|
HC DT VACCINE IM LT 7 YRS
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 90702
|
| Hospital Charge Code |
900501449
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Blue Shield of California Commercial |
$40.97
|
| Rate for Payer: Blue Shield of California EPN |
$26.71
|
| Rate for Payer: Cash Price |
$29.15
|
| Rate for Payer: Central Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.20
|
| Rate for Payer: EPIC Health Plan Senior |
$21.20
|
| Rate for Payer: Galaxy Health WC |
$45.05
|
| Rate for Payer: Global Benefits Group Commercial |
$31.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.60
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Networks By Design Commercial |
$34.45
|
| Rate for Payer: Prime Health Services Commercial |
$45.05
|
|
|
HC DT VACCINE IM LT 7 YRS
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 90702
|
| Hospital Charge Code |
900501449
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$144.79 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$144.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.44
|
| Rate for Payer: Blue Shield of California Commercial |
$32.38
|
| Rate for Payer: Blue Shield of California EPN |
$21.15
|
| Rate for Payer: Cash Price |
$29.15
|
| Rate for Payer: Cash Price |
$29.15
|
| Rate for Payer: Central Health Plan Commercial |
$42.40
|
| Rate for Payer: Cigna of CA HMO |
$33.92
|
| Rate for Payer: Cigna of CA PPO |
$39.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.20
|
| Rate for Payer: EPIC Health Plan Senior |
$21.20
|
| Rate for Payer: Galaxy Health WC |
$45.05
|
| Rate for Payer: Global Benefits Group Commercial |
$31.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$118.77
|
| Rate for Payer: InnovAge PACE Commercial |
$26.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.10
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Networks By Design Commercial |
$34.45
|
| Rate for Payer: Prime Health Services Commercial |
$45.05
|
| Rate for Payer: Riverside University Health System MISP |
$21.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.50
|
| Rate for Payer: United Healthcare All Other HMO |
$26.50
|
| Rate for Payer: United Healthcare HMO Rider |
$26.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.05
|
| Rate for Payer: Vantage Medical Group Senior |
$45.05
|
|
|
HC DUCTOGRAM/ASPIRATION-2 OR MORE
|
Facility
|
OP
|
$1,134.00
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
909001446
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.67 |
| Max. Negotiated Rate |
$1,020.60 |
| Rate for Payer: Adventist Health Commercial |
$226.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$688.68
|
| 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 |
$762.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.73
|
| Rate for Payer: Blue Shield of California Commercial |
$688.34
|
| Rate for Payer: Blue Shield of California EPN |
$450.20
|
| Rate for Payer: Cash Price |
$623.70
|
| Rate for Payer: Cash Price |
$623.70
|
| Rate for Payer: Central Health Plan Commercial |
$907.20
|
| Rate for Payer: Cigna of CA HMO |
$725.76
|
| Rate for Payer: Cigna of CA PPO |
$839.16
|
| 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 |
$963.90
|
| Rate for Payer: Global Benefits Group Commercial |
$680.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,020.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$109.67
|
| 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 |
$756.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.80
|
| 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 |
$850.50
|
| Rate for Payer: Networks By Design Commercial |
$737.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$963.90
|
| 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 |
$680.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$680.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| 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 DUCTOGRAM/ASPIRATION-2 OR MORE
|
Facility
|
IP
|
$1,134.00
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
909001446
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$226.80 |
| Max. Negotiated Rate |
$1,020.60 |
| Rate for Payer: Adventist Health Commercial |
$226.80
|
| Rate for Payer: Cash Price |
$623.70
|
| Rate for Payer: Central Health Plan Commercial |
$907.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$453.60
|
| Rate for Payer: EPIC Health Plan Senior |
$453.60
|
| Rate for Payer: Galaxy Health WC |
$963.90
|
| Rate for Payer: Global Benefits Group Commercial |
$680.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,020.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$756.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$432.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$701.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.80
|
| Rate for Payer: Multiplan Commercial |
$850.50
|
| Rate for Payer: Networks By Design Commercial |
$737.10
|
| Rate for Payer: Prime Health Services Commercial |
$963.90
|
|
|
HC DUCTOGRAM/ASPIRATION- SINGLE
|
Facility
|
OP
|
$1,034.00
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
909001433
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.83 |
| Max. Negotiated Rate |
$930.60 |
| Rate for Payer: Adventist Health Commercial |
$206.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$627.95
|
| 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 |
$547.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.19
|
| Rate for Payer: Blue Shield of California Commercial |
$627.64
|
| Rate for Payer: Blue Shield of California EPN |
$410.50
|
| Rate for Payer: Cash Price |
$568.70
|
| Rate for Payer: Cash Price |
$568.70
|
| Rate for Payer: Central Health Plan Commercial |
$827.20
|
| Rate for Payer: Cigna of CA HMO |
$661.76
|
| Rate for Payer: Cigna of CA PPO |
$765.16
|
| 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 |
$878.90
