|
HC LYMPH NODE NDLE BPSY, DP CE
|
Facility
|
IP
|
$8,340.00
|
|
|
Service Code
|
CPT 38510
|
| Hospital Charge Code |
909000128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,668.00 |
| Max. Negotiated Rate |
$7,089.00 |
| Rate for Payer: Adventist Health Commercial |
$1,668.00
|
| Rate for Payer: Cash Price |
$4,587.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,336.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,336.00
|
| Rate for Payer: Galaxy Health WC |
$7,089.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,004.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,562.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,177.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,162.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,001.60
|
| Rate for Payer: Multiplan Commercial |
$6,672.00
|
| Rate for Payer: Networks By Design Commercial |
$5,421.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,089.00
|
|
|
HC LYMPH NODE NDLE BPSY, INT M
|
Facility
|
OP
|
$8,656.00
|
|
|
Service Code
|
CPT 38530
|
| Hospital Charge Code |
909000130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$99.46 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,731.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,865.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$4,760.80
|
| Rate for Payer: Cash Price |
$4,760.80
|
| Rate for Payer: Cash Price |
$4,760.80
|
| Rate for Payer: Cigna of CA HMO |
$5,539.84
|
| Rate for Payer: Cigna of CA PPO |
$6,405.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,352.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,865.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,568.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,865.48
|
| Rate for Payer: Galaxy Health WC |
$7,357.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,193.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,979.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$99.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,865.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,773.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,865.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,077.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,130.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,519.74
|
| Rate for Payer: Multiplan Commercial |
$6,924.80
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: Networks By Design Commercial |
$5,626.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,357.60
|
| Rate for Payer: Prime Health Services WC |
$7,673.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,193.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,865.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Vantage Medical Group Senior |
$4,865.48
|
|
|
HC LYMPH NODE NDLE BPSY, INT M
|
Facility
|
IP
|
$8,656.00
|
|
|
Service Code
|
CPT 38530
|
| Hospital Charge Code |
909000130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,731.20 |
| Max. Negotiated Rate |
$7,357.60 |
| Rate for Payer: Adventist Health Commercial |
$1,731.20
|
| Rate for Payer: Cash Price |
$4,760.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,462.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,462.40
|
| Rate for Payer: Galaxy Health WC |
$7,357.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,193.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,773.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,297.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,358.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,077.44
|
| Rate for Payer: Multiplan Commercial |
$6,924.80
|
| Rate for Payer: Networks By Design Commercial |
$5,626.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,357.60
|
|
|
HC LYMPH NODE NDLE BPSY,SUPFCL
|
Facility
|
OP
|
$3,714.00
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
909000127
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$118.84 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$742.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| 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 |
$2,042.70
|
| Rate for Payer: Cash Price |
$2,042.70
|
| Rate for Payer: Cash Price |
$2,042.70
|
| Rate for Payer: Cigna of CA HMO |
$2,376.96
|
| Rate for Payer: Cigna of CA PPO |
$2,748.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$3,156.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,228.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,477.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$891.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$2,971.20
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$2,414.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,156.90
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,228.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC LYMPH NODE NDLE BPSY,SUPFCL
|
Facility
|
IP
|
$3,714.00
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
909000127
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$742.80 |
| Max. Negotiated Rate |
$3,156.90 |
| Rate for Payer: Adventist Health Commercial |
$742.80
|
| Rate for Payer: Cash Price |
$2,042.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,485.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,485.60
|
| Rate for Payer: Galaxy Health WC |
$3,156.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,228.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,477.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,415.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,298.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$891.36
|
| Rate for Payer: Multiplan Commercial |
$2,971.20
|
| Rate for Payer: Networks By Design Commercial |
$2,414.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,156.90
|
|
|
HC LYMPHOCYTE SUBSET, EA CELL MAR
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
903901952
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.86 |
| Max. Negotiated Rate |
$749.58 |
| Rate for Payer: Adventist Health Commercial |
$105.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$345.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$385.28
|
| Rate for Payer: Blue Shield of California Commercial |
