|
HC US TRGT DYN MBUBB 1ST LSN
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
CPT 76978
|
| Hospital Charge Code |
906676978
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$130.40 |
| Max. Negotiated Rate |
$586.80 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Cash Price |
$358.60
|
| Rate for Payer: Central Health Plan Commercial |
$521.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.80
|
| Rate for Payer: EPIC Health Plan Senior |
$260.80
|
| Rate for Payer: Galaxy Health WC |
$554.20
|
| Rate for Payer: Global Benefits Group Commercial |
$391.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$586.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$434.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$403.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.40
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
| Rate for Payer: Networks By Design Commercial |
$423.80
|
| Rate for Payer: Prime Health Services Commercial |
$554.20
|
|
|
HC US TRGT DYN MBUBB EA ADD LSN
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT 76979
|
| Hospital Charge Code |
906676979
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$293.40 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: Central Health Plan Commercial |
$260.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.40
|
| Rate for Payer: EPIC Health Plan Senior |
$130.40
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$293.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$217.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.20
|
| Rate for Payer: Multiplan Commercial |
$244.50
|
| Rate for Payer: Networks By Design Commercial |
$211.90
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
|
|
HC US TRGT DYN MBUBB EA ADD LSN
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 76979
|
| Hospital Charge Code |
906676979
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$1,431.99 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$197.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$179.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$244.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,431.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.46
|
| Rate for Payer: Blue Shield of California Commercial |
$197.88
|
| Rate for Payer: Blue Shield of California EPN |
$129.42
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: Central Health Plan Commercial |
$260.80
|
| Rate for Payer: Cigna of CA HMO |
$208.64
|
| Rate for Payer: Cigna of CA PPO |
$241.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.40
|
| Rate for Payer: EPIC Health Plan Senior |
$130.40
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$293.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$319.92
|
| Rate for Payer: InnovAge PACE Commercial |
$163.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$217.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$228.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$228.20
|
| Rate for Payer: Multiplan Commercial |
$244.50
|
| Rate for Payer: Networks By Design Commercial |
$211.90
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
| Rate for Payer: Riverside University Health System MISP |
$130.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$163.00
|
| Rate for Payer: United Healthcare All Other HMO |
$163.00
|
| Rate for Payer: United Healthcare HMO Rider |
$163.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$163.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.10
|
| Rate for Payer: Vantage Medical Group Senior |
$277.10
|
|
|
HC US ULTRA GUIDE/PSEU.AVFISTULA
|
Facility
|
IP
|
$1,710.00
|
|
|
Service Code
|
CPT 76936
|
| Hospital Charge Code |
909001485
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$1,539.00 |
| Rate for Payer: Adventist Health Commercial |
$342.00
|
| Rate for Payer: Cash Price |
$940.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,368.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.00
|
| Rate for Payer: EPIC Health Plan Senior |
$684.00
|
| Rate for Payer: Galaxy Health WC |
$1,453.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,026.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,539.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,140.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$651.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,058.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.00
|
| Rate for Payer: Multiplan Commercial |
$1,282.50
|
| Rate for Payer: Networks By Design Commercial |
$1,111.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,453.50
|
|
|
HC US ULTRA GUIDE/PSEU.AVFISTULA
|
Facility
|
OP
|
$1,710.00
|
|
|
Service Code
|
CPT 76936
|
| Hospital Charge Code |
909001485
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$273.06 |
| Max. Negotiated Rate |
$1,539.00 |
| Rate for Payer: Adventist Health Commercial |
$342.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$395.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,038.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$747.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,004.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1,037.97
|
| Rate for Payer: Blue Shield of California EPN |
$678.87
|
| Rate for Payer: Cash Price |
$940.50
|
| Rate for Payer: Cash Price |
$940.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,368.00
|
| Rate for Payer: Cigna of CA HMO |
$1,094.40
|
| Rate for Payer: Cigna of CA PPO |