|
| Rate for Payer: Global Benefits Group Commercial |
$620.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$930.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$84.83
|
| 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 |
$689.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.80
|
| 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 |
$775.50
|
| Rate for Payer: Networks By Design Commercial |
$672.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$878.90
|
| 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 |
$620.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$620.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| 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 DUCTOGRAM/ASPIRATION- SINGLE
|
Facility
|
IP
|
$1,034.00
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
909001433
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$206.80 |
| Max. Negotiated Rate |
$930.60 |
| Rate for Payer: Adventist Health Commercial |
$206.80
|
| Rate for Payer: Cash Price |
$568.70
|
| Rate for Payer: Central Health Plan Commercial |
$827.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.60
|
| Rate for Payer: EPIC Health Plan Senior |
$413.60
|
| Rate for Payer: Galaxy Health WC |
$878.90
|
| Rate for Payer: Global Benefits Group Commercial |
$620.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$930.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$689.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$393.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$640.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.80
|
| Rate for Payer: Multiplan Commercial |
$775.50
|
| Rate for Payer: Networks By Design Commercial |
$672.10
|
| Rate for Payer: Prime Health Services Commercial |
$878.90
|
|
|
HC DUODNL INT ASP DIAG INCL IG; COLL MUL SPCMNS INCL DRUG ADM
|
Facility
|
OP
|
$3,119.00
|
|
|
Service Code
|
CPT 43757
|
| Hospital Charge Code |
906743757
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$110.79 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$623.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,191.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,510.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,831.79
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,715.45
|
| Rate for Payer: Cash Price |
$1,715.45
|
| Rate for Payer: Cash Price |
$1,715.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,495.20
|
| Rate for Payer: Cigna of CA HMO |
$1,996.16
|
| Rate for Payer: Cigna of CA PPO |
$2,308.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$2,651.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,871.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,807.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$110.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,786.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,080.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$623.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,596.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$2,339.25
|
| Rate for Payer: Networks By Design Commercial |
$2,027.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Prime Health Services Commercial |
$2,651.15
|
| Rate for Payer: Prime Health Services Medicare |
$1,262.74
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,871.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC DUODNL INT ASP DIAG INCL IG; COLL MUL SPCMNS INCL DRUG ADM
|
Facility
|
IP
|
$3,119.00
|
|
|
Service Code
|
CPT 43757
|
| Hospital Charge Code |
906743757
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$623.80 |
| Max. Negotiated Rate |
$2,807.10 |
| Rate for Payer: Adventist Health Commercial |
$623.80
|
| Rate for Payer: Cash Price |
$1,715.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,495.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,247.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,247.60
|
| Rate for Payer: Galaxy Health WC |
$2,651.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,871.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,807.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,080.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,188.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,930.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$623.80
|
| Rate for Payer: Multiplan Commercial |
$2,339.25
|
| Rate for Payer: Networks By Design Commercial |
$2,027.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,651.15
|
|
|
HC DUPLEX ABD PELVIS SCROTAL CONTENTS AND OR RETROPERI ORGANS LIMITED
|
Facility
|
OP
|
$2,152.00
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
906601559
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$1,936.80 |
| Rate for Payer: Adventist Health Commercial |
$430.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,306.91
|
| 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 |
$848.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,263.87
|
| Rate for Payer: Blue Shield of California Commercial |
$1,306.26
|
| Rate for Payer: Blue Shield of California EPN |
$854.34
|
| Rate for Payer: Cash Price |
$1,183.60
|
| Rate for Payer: Cash Price |
$1,183.60
|
| Rate for Payer: Cash Price |
$1,183.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,721.60
|
| Rate for Payer: Cigna of CA HMO |
$1,377.28
|
| Rate for Payer: Cigna of CA PPO |
$1,592.48
|
| 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 |
$1,829.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,291.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,936.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$266.12
|
| 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 |
$1,435.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$430.40
|
| 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 |
$1,614.00
|
| Rate for Payer: Networks By Design Commercial |
