|
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: Galaxy Health WC |
$1,329.40
|
| Rate for Payer: Adventist Health Commercial |
$312.80
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,094.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$625.60
|
| Rate for Payer: EPIC Health Plan Senior |
$625.60
|
| Rate for Payer: Global Benefits Group Commercial |
$938.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$993.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$922.76
|
| 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 COMP W/BENDING VIEWS
|
Facility
|
OP
|
$1,564.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
909001316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.89 |
| Max. Negotiated Rate |
$1,329.40 |
| Rate for Payer: Adventist Health Commercial |
$312.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$403.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$349.46
|
| Rate for Payer: Blue Shield of California Commercial |
$658.44
|
| Rate for Payer: Blue Shield of California Commercial |
$997.83
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna of CA HMO |
$1,000.96
|
| Rate for Payer: Cigna of CA PPO |
$1,157.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,094.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,329.40
|
| Rate for Payer: Global Benefits Group Commercial |
$938.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$88.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$993.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$100.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$938.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$938.40
|
| 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 |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
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 |
$288.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$270.31
|
| Rate for Payer: Blue Shield of California Commercial |
$473.62
|
| Rate for Payer: Blue Shield of California Commercial |
$717.75
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| 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 |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$787.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$956.25
|
| Rate for Payer: Global Benefits Group Commercial |
$675.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$714.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| 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 |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
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 |
$506.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$787.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$714.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$663.75
|
| 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 |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$1,018.35
|
| Rate for Payer: Cash Price |
$1,018.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,584.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,437.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$821.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,335.17
|
| 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: Networks By Design Commercial |
$1,470.95
|
| Rate for Payer: Adventist Health Commercial |
$452.60
|
| Rate for Payer: Cash Price |
$1,018.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,584.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,437.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,335.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$543.12
|
| Rate for Payer: Multiplan Commercial |
$1,810.40
|
| 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 |
$1,791.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,246.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,893.66
|
| Rate for Payer: Blue Shield of California Commercial |
$2,869.72
|
| Rate for Payer: Cash Price |
$2,024.10
|
| Rate for Payer: Cash Price |
$2,024.10
|
| 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 |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,148.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.28
|
| Rate for Payer: EPIC Health Plan Senior |
$768.18
|
| 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/Senior |
$1,145.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$455.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,856.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$515.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$879.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$935.79
|
| 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 |
$698.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
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: Galaxy Health WC |
$3,823.30
|
| Rate for Payer: Adventist Health Commercial |
$899.60
|
| Rate for Payer: Cash Price |
$2,024.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,148.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,799.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,799.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,698.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,856.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,653.82
|
| 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 |
$82.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.56
|
| 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: Vantage Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.02
|
| 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 Medi-Cal |
$6.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.98
|
| Rate for Payer: Blue Shield of California Commercial |
$27.66
|
| Rate for Payer: Blue Shield of California Commercial |
$128.25
|
| Rate for Payer: Blue Shield of California Commercial |
$41.82
|
| Rate for Payer: Blue Shield of California Commercial |
$84.82
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA HMO |
$117.76
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.92
|
| Rate for Payer: EPIC Health Plan Senior |
$6.61
|
| Rate for Payer: EPIC Health Plan Senior |
$6.61
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.86
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.97
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.05
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.87
|
| 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 All Other HMO |
$4.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.01
|
| 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 Commercial/Exchange |
$9.02
|
|
|
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 |
$135.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$211.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$191.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.18
|
| 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 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: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$153.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$153.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.78
|
| 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 Medi-Cal |
$20.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.16
|
| Rate for Payer: Blue Shield of California Commercial |
$42.41
|
| Rate for Payer: Blue Shield of California Commercial |
$139.22
|
| Rate for Payer: Blue Shield of California Commercial |
$64.12
|
| Rate for Payer: Blue Shield of California Commercial |
$210.49
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna of CA HMO |
$58.88
|
| Rate for Payer: Cigna of CA HMO |
$193.28
|
| Rate for Payer: Cigna of CA PPO |
$223.48
|
| Rate for Payer: Cigna of CA PPO |
$68.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$211.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$64.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.56
|
| Rate for Payer: EPIC Health Plan Senior |
$20.37
|
| Rate for Payer: EPIC Health Plan Senior |
$20.37
|
| Rate for Payer: Galaxy Health WC |
$256.70
|
| Rate for Payer: Galaxy Health WC |
$78.20
|
| Rate for Payer: Global Benefits Group Commercial |
$181.20
|
| Rate for Payer: Global Benefits Group Commercial |
$55.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.37
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.52
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$191.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$58.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.82
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: Multiplan Commercial |
$241.60
|
| Rate for Payer: Networks By Design Commercial |
$59.80
|
| Rate for Payer: Networks By Design Commercial |
$196.30
|
| Rate for Payer: Prime Health Services Commercial |
$256.70
|
| Rate for Payer: Prime Health Services Commercial |
$78.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.00
|
| 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 All Other HMO |
$15.00
|
| Rate for Payer: United Healthcare HMO Rider |
$15.00
|
| Rate for Payer: United Healthcare HMO Rider |
$15.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.52
|
| 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 Commercial/Exchange |
$27.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.37
|
| Rate for Payer: Vantage Medical Group Senior |
$18.52
|
| Rate for Payer: Vantage Medical Group Senior |
$18.52
|
|
|
HC LVAD DRSNG KIT W/PVP
|
Facility
|
OP
|
$377.17
|
|
| Hospital Charge Code |
901698966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.43 |