$1,265.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$1,453.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,026.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,539.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: InnovAge PACE Commercial |
$593.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,140.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$651.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$530.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$1,282.50
|
| Rate for Payer: Networks By Design Commercial |
$1,111.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$395.66
|
| Rate for Payer: Prime Health Services Commercial |
$1,453.50
|
| Rate for Payer: Prime Health Services Medicare |
$419.40
|
| Rate for Payer: Riverside University Health System MISP |
$435.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,026.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,026.00
|
| 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 |
$273.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC US VENOUS DUPLX SCAN BILAT
|
Facility
|
OP
|
$1,824.00
|
|
|
Service Code
|
CPT 93985
|
| Hospital Charge Code |
908100985
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$1,641.60 |
| Rate for Payer: Adventist Health Commercial |
$364.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,107.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,240.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,071.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,107.17
|
| Rate for Payer: Blue Shield of California EPN |
$724.13
|
| Rate for Payer: Cash Price |
$1,003.20
|
| Rate for Payer: Cash Price |
$1,003.20
|
| Rate for Payer: Cash Price |
$1,003.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,459.20
|
| Rate for Payer: Cigna of CA HMO |
$1,167.36
|
| Rate for Payer: Cigna of CA PPO |
$1,349.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$1,550.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,094.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,641.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$425.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: InnovAge PACE Commercial |
$460.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,216.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$1,368.00
|
| Rate for Payer: Networks By Design Commercial |
$1,185.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$1,550.40
|
| Rate for Payer: Prime Health Services Medicare |
$325.56
|
| Rate for Payer: Riverside University Health System MISP |
$337.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,094.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,094.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC US VENOUS DUPLX SCAN BILAT
|
Facility
|
IP
|
$1,824.00
|
|
|
Service Code
|
CPT 93985
|
| Hospital Charge Code |
908100985
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$364.80 |
| Max. Negotiated Rate |
$1,641.60 |
| Rate for Payer: Adventist Health Commercial |
$364.80
|
| Rate for Payer: Cash Price |
$1,003.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,459.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$729.60
|
| Rate for Payer: EPIC Health Plan Senior |
$729.60
|
| Rate for Payer: Galaxy Health WC |
$1,550.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,094.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,641.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,216.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$694.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,129.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.80
|
| Rate for Payer: Multiplan Commercial |
$1,368.00
|
| Rate for Payer: Networks By Design Commercial |
$1,185.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,550.40
|
|
|
HC US VENOUS DUPLX SCAN UNILAT
|
Facility
|
OP
|
$531.00
|
|
|
Service Code
|
CPT 93986
|
| Hospital Charge Code |
908100986
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$106.20 |
| Max. Negotiated Rate |
$1,588.00 |
| Rate for Payer: Adventist Health Commercial |
$106.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$322.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$705.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$311.86
|
| Rate for Payer: Blue Shield of California Commercial |
$322.32
|
| Rate for Payer: Blue Shield of California EPN |
$210.81
|
| Rate for Payer: Cash Price |
$292.05
|
| Rate for Payer: Cash Price |
$292.05
|
| Rate for Payer: Cash Price |
$292.05
|
| Rate for Payer: Central Health Plan Commercial |
$424.80
|
| Rate for Payer: Cigna of CA HMO |
$339.84
|
| Rate for Payer: Cigna of CA PPO |
$392.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$451.35
|
| Rate for Payer: Global Benefits Group Commercial |
$318.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$477.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$245.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$354.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$271.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$398.25
|
| Rate for Payer: Networks By Design Commercial |
$345.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$451.35
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$318.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$318.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC US VENOUS DUPLX SCAN UNILAT
|
Facility
|
IP
|
$531.00
|
|
|
Service Code
|
CPT 93986
|
| Hospital Charge Code |
908100986
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$106.20 |
| Max. Negotiated Rate |
$477.90 |
| Rate for Payer: Adventist Health Commercial |
