commercial |
$956.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$675.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$675.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC LUM SPINE W/OBLIQUES
|
Facility
|
IP
|
$1,125.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
909001317
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$956.25 |
| Rate for Payer: Adventist Health Commercial |
$225.00
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$450.00
|
| Rate for Payer: EPIC Health Plan Senior |
$450.00
|
| Rate for Payer: Galaxy Health WC |
$956.25
|
| Rate for Payer: Global Benefits Group Commercial |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$750.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$428.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$696.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Multiplan Commercial |
$900.00
|
| Rate for Payer: Networks By Design Commercial |
$731.25
|
| Rate for Payer: Prime Health Services Commercial |
$956.25
|
|
|
HC LUNG BIOPSY, PERCUTANEOUS
|
Facility
|
OP
|
$2,263.00
|
|
|
Service Code
|
CPT 32405
|
| Hospital Charge Code |
909000124
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$452.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$452.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,923.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,697.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| 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 |
$1,244.65
|
| Rate for Payer: Cash Price |
$1,244.65
|
| Rate for Payer: Cigna of CA HMO |
$1,448.32
|
| Rate for Payer: Cigna of CA PPO |
$1,674.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,923.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,923.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,923.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$905.20
|
| Rate for Payer: EPIC Health Plan Senior |
$905.20
|
| Rate for Payer: Galaxy Health WC |
$1,923.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,357.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,509.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$862.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,400.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$543.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,584.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,584.10
|
| Rate for Payer: Multiplan Commercial |
$1,810.40
|
| Rate for Payer: Networks By Design Commercial |
$1,470.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,923.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,357.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,131.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,131.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,131.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,131.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,923.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,923.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,923.55
|
|
|
HC LUNG BIOPSY, PERCUTANEOUS
|
Facility
|
IP
|
$2,263.00
|
|
|
Service Code
|
CPT 32405
|
| Hospital Charge Code |
909000124
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$452.60 |
| Max. Negotiated Rate |
$1,923.55 |
| Rate for Payer: Adventist Health Commercial |
$452.60
|
| Rate for Payer: Cash Price |
$1,244.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$905.20
|
| Rate for Payer: EPIC Health Plan Senior |
$905.20
|
| Rate for Payer: Galaxy Health WC |
$1,923.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,357.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,509.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$862.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,400.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$543.12
|
| Rate for Payer: Multiplan Commercial |
$1,810.40
|
| Rate for Payer: Networks By Design Commercial |
$1,470.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,923.55
|
|
|
HC LUNG DIFFER PERF & VENTILATION
|
Facility
|
OP
|
$4,498.00
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
909301402
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$455.78 |
| Max. Negotiated Rate |
$3,823.30 |
| Rate for Payer: Adventist Health Commercial |
$899.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,950.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,150.05
|
| Rate for Payer: Blue Shield of California Commercial |
$2,752.78
|
| Rate for Payer: Blue Shield of California EPN |
$1,817.19
|
| Rate for Payer: Cash Price |
$2,473.90
|
| Rate for Payer: Cash Price |
$2,473.90
|
| Rate for Payer: Cigna of CA HMO |
$2,878.72
|
| Rate for Payer: Cigna of CA PPO |
$3,328.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.31
|
| Rate for Payer: EPIC Health Plan Senior |
$683.93
|
| Rate for Payer: Galaxy Health WC |
$3,823.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,698.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,121.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$455.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,000.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$515.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$683.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$861.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$916.47
|
| Rate for Payer: Multiplan Commercial |
$3,598.40
|
| Rate for Payer: Networks By Design Commercial |
$2,923.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,823.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,698.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,698.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$809.82
|
| Rate for Payer: United Healthcare All Other HMO |
$809.82
|
| Rate for Payer: United Healthcare HMO Rider |
$809.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$809.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$683.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
HC LUNG DIFFER PERF & VENTILATION
|
Facility
|
IP
|
$4,498.00
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
909301402
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$899.60 |
| Max. Negotiated Rate |
$3,823.30 |
| Rate for Payer: Adventist Health Commercial |
$899.60
|
| Rate for Payer: Cash Price |
$2,473.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,799.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,799.20
|
| Rate for Payer: Galaxy Health WC |