$352.56
|
| Rate for Payer: Blue Shield of California EPN |
$232.93
|
| Rate for Payer: Cash Price |
$289.85
|
| Rate for Payer: Cash Price |
$289.85
|
| Rate for Payer: Cigna of CA HMO |
$337.28
|
| Rate for Payer: Cigna of CA PPO |
$389.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$457.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.03
|
| Rate for Payer: EPIC Health Plan Senior |
$457.06
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$749.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$457.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$351.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$457.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$575.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.46
|
| Rate for Payer: Multiplan Commercial |
$421.60
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$316.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$316.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$457.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Vantage Medical Group Senior |
$457.06
|
|
|
HC LYMPHOCYTE SUBSET, EA CELL MAR
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
903901952
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$105.40 |
| Max. Negotiated Rate |
$447.95 |
| Rate for Payer: Adventist Health Commercial |
$105.40
|
| Rate for Payer: Cash Price |
$289.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.80
|
| Rate for Payer: EPIC Health Plan Senior |
$210.80
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$351.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$326.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.48
|
| Rate for Payer: Multiplan Commercial |
$421.60
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
|
|
HC LYSIS OF LABIAL ADHESIONS
|
Facility
|
IP
|
$7,759.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
902400744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,551.80 |
| Max. Negotiated Rate |
$6,595.15 |
| Rate for Payer: Adventist Health Commercial |
$1,551.80
|
| Rate for Payer: Cash Price |
$4,267.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,103.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,103.60
|
| Rate for Payer: Galaxy Health WC |
$6,595.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,655.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,175.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,956.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,802.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,862.16
|
| Rate for Payer: Multiplan Commercial |
$6,207.20
|
| Rate for Payer: Networks By Design Commercial |
$5,043.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,595.15
|
|
|
HC LYSIS OF LABIAL ADHESIONS
|
Facility
|
OP
|
$7,759.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
902400744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$321.10 |
| Max. Negotiated Rate |
$6,625.45 |
| Rate for Payer: Adventist Health Commercial |
$1,551.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$4,267.45
|
| Rate for Payer: Cash Price |
$4,267.45
|
| Rate for Payer: Cash Price |
$4,267.45
|
| Rate for Payer: Cigna of CA HMO |
$4,965.76
|
| Rate for Payer: Cigna of CA PPO |
$5,741.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$6,595.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,655.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,175.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,862.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,090.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$6,207.20
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$5,043.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,595.15
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,655.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,879.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,879.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,879.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,879.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC LYSIS OF LABIAL ADHESIONS
|
Facility
|
IP
|
$7,759.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
902400744
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,551.80 |
| Max. Negotiated Rate |
$6,595.15 |
| Rate for Payer: Adventist Health Commercial |
$1,551.80
|
| Rate for Payer: Cash Price |
$4,267.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,103.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,103.60
|
| Rate for Payer: Galaxy Health WC |
$6,595.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,655.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,175.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,956.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,802.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,862.16
|
| Rate for Payer: Multiplan Commercial |
$6,207.20
|
| Rate for Payer: Networks By Design Commercial |
$5,043.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,595.15
|
|
|
HC LYSIS OF LABIAL ADHESIONS
|
Facility
|
OP
|
$7,759.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
902400744
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$283.92 |
| Max. Negotiated Rate |
$6,625.45 |
| Rate for Payer: Adventist Health Commercial |
$1,551.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$4,267.45
|
| Rate for Payer: Cash Price |
$4,267.45
|
| Rate for Payer: Cash Price |
$4,267.45
|
| Rate for Payer: Cigna of CA HMO |
$4,965.76
|
| Rate for Payer: Cigna of CA PPO |
$5,741.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$6,595.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,655.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$283.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,175.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,862.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,090.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$6,207.20
|
| Rate for Payer: Networks By Design Commercial |
$5,043.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,595.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,655.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,655.40