$106.20
|
| Rate for Payer: Cash Price |
$292.05
|
| Rate for Payer: Central Health Plan Commercial |
$424.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$212.40
|
| Rate for Payer: EPIC Health Plan Senior |
$212.40
|
| Rate for Payer: Galaxy Health WC |
$451.35
|
| Rate for Payer: Global Benefits Group Commercial |
$318.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$477.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$354.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$328.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.20
|
| Rate for Payer: Multiplan Commercial |
$398.25
|
| Rate for Payer: Networks By Design Commercial |
$345.15
|
| Rate for Payer: Prime Health Services Commercial |
$451.35
|
|
|
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: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Blue Shield of California Commercial |
$622.26
|
| Rate for Payer: Blue Shield of California EPN |
$405.72
|
| Rate for Payer: Cash Price |
$442.75
|
| 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 Senior |
$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 |
$536.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.30
|
| 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: United Healthcare All Other Commercial |
$302.12
|
| Rate for Payer: United Healthcare All Other HMO |
$294.07
|
| Rate for Payer: United Healthcare HMO Rider |
$287.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.64
|
|
|
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 |
$724.50 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$442.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$603.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$367.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$445.73
|
| Rate for Payer: Blue Shield of California Commercial |
$622.26
|
| Rate for Payer: Blue Shield of California EPN |
$405.72
|
| Rate for Payer: Cash Price |
$442.75
|
| 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: Dignity Health Medi-Cal |
$684.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$684.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$402.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$563.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$563.50
|
| 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 System 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 |
$302.12
|
| Rate for Payer: United Healthcare All Other HMO |
$294.07
|
| Rate for Payer: United Healthcare HMO Rider |
$287.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$684.25
|
| Rate for Payer: Vantage Medical Group Senior |
$684.25
|
|
|
HC VACCINE FLU
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
949000151
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$66.55
|
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Senior |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
|
|
HC VACCINE FLU
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
949000151
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$58.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.06
|
| Rate for Payer: Blue Shield of California Commercial |
$73.93
|
| Rate for Payer: Blue Shield of California EPN |
$48.28
|
| Rate for Payer: Cash Price |
$66.55
|
| Rate for Payer: Cash Price |
$66.55
|
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: Cigna of CA HMO |
$77.44
|
| Rate for Payer: Cigna of CA PPO |
$89.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.15
|
| Rate for Payer: EPIC Health Plan Senior |
$58.63
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.63
|
| Rate for Payer: InnovAge PACE Commercial |
$87.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.56
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$58.63
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
| Rate for Payer: Prime Health Services Medicare |
$62.15
|
| Rate for Payer: Riverside University Health System MISP |
$64.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.50
|
| Rate for Payer: United Healthcare All Other HMO |
$60.50
|
| Rate for Payer: United Healthcare HMO Rider |
$60.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$58.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Vantage Medical Group Senior |
$58.63
|
|
|
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 |
$317.17 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$204.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$184.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$317.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.34
|
| Rate for Payer: Blue Shield of California Commercial |
$183.13
|
| Rate for Payer: Blue Shield of California EPN |
$166.48
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| 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: Dignity Health Medi-Cal |
$285.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$140.75
|
| Rate for Payer: InnovAge PACE Commercial |
$168.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$275.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.20
|
| 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 System 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 |
$126.10
|
| Rate for Payer: United Healthcare All Other HMO |
$122.74
|
| Rate for Payer: United Healthcare HMO Rider |
$120.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$285.60
|
| 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 |
949000003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Blue Shield of California Commercial |
$259.73
|
