|
HC US SOFT TISS EXT COMP
|
Facility
IP
|
$1,999.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
906601419
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$399.80 |
| Max. Negotiated Rate |
$1,799.10 |
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,599.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$799.60
|
| Rate for Payer: Galaxy Health WC |
$1,699.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,199.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,799.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,333.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.80
|
| Rate for Payer: Multiplan Commercial |
$1,499.25
|
| Rate for Payer: Networks By Design Commercial |
$1,299.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,699.15
|
|
|
HC US SOFT TISS EXT LMTD
|
Facility
IP
|
$1,786.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
906601421
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$357.20 |
| Max. Negotiated Rate |
$1,607.40 |
| Rate for Payer: Cash Price |
$803.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,428.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$714.40
|
| Rate for Payer: Galaxy Health WC |
$1,518.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,071.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,607.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.20
|
| Rate for Payer: Multiplan Commercial |
$1,339.50
|
| Rate for Payer: Networks By Design Commercial |
$1,160.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,518.10
|
|
|
HC US SOFT TISS EXT LMTD
|
Facility
OP
|
$1,786.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
906601421
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$56.39 |
| Max. Negotiated Rate |
$16,107.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,055.17
|
| Rate for Payer: BCBS Transplant Transplant |
$1,071.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,103.75
|
| Rate for Payer: Blue Shield of California EPN |
$868.00
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$803.70
|
| Rate for Payer: Cash Price |
$803.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,428.80
|
| Rate for Payer: Cigna of CA HMO |
$1,143.04
|
| Rate for Payer: Cigna of CA PPO |
$1,321.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,518.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,071.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,607.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,339.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,339.50
|
| Rate for Payer: Networks By Design Commercial |
$1,160.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,518.10
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,071.60
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,071.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,071.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,107.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US SOFT TISSUE MASS,HEAD/NECK
|
Facility
IP
|
$1,629.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
906601405
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$325.80 |
| Max. Negotiated Rate |
$1,466.10 |
| Rate for Payer: Cash Price |
$733.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,303.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.60
|
| Rate for Payer: Galaxy Health WC |
$1,384.65
|
| Rate for Payer: Global Benefits Group Commercial |
$977.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,466.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,086.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.80
|
| Rate for Payer: Multiplan Commercial |
$1,221.75
|
| Rate for Payer: Networks By Design Commercial |
$1,058.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,384.65
|
|
|
HC US SOFT TISSUE MASS,HEAD/NECK
|
Facility
OP
|
$1,629.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
906601405
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$24,656.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$510.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$296.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$962.41
|
| Rate for Payer: BCBS Transplant Transplant |
$977.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,006.72
|
| Rate for Payer: Blue Shield of California EPN |
$791.69
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$733.05
|
| Rate for Payer: Cash Price |
$733.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,303.20
|
| Rate for Payer: Cigna of CA HMO |
$1,042.56
|
| Rate for Payer: Cigna of CA PPO |
$1,205.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,384.65
|
| Rate for Payer: Global Benefits Group Commercial |
$977.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,466.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,221.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,086.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,221.75
|
| Rate for Payer: Networks By Design Commercial |
$1,058.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,384.65
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$977.40
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$977.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$977.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24,656.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US TRANSRECTAL
|
Facility
IP
|
$2,062.00
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
906601408
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$412.40 |
| Max. Negotiated Rate |
$1,855.80 |
| Rate for Payer: Cash Price |
$927.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,649.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$824.80
|
| Rate for Payer: Galaxy Health WC |
$1,752.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,237.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,855.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,375.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.40
|
| Rate for Payer: Multiplan Commercial |
$1,546.50
|
| Rate for Payer: Networks By Design Commercial |
$1,340.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,752.70
|
|
|
HC US TRANSRECTAL
|
Facility
OP
|
$2,062.00
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
906601408
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$24,656.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$539.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$283.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,218.23
|
| Rate for Payer: BCBS Transplant Transplant |
$1,237.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,274.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,002.13
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$927.90
|
| Rate for Payer: Cash Price |