$1,398.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,829.20
|
| 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 |
$1,291.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,291.20
|
| 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 DUPLEX ABD PELVIS SCROTAL CONTENTS AND OR RETROPERI ORGANS LIMITED
|
Facility
|
IP
|
$2,152.00
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
906601559
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$430.40 |
| Max. Negotiated Rate |
$1,936.80 |
| Rate for Payer: Adventist Health Commercial |
$430.40
|
| Rate for Payer: Cash Price |
$1,183.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,721.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$860.80
|
| Rate for Payer: EPIC Health Plan Senior |
$860.80
|
| Rate for Payer: Galaxy Health WC |
$1,829.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,291.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,936.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,435.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$819.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,332.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$430.40
|
| Rate for Payer: Multiplan Commercial |
$1,614.00
|
| Rate for Payer: Networks By Design Commercial |
$1,398.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,829.20
|
|
|
HC DUPLEX SCAN AORTA/VENA CAVA
|
Facility
|
OP
|
$2,485.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
906601159
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$282.34 |
| Max. Negotiated Rate |
$2,236.50 |
| Rate for Payer: Adventist Health Commercial |
$497.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,509.14
|
| 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 |
$1,030.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,459.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1,508.39
|
| Rate for Payer: Blue Shield of California EPN |
$986.54
|
| Rate for Payer: Cash Price |
$1,366.75
|
| Rate for Payer: Cash Price |
$1,366.75
|
| Rate for Payer: Cash Price |
$1,366.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,988.00
|
| Rate for Payer: Cigna of CA HMO |
$1,590.40
|
| Rate for Payer: Cigna of CA PPO |
$1,838.90
|
| 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 |
$2,112.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,491.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,236.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$282.34
|
| 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 |
$1,657.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.00
|
| 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 |
$1,863.75
|
| Rate for Payer: Networks By Design Commercial |
$1,615.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$2,112.25
|
| 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 |
$1,491.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,491.00
|
| 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 DUPLEX SCAN AORTA/VENA CAVA
|
Facility
|
IP
|
$2,485.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
906601159
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$497.00 |
| Max. Negotiated Rate |
$2,236.50 |
| Rate for Payer: Adventist Health Commercial |
$497.00
|
| Rate for Payer: Cash Price |
$1,366.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,988.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$994.00
|
| Rate for Payer: EPIC Health Plan Senior |
$994.00
|
| Rate for Payer: Galaxy Health WC |
$2,112.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,491.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,236.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,657.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$946.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,538.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.00
|
| Rate for Payer: Multiplan Commercial |
$1,863.75
|
| Rate for Payer: Networks By Design Commercial |
$1,615.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,112.25
|
|
|
HC DUPLX EXT VEIN BILAT
|
Facility
|
OP
|
$3,208.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
908100110
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$289.37 |
| Max. Negotiated Rate |
$2,887.20 |
| Rate for Payer: Adventist Health Commercial |
$641.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,948.22
|
| 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 |
$945.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,884.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,947.26
|
| Rate for Payer: Blue Shield of California EPN |
$1,273.58
|
| Rate for Payer: Cash Price |
$1,764.40
|
| Rate for Payer: Cash Price |
$1,764.40
|
| Rate for Payer: Cash Price |
$1,764.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,566.40
|
| Rate for Payer: Cigna of CA HMO |
$2,053.12
|
| Rate for Payer: Cigna of CA PPO |
$2,373.92
|
| 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 |
$2,726.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,924.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,887.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.37
|
| 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 |
$2,139.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$641.60
|
| 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 |
$2,406.00
|
| Rate for Payer: Networks By Design Commercial |
$2,085.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$2,726.80
|
| 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 |
$1,924.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,924.80
|
| 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 DUPLX EXT VEIN BILAT
|
Facility
|
IP
|
$3,208.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
908100110
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$641.60 |
| Max. Negotiated Rate |
$2,887.20 |
| Rate for Payer: Adventist Health Commercial |
$641.60
|