| Rate for Payer: Blue Shield of California EPN |
$169.34
|
| Rate for Payer: Cash Price |
$184.80
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$128.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.98
|
| 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: United Healthcare All Other Commercial |
$126.10
|
| Rate for Payer: United Healthcare All Other HMO |
$122.74
|
| Rate for Payer: United Healthcare HMO Rider |
$120.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.04
|
|
|
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: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Blue Shield of California Commercial |
$259.73
|
| Rate for Payer: Blue Shield of California EPN |
$169.34
|
| Rate for Payer: Cash Price |
$184.80
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$128.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.98
|
| 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: United Healthcare All Other Commercial |
$126.10
|
| Rate for Payer: United Healthcare All Other HMO |
$122.74
|
| Rate for Payer: United Healthcare HMO Rider |
$120.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.04
|
|
|
HC VACCINE HEPATITIS B
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT 90747
|
| Hospital Charge Code |
941000003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Blue Shield of California Commercial |
$259.73
|
| Rate for Payer: Blue Shield of California EPN |
$169.34
|
| Rate for Payer: Cash Price |
$184.80
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$128.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.98
|
| 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: United Healthcare All Other Commercial |
$126.10
|
| Rate for Payer: United Healthcare All Other HMO |
$122.74
|
| Rate for Payer: United Healthcare HMO Rider |
$120.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.04
|
|
|
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 |
$317.17 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$204.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$184.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$317.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.34
|
| Rate for Payer: Blue Shield of California Commercial |
$183.13
|
| Rate for Payer: Blue Shield of California EPN |
$166.48
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| 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: Dignity Health Medi-Cal |
$285.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$140.75
|
| Rate for Payer: InnovAge PACE Commercial |
$168.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$275.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.20
|
| 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 System 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 |
$126.10
|
| Rate for Payer: United Healthcare All Other HMO |
$122.74
|
| Rate for Payer: United Healthcare HMO Rider |
$120.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$285.60
|
| 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 |
942100003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$317.17 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$204.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$184.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$317.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.34
|
| Rate for Payer: Blue Shield of California Commercial |
$183.13
|
| Rate for Payer: Blue Shield of California EPN |
$166.48
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| 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: Dignity Health Medi-Cal |
$285.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$140.75
|
| Rate for Payer: InnovAge PACE Commercial |
$168.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$275.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.20
|
| 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 System 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 |
$126.10
|
| Rate for Payer: United Healthcare All Other HMO |
$122.74
|
| Rate for Payer: United Healthcare HMO Rider |
$120.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$285.60
|
| Rate for Payer: Vantage Medical Group Senior |
$285.60
|
|
|
HC VACCINE HEPATITITS B
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT 90747
|
| Hospital Charge Code |
943100003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$317.17 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$204.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$184.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$317.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.34
|
| Rate for Payer: Blue Shield of California Commercial |
$183.13
|
| Rate for Payer: Blue Shield of California EPN |
$166.48
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| 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: Dignity Health Medi-Cal |
$285.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$140.75
|
| Rate for Payer: InnovAge PACE Commercial |
$168.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$275.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.20
|
| 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 System 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 |
$126.10
|
| Rate for Payer: United Healthcare All Other HMO |
$122.74
|
| Rate for Payer: United Healthcare HMO Rider |
$120.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$285.60
|
| Rate for Payer: Vantage Medical Group Senior |
$285.60
|
|
|
HC VACCINE HEPATITITS B