$927.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,649.60
|
| Rate for Payer: Cigna of CA HMO |
$1,319.68
|
| Rate for Payer: Cigna of CA PPO |
$1,525.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,752.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,237.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,855.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,546.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,375.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,546.50
|
| Rate for Payer: Networks By Design Commercial |
$1,340.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,752.70
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,237.20
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,237.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,237.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24,656.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US TRGT DYN MBUBB 1ST LSN
|
Facility
IP
|
$580.00
|
|
|
Service Code
|
CPT 76978
|
| Hospital Charge Code |
906676978
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC US TRGT DYN MBUBB 1ST LSN
|
Facility
OP
|
$580.00
|
|
|
Service Code
|
CPT 76978
|
| Hospital Charge Code |
906676978
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$51,644.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$229.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,388.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,961.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.66
|
| Rate for Payer: BCBS Transplant Transplant |
$348.00
|
| Rate for Payer: Blue Shield of California Commercial |
$358.44
|
| Rate for Payer: Blue Shield of California EPN |
$281.88
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$435.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$376.48
|
| Rate for Payer: IEHP medi-cal |
$378.77
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Innovage PACE Commercial |
$344.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Prime Health Services Medicare |
$243.33
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: Riverside University Health MISP |
$252.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$516.45
|
| Rate for Payer: United Healthcare All Other HMO |
$516.45
|
| Rate for Payer: United Healthcare HMO Rider |
$516.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51,644.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC US TRGT DYN MBUBB EA ADD LSN
|
Facility
OP
|
$290.00
|
|
|
Service Code
|
CPT 76979
|
| Hospital Charge Code |
906676979
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$1,431.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,013.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$159.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,431.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.33
|
| Rate for Payer: BCBS Transplant Transplant |
$174.00
|
| Rate for Payer: Blue Shield of California Commercial |
$179.22
|
| Rate for Payer: Blue Shield of California EPN |
$140.94
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Cigna of CA HMO |
$185.60
|
| Rate for Payer: Cigna of CA PPO |
$214.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$217.50
|
| Rate for Payer: IEHP medi-cal |
$101.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$188.50
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$174.00
|
| Rate for Payer: Riverside University Health MISP |
$116.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$145.00
|
| Rate for Payer: United Healthcare All Other HMO |
$145.00
|
| Rate for Payer: United Healthcare HMO Rider |
$145.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.50
|
| Rate for Payer: Vantage Medical Group Senior |
$246.50
|
|
|
HC US TRGT DYN MBUBB EA ADD LSN
|
Facility
IP
|
$290.00
|
|
|
Service Code
|
CPT 76979
|
| Hospital Charge Code |
906676979
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$188.50
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
|
|
HC US ULTRA GUIDE/PSEU.AVFISTULA
|
Facility
OP
|
$1,750.00
|
|
|
Service Code
|
CPT 76936
|
| Hospital Charge Code |
909001485
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$273.06 |
| Max. Negotiated Rate |
$27,305.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$392.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$598.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$747.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,033.90
|
| Rate for Payer: BCBS Transplant Transplant |
$1,050.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,081.50
|
| Rate for Payer: Blue Shield of California EPN |
$850.50
|
| Rate for Payer: Caremore Medicare Advantage |
$392.17
|
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,400.00
|
| Rate for Payer: Cigna of CA HMO |
$1,120.00
|
| Rate for Payer: Cigna of CA PPO |
$1,295.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$1,487.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,050.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,575.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,312.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$643.16
|
| Rate for Payer: IEHP medi-cal |
$647.08
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Innovage PACE Commercial |
$588.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,167.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$350.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$1,312.50
|
| Rate for Payer: Networks By Design Commercial |
$1,137.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,487.50
|
| Rate for Payer: Prime Health Services Medicare |
$415.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,050.00
|
| Rate for Payer: Riverside University Health MISP |
$431.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,050.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,050.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$273.06
|
| Rate for Payer: United Healthcare All Other HMO |
$273.06
|
| Rate for Payer: United Healthcare HMO Rider |
$273.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27,305.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC US ULTRA GUIDE/PSEU.AVFISTULA
|
Facility
IP
|
$1,750.00
|
|
|
Service Code
|
CPT 76936
|
| Hospital Charge Code |
909001485
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$1,575.00 |
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.00
|
| Rate for Payer: Galaxy Health WC |
$1,487.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,050.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,575.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,167.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$350.00
|
| Rate for Payer: Multiplan Commercial |
$1,312.50
|
| Rate for Payer: Networks By Design Commercial |
$1,137.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,487.50
|
|
|