| Max. Negotiated Rate |
$320.59 |
| Rate for Payer: Adventist Health Commercial |
$75.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$247.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$282.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$242.03
|
| Rate for Payer: Cash Price |
$169.73
|
| Rate for Payer: Cigna of CA HMO |
$241.39
|
| Rate for Payer: Cigna of CA PPO |
$279.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$320.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$264.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.87
|
| Rate for Payer: EPIC Health Plan Senior |
$150.87
|
| Rate for Payer: Galaxy Health WC |
$320.59
|
| Rate for Payer: Global Benefits Group Commercial |
$226.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$239.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$222.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.02
|
| Rate for Payer: Multiplan Commercial |
$301.74
|
| Rate for Payer: Networks By Design Commercial |
$245.16
|
| Rate for Payer: Prime Health Services Commercial |
$320.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.59
|
| Rate for Payer: United Healthcare All Other HMO |
$188.59
|
| Rate for Payer: United Healthcare HMO Rider |
$188.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.59
|
| Rate for Payer: Vantage Medical Group Senior |
$320.59
|
|
|
HC LVAD DRSNG KIT W/PVP
|
Facility
|
IP
|
$377.17
|
|
| Hospital Charge Code |
901698966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.43 |
| Max. Negotiated Rate |
$320.59 |
| Rate for Payer: Adventist Health Commercial |
$75.43
|
| Rate for Payer: Cash Price |
$169.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$264.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.87
|
| Rate for Payer: EPIC Health Plan Senior |
$150.87
|
| Rate for Payer: Galaxy Health WC |
$320.59
|
| Rate for Payer: Global Benefits Group Commercial |
$226.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$239.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$222.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.52
|
| Rate for Payer: Multiplan Commercial |
$301.74
|
| Rate for Payer: Networks By Design Commercial |
$245.16
|
| Rate for Payer: Prime Health Services Commercial |
$320.59
|
|
|
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 |
$6,700.73 |
| Rate for Payer: Adventist Health Commercial |
$299.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,933.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,801.50
|
| Rate for Payer: Blue Shield of California Commercial |
$630.66
|
| Rate for Payer: Blue Shield of California Commercial |
$955.72
|
| Rate for Payer: Cash Price |
$674.10
|
| Rate for Payer: Cash Price |
$674.10
|
| 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 |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,048.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| 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/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$219.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$951.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$248.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$359.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| 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 |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
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 |
$674.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,048.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$951.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$883.82
|
| 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
|
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 |
$1,008.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,569.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,423.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,322.78
|
| 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 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 |
$3,340.64 |
| Rate for Payer: Adventist Health Commercial |
$448.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,933.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,600.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,430.40
|
| Rate for Payer: Blue Shield of California Commercial |
$943.88
|
| Rate for Payer: Cash Price |
$1,008.90
|
| Rate for Payer: Cash Price |
$1,008.90
|
| 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 |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,569.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| 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/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$218.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,423.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,834.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$538.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,551.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,713.00
|
| 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 |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
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 |
$2,933.48 |
| Rate for Payer: Adventist Health Commercial |
$298.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,933.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,600.26
|
| Rate for Payer: Blue Shield of California Commercial |
$628.97
|
| Rate for Payer: Blue Shield of California Commercial |
$953.17
|
| Rate for Payer: Cash Price |
$672.30
|
| Rate for Payer: Cash Price |
$672.30
|
| 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 |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,045.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| 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/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$218.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$948.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,016.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,081.14
|
| 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 |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
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 |
$672.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,045.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$948.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$881.46
|
| 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, 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 |
$6,700.73 |
| Rate for Payer: Adventist Health Commercial |
$449.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,933.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,791.98
|
| Rate for Payer: Blue Shield of California Commercial |
$1,433.59
|
| Rate for Payer: Blue Shield of California Commercial |
$945.99
|
| Rate for Payer: Cash Price |
$1,011.15
|
| Rate for Payer: Cash Price |
$1,011.15
|
| 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 |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,572.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$1,909.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,348.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$232.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,426.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$263.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$539.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| 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 |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
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 |
$1,011.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,572.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,426.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,325.73
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$392.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$355.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$859.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$330.40
|
| 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 |
$280.00
|
| 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 |
$252.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$392.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$355.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$330.40
|
| 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
|
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 |
$1,851.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,921.89
|
| Rate for Payer: Blue Shield of California Commercial |
$1,910.81
|
| Rate for Payer: Blue Shield of California Commercial |
$1,260.89
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: Cash Price |
$1,347.75
|
| 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 |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,096.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.28
|
| Rate for Payer: EPIC Health Plan Senior |
$768.18
|
| 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/Senior |
$1,145.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$318.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,901.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$360.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$718.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$879.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$935.79
|
| 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 |
$698.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