| Rate for Payer: Cash Price |
$1,764.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,566.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,283.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.20
|
| Rate for Payer: Galaxy Health WC |
$2,726.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,924.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,887.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,139.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,222.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,985.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$641.60
|
| Rate for Payer: Multiplan Commercial |
$2,406.00
|
| Rate for Payer: Networks By Design Commercial |
$2,085.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,726.80
|
|
|
HC DUPLX EXT VEIN UNILAT
|
Facility
|
OP
|
$2,019.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
908100124
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$1,817.10 |
| Rate for Payer: Adventist Health Commercial |
$403.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,226.14
|
| 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 |
$737.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,185.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,225.53
|
| Rate for Payer: Blue Shield of California EPN |
$801.54
|
| Rate for Payer: Cash Price |
$1,110.45
|
| Rate for Payer: Cash Price |
$1,110.45
|
| Rate for Payer: Cash Price |
$1,110.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,615.20
|
| Rate for Payer: Cigna of CA HMO |
$1,292.16
|
| Rate for Payer: Cigna of CA PPO |
$1,494.06
|
| 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 |
$1,716.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,211.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,817.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$145.44
|
| 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 |
$1,346.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.80
|
| 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 |
$1,514.25
|
| Rate for Payer: Networks By Design Commercial |
$1,312.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,716.15
|
| 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 |
$1,211.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,211.40
|
| 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 |
$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 DUPLX EXT VEIN UNILAT
|
Facility
|
IP
|
$2,019.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
908100124
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$403.80 |
| Max. Negotiated Rate |
$1,817.10 |
| Rate for Payer: Adventist Health Commercial |
$403.80
|
| Rate for Payer: Cash Price |
$1,110.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$807.60
|
| Rate for Payer: EPIC Health Plan Senior |
$807.60
|
| Rate for Payer: Galaxy Health WC |
$1,716.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,211.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,817.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,346.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$769.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,249.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.80
|
| Rate for Payer: Multiplan Commercial |
$1,514.25
|
| Rate for Payer: Networks By Design Commercial |
$1,312.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,716.15
|
|
|
HC DUPLX LO EXT ARTERY BILAT
|
Facility
|
IP
|
$2,916.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
908100106
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$583.20 |
| Max. Negotiated Rate |
$2,624.40 |
| Rate for Payer: Adventist Health Commercial |
$583.20
|
| Rate for Payer: Cash Price |
$1,603.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,332.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,166.40
|
| Rate for Payer: Galaxy Health WC |
$2,478.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,749.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,624.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,944.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,111.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,805.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.20
|
| Rate for Payer: Multiplan Commercial |
$2,187.00
|
| Rate for Payer: Networks By Design Commercial |
$1,895.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,478.60
|
|
|
HC DUPLX LO EXT ARTERY BILAT
|
Facility
|
OP
|
$2,916.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
908100106
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$166.62 |
| Max. Negotiated Rate |
$2,624.40 |
| Rate for Payer: Adventist Health Commercial |
$583.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,770.89
|
| 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 |
$999.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,712.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1,770.01
|
| Rate for Payer: Blue Shield of California EPN |
$1,157.65
|
| Rate for Payer: Cash Price |
$1,603.80
|
| Rate for Payer: Cash Price |
$1,603.80
|
| Rate for Payer: Cash Price |
$1,603.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,332.80
|
| Rate for Payer: Cigna of CA HMO |
$1,866.24
|
| Rate for Payer: Cigna of CA PPO |
$2,157.84
|
| 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 |
$2,478.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,749.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,624.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$166.62
|
| 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 |
$1,944.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.20
|
| 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 |
$2,187.00
|
| Rate for Payer: Networks By Design Commercial |
$1,895.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$2,478.60
|
| 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 |