HC US VENOUS DUPLX SCAN BILAT
|
Facility
IP
|
$871.00
|
|
|
Service Code
|
CPT 93985
|
| Hospital Charge Code |
908100985
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$174.20 |
| Max. Negotiated Rate |
$783.90 |
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Central Health Plan Commercial |
$696.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.40
|
| Rate for Payer: Galaxy Health WC |
$740.35
|
| Rate for Payer: Global Benefits Group Commercial |
$522.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$783.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.20
|
| Rate for Payer: Multiplan Commercial |
$653.25
|
| Rate for Payer: Networks By Design Commercial |
$566.15
|
| Rate for Payer: Prime Health Services Commercial |
$740.35
|
|
|
HC US VENOUS DUPLX SCAN BILAT
|
Facility
OP
|
$871.00
|
|
|
Service Code
|
CPT 93985
|
| Hospital Charge Code |
908100985
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$174.20 |
| Max. Negotiated Rate |
$1,507.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$306.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,418.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,240.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$514.59
|
| Rate for Payer: BCBS Transplant Transplant |
$522.60
|
| Rate for Payer: Blue Shield of California Commercial |
$538.28
|
| Rate for Payer: Blue Shield of California EPN |
$423.31
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Central Health Plan Commercial |
$696.80
|
| Rate for Payer: Cigna of CA HMO |
$557.44
|
| Rate for Payer: Cigna of CA PPO |
$644.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$740.35
|
| Rate for Payer: Global Benefits Group Commercial |
$522.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$783.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$653.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$502.10
|
| Rate for Payer: IEHP medi-cal |
$505.16
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Innovage PACE Commercial |
$459.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$653.25
|
| Rate for Payer: Networks By Design Commercial |
$566.15
|
| Rate for Payer: Prime Health Services Commercial |
$740.35
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$522.60
|
| Rate for Payer: Riverside University Health MISP |
$336.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$522.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$522.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC US VENOUS DUPLX SCAN UNILAT
|
Facility
IP
|
$419.00
|
|
|
Service Code
|
CPT 93986
|
| Hospital Charge Code |
908100986
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$83.80 |
| Max. Negotiated Rate |
$377.10 |
| Rate for Payer: Cash Price |
$188.55
|
| Rate for Payer: Central Health Plan Commercial |
$335.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.60
|
| Rate for Payer: Galaxy Health WC |
$356.15
|
| Rate for Payer: Global Benefits Group Commercial |
$251.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$377.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$279.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.80
|
| Rate for Payer: Multiplan Commercial |
$314.25
|
| Rate for Payer: Networks By Design Commercial |
$272.35
|
| Rate for Payer: Prime Health Services Commercial |
$356.15
|
|
|
HC US VENOUS DUPLX SCAN UNILAT
|
Facility
OP
|
$419.00
|
|
|
Service Code
|
CPT 93986
|
| Hospital Charge Code |
908100986
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$83.80 |
| Max. Negotiated Rate |
$1,507.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$685.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$705.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$247.55
|
| Rate for Payer: BCBS Transplant Transplant |
$251.40
|
| Rate for Payer: Blue Shield of California Commercial |
$258.94
|
| Rate for Payer: Blue Shield of California EPN |
$203.63
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$188.55
|
| Rate for Payer: Cash Price |
$188.55
|
| Rate for Payer: Cash Price |
$188.55
|
| Rate for Payer: Central Health Plan Commercial |
$335.20
|
| Rate for Payer: Cigna of CA HMO |
$268.16
|
| Rate for Payer: Cigna of CA PPO |
$310.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$356.15
|
| Rate for Payer: Global Benefits Group Commercial |
$251.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$377.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$314.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$279.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$314.25
|
| Rate for Payer: Networks By Design Commercial |
$272.35
|
| Rate for Payer: Prime Health Services Commercial |
$356.15
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$251.40
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$251.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$251.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC UTRAVERSE BALLOON
|
Facility
OP
|
$805.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909000018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$2,679.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,679.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$442.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$442.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$367.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$448.38
|
| Rate for Payer: BCBS Transplant Transplant |
$483.00
|
| Rate for Payer: Blue Shield of California Commercial |
$603.75
|
| Rate for Payer: Blue Shield of California EPN |
$437.92
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Central Health Plan Commercial |
$644.00
|
| Rate for Payer: Cigna of CA HMO |
$563.50
|
| Rate for Payer: Cigna of CA PPO |
$563.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$684.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$322.00
|
| Rate for Payer: Galaxy Health WC |
$684.25
|
| Rate for Payer: Global Benefits Group Commercial |
$483.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$724.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$603.75
|
| Rate for Payer: IEHP medi-cal |
$281.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: Networks By Design Commercial |
$402.50
|
| Rate for Payer: Prime Health Services Commercial |
$684.25
|
| Rate for Payer: Riverside University Health MISP |
$322.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$483.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$483.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$402.50
|
| Rate for Payer: United Healthcare All Other HMO |
$402.50
|
| Rate for Payer: United Healthcare HMO Rider |
$402.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$402.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$684.25
|
| Rate for Payer: Vantage Medical Group Senior |