$3,823.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,698.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,000.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,713.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,784.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.52
|
| Rate for Payer: Multiplan Commercial |
$3,598.40
|
| Rate for Payer: Networks By Design Commercial |
$2,923.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,823.30
|
|
|
HC LUPUS SCREEN PTT
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900912006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC LUPUS SCREEN PTT
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900912006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.32
|
| Rate for Payer: Blue Shield of California Commercial |
$123.10
|
| Rate for Payer: Blue Shield of California EPN |
$81.33
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cigna of CA HMO |
$117.76
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.11
|
| Rate for Payer: EPIC Health Plan Senior |
$6.01
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.05
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.87
|
| Rate for Payer: United Healthcare All Other HMO |
$4.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
|
|
HC LUTEINIZING HORMON
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
900910886
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$256.70 |
| Rate for Payer: Adventist Health Commercial |
$60.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$198.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.93
|
| Rate for Payer: Blue Shield of California Commercial |
$202.04
|
| Rate for Payer: Blue Shield of California EPN |
$133.48
|
| Rate for Payer: Cash Price |
$166.10
|
| Rate for Payer: Cash Price |
$166.10
|
| Rate for Payer: Cigna of CA HMO |
$193.28
|
| Rate for Payer: Cigna of CA PPO |
$223.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.00
|
| Rate for Payer: EPIC Health Plan Senior |
$18.52
|
| Rate for Payer: Galaxy Health WC |
$256.70
|
| Rate for Payer: Global Benefits Group Commercial |
$181.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$201.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.82
|
| Rate for Payer: Multiplan Commercial |
$241.60
|
| Rate for Payer: Networks By Design Commercial |
$196.30
|
| Rate for Payer: Prime Health Services Commercial |
$256.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15.00
|
| Rate for Payer: United Healthcare HMO Rider |
$15.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.37
|
| Rate for Payer: Vantage Medical Group Senior |
$18.52
|
|
|
HC LUTEINIZING HORMON
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
900910886
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$256.70 |
| Rate for Payer: Adventist Health Commercial |
$60.40
|
| Rate for Payer: Cash Price |
$166.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.80
|
| Rate for Payer: EPIC Health Plan Senior |
$120.80
|
| Rate for Payer: Galaxy Health WC |
$256.70
|
| Rate for Payer: Global Benefits Group Commercial |
$181.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$201.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$186.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.48
|
| Rate for Payer: Multiplan Commercial |
$241.60
|
| Rate for Payer: Networks By Design Commercial |
$196.30
|
| Rate for Payer: Prime Health Services Commercial |
$256.70
|
|
|
HC LYMPHANGIOGRAM, ABD/PLV UL
|
Facility
|
OP
|
$1,498.00
|
|
|
Service Code
|
CPT 75805
|
| Hospital Charge Code |
909001374
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.68 |
| Max. Negotiated Rate |
$6,558.70 |
| Rate for Payer: Adventist Health Commercial |
$299.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$982.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,723.93
|
| Rate for Payer: Blue Shield of California Commercial |
$916.78
|
| Rate for Payer: Blue Shield of California EPN |
$605.19
|
| Rate for Payer: Cash Price |
$823.90
|
| Rate for Payer: Cash Price |
$823.90
|
| Rate for Payer: Cigna of CA HMO |
$958.72
|
| Rate for Payer: Cigna of CA PPO |
$1,108.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$1,273.30
|
| Rate for Payer: Global Benefits Group Commercial |
$898.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$219.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$999.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$359.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$1,198.40
|
| Rate for Payer: Networks By Design Commercial |
$973.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,273.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$898.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$898.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,088.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,088.13
|
| Rate for Payer: United Healthcare HMO Rider |
$1,088.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,088.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC LYMPHANGIOGRAM, ABD/PLV UL
|
Facility
|
IP
|
$1,498.00
|
|
|
Service Code
|
CPT 75805
|
| Hospital Charge Code |
909001374
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$299.60 |
| Max. Negotiated Rate |
$1,273.30 |
| Rate for Payer: Adventist Health Commercial |
$299.60
|
| Rate for Payer: Cash Price |
$823.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$599.20
|
| Rate for Payer: EPIC Health Plan Senior |
$599.20
|
| Rate for Payer: Galaxy Health WC |
$1,273.30
|
| Rate for Payer: Global Benefits Group Commercial |
$898.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$999.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$570.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$927.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$359.52
|
| Rate for Payer: Multiplan Commercial |
$1,198.40
|
| Rate for Payer: Networks By Design Commercial |
$973.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,273.30
|
|
|
HC LYMPHANGIOGRAM EXT BILAT
|
Facility
|
OP
|
$2,242.00
|
|
|
Service Code
|
CPT 75803
|
| Hospital Charge Code |
909001373
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$218.06 |
| Max. Negotiated Rate |
$3,237.03 |
| Rate for Payer: Adventist Health Commercial |
$448.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,470.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,531.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1,372.10
|
| Rate for Payer: Blue Shield of California EPN |