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT 90747
|
| Hospital Charge Code |
943100003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Blue Shield of California Commercial |
$259.73
|
| Rate for Payer: Blue Shield of California EPN |
$169.34
|
| Rate for Payer: Cash Price |
$184.80
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$128.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.98
|
| 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: United Healthcare All Other Commercial |
$126.10
|
| Rate for Payer: United Healthcare All Other HMO |
$122.74
|
| Rate for Payer: United Healthcare HMO Rider |
$120.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.04
|
|
|
HC VACCINE INFLUENZA >3YR
|
Facility
|
IP
|
$48.83
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
942102039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$43.95 |
| Rate for Payer: Adventist Health Commercial |
$9.77
|
| Rate for Payer: Blue Shield of California Commercial |
$37.75
|
| Rate for Payer: Blue Shield of California EPN |
$24.61
|
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Central Health Plan Commercial |
$39.06
|
| Rate for Payer: Cigna of CA HMO |
$34.18
|
| Rate for Payer: Cigna of CA PPO |
$34.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.53
|
| Rate for Payer: EPIC Health Plan Senior |
$19.53
|
| Rate for Payer: Galaxy Health WC |
$41.51
|
| Rate for Payer: Global Benefits Group Commercial |
$29.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.77
|
| Rate for Payer: Multiplan Commercial |
$36.62
|
| Rate for Payer: Networks By Design Commercial |
$24.41
|
| Rate for Payer: Prime Health Services Commercial |
$41.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.33
|
| Rate for Payer: United Healthcare All Other HMO |
$17.84
|
| Rate for Payer: United Healthcare HMO Rider |
$17.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.99
|
|
|
HC VACCINE INFLUENZA >3YR
|
Facility
|
OP
|
$48.83
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
942102039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$50.94 |
| Rate for Payer: Adventist Health Commercial |
$9.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.23
|
| Rate for Payer: Blue Shield of California Commercial |
$25.88
|
| Rate for Payer: Blue Shield of California EPN |
$23.53
|
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Central Health Plan Commercial |
$39.06
|
| Rate for Payer: Cigna of CA HMO |
$34.18
|
| Rate for Payer: Cigna of CA PPO |
$34.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.53
|
| Rate for Payer: EPIC Health Plan Senior |
$19.53
|
| Rate for Payer: Galaxy Health WC |
$41.51
|
| Rate for Payer: Global Benefits Group Commercial |
$29.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.35
|
| Rate for Payer: InnovAge PACE Commercial |
$24.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.18
|
| Rate for Payer: Multiplan Commercial |
$36.62
|
| Rate for Payer: Networks By Design Commercial |
$24.41
|
| Rate for Payer: Prime Health Services Commercial |
$41.51
|
| Rate for Payer: Riverside University Health System MISP |
$19.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.33
|
| Rate for Payer: United Healthcare All Other HMO |
$17.84
|
| Rate for Payer: United Healthcare HMO Rider |
$17.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.51
|
| Rate for Payer: Vantage Medical Group Senior |
$41.51
|
|
|
HC VACCINE INFLUENZA GT 3 YR
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
941002039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.23
|
| Rate for Payer: Blue Shield of California Commercial |
$25.88
|
| Rate for Payer: Blue Shield of California EPN |
$23.53
|
| Rate for Payer: Cash Price |
$33.55
|
| Rate for Payer: Cash Price |
$33.55
|
| Rate for Payer: Central Health Plan Commercial |
$48.80
|
| Rate for Payer: Cigna of CA HMO |
$42.70
|
| Rate for Payer: Cigna of CA PPO |
$42.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Senior |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.35
|
| Rate for Payer: InnovAge PACE Commercial |
$30.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.70
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
| Rate for Payer: Networks By Design Commercial |
$30.50
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
| Rate for Payer: Riverside University Health System MISP |
$24.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.89
|
| Rate for Payer: United Healthcare All Other HMO |
$22.28
|
| Rate for Payer: United Healthcare HMO Rider |
$21.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.85
|
| Rate for Payer: Vantage Medical Group Senior |
$51.85
|
|
|
HC VACCINE INFLUENZA GT 3 YR
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
941002039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Blue Shield of California Commercial |
$47.15
|
| Rate for Payer: Blue Shield of California EPN |
$30.74
|
| Rate for Payer: Cash Price |
$33.55
|
| Rate for Payer: Central Health Plan Commercial |
$48.80
|
| Rate for Payer: Cigna of CA HMO |
$42.70
|
| Rate for Payer: Cigna of CA PPO |
$42.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Senior |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.20
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
| Rate for Payer: Networks By Design Commercial |
$30.50
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.89
|
| Rate for Payer: United Healthcare All Other HMO |
$22.28
|
| Rate for Payer: United Healthcare HMO Rider |
$21.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.98
|
|