$684.25
|
|
|
HC UTRAVERSE BALLOON
|
Facility
IP
|
$805.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909000018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$724.50 |
| Rate for Payer: Blue Shield of California EPN |
$429.87
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Central Health Plan Commercial |
$644.00
|
| Rate for Payer: Cigna of CA HMO |
$563.50
|
| Rate for Payer: Cigna of CA PPO |
$563.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$322.00
|
| Rate for Payer: Galaxy Health WC |
$684.25
|
| Rate for Payer: Global Benefits Group Commercial |
$483.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$724.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: Prime Health Services Commercial |
$684.25
|
|
|
HC VACCINE FLU
|
Facility
OP
|
$129.00
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
949000151
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$59.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$59.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.21
|
| Rate for Payer: BCBS Transplant Transplant |
$77.40
|
| Rate for Payer: Blue Shield of California Commercial |
$81.14
|
| Rate for Payer: Blue Shield of California EPN |
$63.08
|
| Rate for Payer: Caremore Medicare Advantage |
$59.35
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Central Health Plan Commercial |
$103.20
|
| Rate for Payer: Cigna of CA HMO |
$82.56
|
| Rate for Payer: Cigna of CA PPO |
$95.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$96.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$97.33
|
| Rate for Payer: IEHP medi-cal |
$97.93
|
| Rate for Payer: IEHP Medicare Advantage |
$59.35
|
| Rate for Payer: Innovage PACE Commercial |
$89.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
| Rate for Payer: Networks By Design Commercial |
$83.85
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
| Rate for Payer: Prime Health Services Medicare |
$62.91
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$77.40
|
| Rate for Payer: Riverside University Health MISP |
$65.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.50
|
| Rate for Payer: United Healthcare All Other HMO |
$64.50
|
| Rate for Payer: United Healthcare HMO Rider |
$64.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC VACCINE FLU
|
Facility
IP
|
$129.00
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
949000151
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Central Health Plan Commercial |
$103.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.80
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
| Rate for Payer: Networks By Design Commercial |
$83.85
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
|
|
HC VACCINE HEPATITIS B
|
Facility
OP
|
$336.00
|
|
|
Service Code
|
CPT 90747
|
| Hospital Charge Code |
949000003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$863.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$863.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$184.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$184.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$387.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$424.47
|
| Rate for Payer: BCBS Transplant Transplant |
$201.60
|
| Rate for Payer: Blue Shield of California Commercial |
$158.86
|
| Rate for Payer: Blue Shield of California EPN |
$144.42
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Central Health Plan Commercial |
$268.80
|
| Rate for Payer: Cigna of CA HMO |
$235.20
|
| Rate for Payer: Cigna of CA PPO |
$235.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$302.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$252.00
|
| Rate for Payer: IEHP medi-cal |
$140.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$168.00
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
| Rate for Payer: Riverside University Health MISP |
$134.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Other HMO |
$168.00
|
| Rate for Payer: United Healthcare HMO Rider |
$168.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$285.60
|
| Rate for Payer: Vantage Medical Group Senior |
$285.60
|
|
|
HC VACCINE HEPATITIS B
|
Facility
OP
|
$336.00
|
|
|
Service Code
|
CPT 90747
|
| Hospital Charge Code |
941000003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$863.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$863.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$184.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$184.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$387.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$424.47
|
| Rate for Payer: BCBS Transplant Transplant |
$201.60
|
| Rate for Payer: Blue Shield of California Commercial |
$158.86
|
| Rate for Payer: Blue Shield of California EPN |
$144.42
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Central Health Plan Commercial |
$268.80
|
| Rate for Payer: Cigna of CA HMO |
$235.20
|
| Rate for Payer: Cigna of CA PPO |
$235.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$302.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$252.00
|
| Rate for Payer: IEHP medi-cal |
$140.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$168.00
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
| Rate for Payer: Riverside University Health MISP |
$134.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Other HMO |
$168.00
|
| Rate for Payer: United Healthcare HMO Rider |
$168.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$285.60
|
| Rate for Payer: Vantage Medical Group Senior |
$285.60
|
|
|
HC VACCINE HEPATITIS B
|
Facility
IP
|
$336.00
|
|
|
Service Code
|
CPT 90747
|
| Hospital Charge Code |
942100003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Blue Shield of California Commercial |
$252.00
|
| Rate for Payer: Blue Shield of California EPN |
$179.42
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Central Health Plan Commercial |
$268.80
|
| Rate for Payer: Cigna of CA HMO |
$235.20
|
| Rate for Payer: Cigna of CA PPO |
$235.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$302.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$168.00
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
|
|
HC VACCINE HEPATITIS B
|
Facility
IP
|
$336.00
|
|
|
Service Code
|
CPT 90747
|
| Hospital Charge Code |
949000003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Blue Shield of California Commercial |
$252.00
|
| Rate for Payer: Blue Shield of California EPN |
$179.42
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Central Health Plan Commercial |
$268.80
|
| Rate for Payer: Cigna of CA HMO |
$235.20
|
| Rate for Payer: Cigna of CA PPO |
$235.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$302.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$168.00
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
|