$905.77
|
| Rate for Payer: Cash Price |
$1,233.10
|
| Rate for Payer: Cash Price |
$1,233.10
|
| Rate for Payer: Cigna of CA HMO |
$1,434.88
|
| Rate for Payer: Cigna of CA PPO |
$1,659.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$1,905.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,345.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$218.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,495.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$538.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$1,793.60
|
| Rate for Payer: Networks By Design Commercial |
$1,457.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,905.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,345.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,345.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,088.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,088.13
|
| Rate for Payer: United Healthcare HMO Rider |
$1,088.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,088.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC LYMPHANGIOGRAM EXT BILAT
|
Facility
|
IP
|
$2,242.00
|
|
|
Service Code
|
CPT 75803
|
| Hospital Charge Code |
909001373
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$448.40 |
| Max. Negotiated Rate |
$1,905.70 |
| Rate for Payer: Adventist Health Commercial |
$448.40
|
| Rate for Payer: Cash Price |
$1,233.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$896.80
|
| Rate for Payer: EPIC Health Plan Senior |
$896.80
|
| Rate for Payer: Galaxy Health WC |
$1,905.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,345.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,495.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$854.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,387.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$538.08
|
| Rate for Payer: Multiplan Commercial |
$1,793.60
|
| Rate for Payer: Networks By Design Commercial |
$1,457.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,905.70
|
|
|
HC LYMPHANGIOGRAM EXT UNILAT
|
Facility
|
IP
|
$1,494.00
|
|
|
Service Code
|
CPT 75801
|
| Hospital Charge Code |
909001375
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$298.80 |
| Max. Negotiated Rate |
$1,269.90 |
| Rate for Payer: Adventist Health Commercial |
$298.80
|
| Rate for Payer: Cash Price |
$821.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$597.60
|
| Rate for Payer: EPIC Health Plan Senior |
$597.60
|
| Rate for Payer: Galaxy Health WC |
$1,269.90
|
| Rate for Payer: Global Benefits Group Commercial |
$896.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$996.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$569.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$924.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.56
|
| Rate for Payer: Multiplan Commercial |
$1,195.20
|
| Rate for Payer: Networks By Design Commercial |
$971.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,269.90
|
|
|
HC LYMPHANGIOGRAM EXT UNILAT
|
Facility
|
OP
|
$1,494.00
|
|
|
Service Code
|
CPT 75801
|
| Hospital Charge Code |
909001375
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$218.06 |
| Max. Negotiated Rate |
$1,531.36 |
| Rate for Payer: Adventist Health Commercial |
$298.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$979.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,531.36
|
| Rate for Payer: Blue Shield of California Commercial |
$914.33
|
| Rate for Payer: Blue Shield of California EPN |
$603.58
|
| Rate for Payer: Cash Price |
$821.70
|
| Rate for Payer: Cash Price |
$821.70
|
| Rate for Payer: Cigna of CA HMO |
$956.16
|
| Rate for Payer: Cigna of CA PPO |
$1,105.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$1,269.90
|
| Rate for Payer: Global Benefits Group Commercial |
$896.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$218.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$996.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$1,195.20
|
| Rate for Payer: Networks By Design Commercial |
$971.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,269.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$896.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$896.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,088.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,088.13
|
| Rate for Payer: United Healthcare HMO Rider |
$1,088.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,088.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC LYMPHANGIOGRAM, PELV BILAT
|
Facility
|
IP
|
$2,247.00
|
|
|
Service Code
|
CPT 75807
|
| Hospital Charge Code |
909001365
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$449.40 |
| Max. Negotiated Rate |
$1,909.95 |
| Rate for Payer: Adventist Health Commercial |
$449.40
|
| Rate for Payer: Cash Price |
$1,235.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$898.80
|
| Rate for Payer: EPIC Health Plan Senior |
$898.80
|
| Rate for Payer: Galaxy Health WC |
$1,909.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,348.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,498.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$856.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,390.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$539.28
|
| Rate for Payer: Multiplan Commercial |
$1,797.60
|
| Rate for Payer: Networks By Design Commercial |
$1,460.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,909.95
|
|
|
HC LYMPHANGIOGRAM, PELV BILAT
|
Facility
|
OP
|
$2,247.00
|
|
|
Service Code
|
CPT 75807
|
| Hospital Charge Code |
909001365
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$232.65 |
| Max. Negotiated Rate |
$6,558.70 |
| Rate for Payer: Galaxy Health WC |
$1,909.95
|
| Rate for Payer: Adventist Health Commercial |
$449.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,473.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,714.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1,375.16
|
| Rate for Payer: Blue Shield of California EPN |
$907.79
|
| Rate for Payer: Cash Price |
$1,235.85
|
| Rate for Payer: Cash Price |
$1,235.85
|
| Rate for Payer: Cigna of CA HMO |
$1,438.08
|
| Rate for Payer: Cigna of CA PPO |
$1,662.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1,348.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$232.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,498.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$539.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$1,797.60