|
| 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 |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC MAGNESIUM
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900910230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.77
|
| Rate for Payer: Blue Shield of California Commercial |
$101.69
|
| Rate for Payer: Blue Shield of California EPN |
$67.18
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.04
|
| Rate for Payer: EPIC Health Plan Senior |
$6.70
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.98
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.43
|
| Rate for Payer: United Healthcare All Other HMO |
$5.43
|
| Rate for Payer: United Healthcare HMO Rider |
$5.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Vantage Medical Group Senior |
$6.70
|
|
|
HC MAGNESIUM
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900910230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
|
HC MALARIA QUANTITAT
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911640
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$166.60 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$128.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.18
|
| Rate for Payer: Blue Shield of California Commercial |
$131.12
|
| Rate for Payer: Blue Shield of California EPN |
$86.63
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.09
|
| Rate for Payer: EPIC Health Plan Senior |
$5.99
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.03
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
|
|
HC MALARIA QUANTITAT
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911640
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$166.60 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.04
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC MALARIA SCREEN AG TEST
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
900912441
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$166.60 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.04
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC MALARIA SCREEN AG TEST
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
900912441
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.18 |
| Max. Negotiated Rate |
$166.60 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$128.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.77
|
| Rate for Payer: Blue Shield of California Commercial |
$131.12
|
| Rate for Payer: Blue Shield of California EPN |
$86.63
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.69
|
| Rate for Payer: EPIC Health Plan Senior |
$16.07
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.53
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO |
$13.01
|
| Rate for Payer: United Healthcare HMO Rider |
$13.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
|
|
HC MALARIA SMEARS
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911686
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$166.60 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$128.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.18
|
| Rate for Payer: Blue Shield of California Commercial |
$131.12
|
| Rate for Payer: Blue Shield of California EPN |
$86.63
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.09
|
| Rate for Payer: EPIC Health Plan Senior |
$5.99
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.03
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
|
|
HC MALARIA SMEARS
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911686
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$166.60 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.04
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC MAMMARY DUCTOGRAM
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
CPT 19030
|
| Hospital Charge Code |
909000103
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$110.80 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$110.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$470.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$304.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$415.50
|
| 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 |
$304.70
|
| Rate for Payer: Cash Price |
$304.70
|
| Rate for Payer: Cash Price |
$304.70
|
| Rate for Payer: Cigna of CA HMO |
$354.56
|
| Rate for Payer: Cigna of CA PPO |
$409.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$470.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$470.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$470.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.60
|
| Rate for Payer: EPIC Health Plan Senior |
$221.60
|
| Rate for Payer: Galaxy Health WC |
$470.90
|
| Rate for Payer: Global Benefits Group Commercial |
$332.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$325.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$369.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$342.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$387.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$387.80
|
| Rate for Payer: Multiplan Commercial |
$443.20
|
| Rate for Payer: Networks By Design Commercial |
$360.10
|
| Rate for Payer: Prime Health Services Commercial |
$470.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$332.40
|
| 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 |
$470.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$470.90
|
| Rate for Payer: Vantage Medical Group Senior |
$470.90
|
|
|
HC MAMMARY DUCTOGRAM
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
CPT 19030
|
| Hospital Charge Code |
909000103
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$110.80 |
| Max. Negotiated Rate |
$470.90 |
| Rate for Payer: Adventist Health Commercial |
$110.80
|
| Rate for Payer: Cash Price |
$304.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.60
|
| Rate for Payer: EPIC Health Plan Senior |
$221.60
|
| Rate for Payer: Galaxy Health WC |
$470.90
|
| Rate for Payer: Global Benefits Group Commercial |
$332.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$369.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$342.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.96
|
| Rate for Payer: Multiplan Commercial |
$443.20
|
| Rate for Payer: Networks By Design Commercial |
$360.10
|
| Rate for Payer: Prime Health Services Commercial |
$470.90
|
|
|
HC MAMMOGRAPHY DIGITAL BILAT
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
CPT 77066
|
| Hospital Charge Code |
909002011
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$722.50 |
| Rate for Payer: Adventist Health Commercial |
$170.00
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.00
|
| Rate for Payer: EPIC Health Plan Senior |
$340.00
|
| Rate for Payer: Galaxy Health WC |
$722.50
|
| Rate for Payer: Global Benefits Group Commercial |
$510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$566.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$323.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$526.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.00
|
| Rate for Payer: Multiplan Commercial |
$680.00
|
| Rate for Payer: Networks By Design Commercial |
$552.50
|
| Rate for Payer: Prime Health Services Commercial |
$722.50
|
|
|
HC MAMMOGRAPHY DIGITAL BILAT
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
CPT 77066
|
| Hospital Charge Code |
909002011
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$722.50 |
| Rate for Payer: Adventist Health Commercial |
$170.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$557.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$722.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$637.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$521.99
|
| Rate for Payer: Blue Shield of California Commercial |
$520.20
|
| Rate for Payer: Blue Shield of California EPN |
$343.40
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cigna of CA HMO |
$544.00
|
| Rate for Payer: Cigna of CA PPO |
$629.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$722.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$722.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$722.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.00
|
| Rate for Payer: EPIC Health Plan Senior |
$340.00
|
| Rate for Payer: Galaxy Health WC |
$722.50
|
| Rate for Payer: Global Benefits Group Commercial |
$510.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$248.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$566.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$526.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$595.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$595.00
|
| Rate for Payer: Multiplan Commercial |
$680.00
|
| Rate for Payer: Networks By Design Commercial |
$552.50
|
| Rate for Payer: Prime Health Services Commercial |
$722.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$510.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$510.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$321.54
|
| Rate for Payer: United Healthcare All Other HMO |
$321.54
|
| Rate for Payer: United Healthcare HMO Rider |
$321.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$321.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$722.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$722.50
|
| Rate for Payer: Vantage Medical Group Senior |
$722.50
|
|
|
HC MAMMOGRAPHY DIGITAL UNILAT ALL VIEWS
|
Facility
|
IP
|
$574.00
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
909002012
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$114.80 |
| Max. Negotiated Rate |
$487.90 |
| Rate for Payer: Adventist Health Commercial |
$114.80
|
| Rate for Payer: Cash Price |
$315.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.60
|
| Rate for Payer: EPIC Health Plan Senior |
$229.60
|
| Rate for Payer: Galaxy Health WC |
$487.90
|
| Rate for Payer: Global Benefits Group Commercial |
$344.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$382.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.76
|
| Rate for Payer: Multiplan Commercial |
$459.20
|
| Rate for Payer: Networks By Design Commercial |
$373.10
|
| Rate for Payer: Prime Health Services Commercial |
$487.90
|
|
|
HC MAMMOGRAPHY DIGITAL UNILAT ALL VIEWS
|
Facility
|
OP
|
$574.00
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
909002012
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$114.80 |
| Max. Negotiated Rate |
$487.90 |
| Rate for Payer: Adventist Health Commercial |
$114.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$376.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$487.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$315.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$430.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$352.49
|
| Rate for Payer: Blue Shield of California Commercial |
$351.29
|
| Rate for Payer: Blue Shield of California EPN |
$231.90
|
| Rate for Payer: Cash Price |
$315.70
|
| Rate for Payer: Cash Price |
$315.70
|
| Rate for Payer: Cigna of CA HMO |
$367.36
|
| Rate for Payer: Cigna of CA PPO |
$424.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$487.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$487.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$487.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.60
|
| Rate for Payer: EPIC Health Plan Senior |
$229.60
|
| Rate for Payer: Galaxy Health WC |
$487.90
|
| Rate for Payer: Global Benefits Group Commercial |
$344.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$196.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$382.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$401.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$401.80
|
| Rate for Payer: Multiplan Commercial |
$459.20
|
| Rate for Payer: Networks By Design Commercial |
$373.10
|
| Rate for Payer: Prime Health Services Commercial |
$487.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$344.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$344.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$252.70
|
| Rate for Payer: United Healthcare All Other HMO |
$252.70
|
| Rate for Payer: United Healthcare HMO Rider |
$252.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$252.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$487.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$487.90
|
| Rate for Payer: Vantage Medical Group Senior |
$487.90
|
|