|
| Rate for Payer: Networks By Design Commercial |
$1,460.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,909.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,348.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,348.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,088.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,088.13
|
| Rate for Payer: United Healthcare HMO Rider |
$1,088.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,088.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC LYMPHANGIOGRAPHY INJECTION
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT 38790
|
| Hospital Charge Code |
909000131
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$420.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| 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 |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cigna of CA HMO |
$358.40
|
| Rate for Payer: Cigna of CA PPO |
$414.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$476.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$476.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$759.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$859.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$392.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$392.00
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Networks By Design Commercial |
$364.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$476.00
|
| Rate for Payer: Vantage Medical Group Senior |
$476.00
|
|
|
HC LYMPHANGIOGRAPHY INJECTION
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT 38790
|
| Hospital Charge Code |
909000131
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$476.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.40
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Networks By Design Commercial |
$364.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
|
|
HC LYMPHAT/ANTIMONY SCA
|
Facility
|
IP
|
$2,995.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
909301341
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$599.00 |
| Max. Negotiated Rate |
$2,545.75 |
| Rate for Payer: Adventist Health Commercial |
$599.00
|
| Rate for Payer: Cash Price |
$1,647.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,198.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,198.00
|
| Rate for Payer: Galaxy Health WC |
$2,545.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,797.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,997.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,141.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,853.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$718.80
|
| Rate for Payer: Multiplan Commercial |
$2,396.00
|
| Rate for Payer: Networks By Design Commercial |
$1,946.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,545.75
|
|
|
HC LYMPHAT/ANTIMONY SCA
|
Facility
|
OP
|
$2,995.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
909301341
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$318.44 |
| Max. Negotiated Rate |
$2,545.75 |
| Rate for Payer: Adventist Health Commercial |
$599.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,964.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,839.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1,832.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,209.98
|
| Rate for Payer: Cash Price |
$1,647.25
|
| Rate for Payer: Cash Price |
$1,647.25
|
| Rate for Payer: Cigna of CA HMO |
$1,916.80
|
| Rate for Payer: Cigna of CA PPO |
$2,216.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.31
|
| Rate for Payer: EPIC Health Plan Senior |
$683.93
|
| Rate for Payer: Galaxy Health WC |
$2,545.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,797.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,121.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$318.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,997.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$683.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$718.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$861.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$916.47
|
| Rate for Payer: Multiplan Commercial |
$2,396.00
|
| Rate for Payer: Networks By Design Commercial |
$1,946.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,545.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,797.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,797.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$654.98
|
| Rate for Payer: United Healthcare All Other HMO |
$654.98
|
| Rate for Payer: United Healthcare HMO Rider |
$654.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$654.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$683.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
HC LYMPH EDEMA GAUNTLET-CUSTM MAD
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$224.40 |
| Rate for Payer: Adventist Health Commercial |
$108.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.91
|
| Rate for Payer: Blue Shield of California Commercial |
$194.83
|
| Rate for Payer: Blue Shield of California EPN |
$128.30
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna of CA HMO |
$184.80
|
| Rate for Payer: Cigna of CA PPO |
$184.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$224.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$224.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Senior |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.80
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: Networks By Design Commercial |
$132.00
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.08
|
| Rate for Payer: United Healthcare All Other HMO |
$96.44
|
| Rate for Payer: United Healthcare HMO Rider |
$94.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Vantage Medical Group Senior |
$224.40
|
|
|
HC LYMPH EDEMA GAUNTLET-CUSTM MAD
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna of CA HMO |
$184.80
|
| Rate for Payer: Cigna of CA PPO |
$184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Senior |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.36
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: Networks By Design Commercial |
$132.00
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.08
|
| Rate for Payer: United Healthcare All Other HMO |
$96.44
|
| Rate for Payer: United Healthcare HMO Rider |
$94.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.46
|
|