$1,749.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,749.60
|
| 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 |
$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 DUPLX LO EXT ARTERY UNI
|
Facility
|
OP
|
$2,093.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
908100123
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$1,883.70 |
| Rate for Payer: Adventist Health Commercial |
$418.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,271.08
|
| 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 |
$667.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,229.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,270.45
|
| Rate for Payer: Blue Shield of California EPN |
$830.92
|
| Rate for Payer: Cash Price |
$1,151.15
|
| Rate for Payer: Cash Price |
$1,151.15
|
| Rate for Payer: Cash Price |
$1,151.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,674.40
|
| Rate for Payer: Cigna of CA HMO |
$1,339.52
|
| Rate for Payer: Cigna of CA PPO |
$1,548.82
|
| 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 |
$1,779.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,255.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,883.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$146.01
|
| 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 |
$1,396.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.60
|
| 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 |
$1,569.75
|
| Rate for Payer: Networks By Design Commercial |
$1,360.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,779.05
|
| 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 |
$1,255.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,255.80
|
| 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 DUPLX LO EXT ARTERY UNI
|
Facility
|
IP
|
$2,093.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
908100123
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$418.60 |
| Max. Negotiated Rate |
$1,883.70 |
| Rate for Payer: Adventist Health Commercial |
$418.60
|
| Rate for Payer: Cash Price |
$1,151.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,674.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$837.20
|
| Rate for Payer: EPIC Health Plan Senior |
$837.20
|
| Rate for Payer: Galaxy Health WC |
$1,779.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,255.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,883.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,396.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$797.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,295.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.60
|
| Rate for Payer: Multiplan Commercial |
$1,569.75
|
| Rate for Payer: Networks By Design Commercial |
$1,360.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,779.05
|
|
|
HC DUPLX UP EXT ARTERY BILAT
|
Facility
|
OP
|
$2,770.00
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
908100105
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$159.98 |
| Max. Negotiated Rate |
$2,493.00 |
| Rate for Payer: Adventist Health Commercial |
$554.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,682.22
|
| 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 |
$1,057.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,626.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1,681.39
|
| Rate for Payer: Blue Shield of California EPN |
$1,099.69
|
| Rate for Payer: Cash Price |
$1,523.50
|
| Rate for Payer: Cash Price |
$1,523.50
|
| Rate for Payer: Cash Price |
$1,523.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,216.00
|
| Rate for Payer: Cigna of CA HMO |
$1,772.80
|
| Rate for Payer: Cigna of CA PPO |
$2,049.80
|
| 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 |
$2,354.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,662.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,493.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$159.98
|
| 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 |
$1,847.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.00
|
| 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 |
$2,077.50
|
| Rate for Payer: Networks By Design Commercial |
$1,800.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$2,354.50
|
| 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 |
$1,662.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,662.00
|
| 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 DUPLX UP EXT ARTERY BILAT
|
Facility
|
IP
|
$2,770.00
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
908100105
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$554.00 |
| Max. Negotiated Rate |
$2,493.00 |
| Rate for Payer: Adventist Health Commercial |
$554.00
|
| Rate for Payer: Cash Price |
$1,523.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,216.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,108.00
|
| Rate for Payer: Galaxy Health WC |
$2,354.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,662.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,493.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,847.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,055.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,714.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.00
|
| Rate for Payer: Multiplan Commercial |
$2,077.50
|
| Rate for Payer: Networks By Design Commercial |
$1,800.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,354.50
|
|
|
HC DUPLX UP EXT ARTERY UNI
|
Facility
|
OP
|
$2,323.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
908100120
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,090.70 |
| Rate for Payer: Adventist Health Commercial |
$464.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,410.76
|
| 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 |
$703.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,364.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,410.06
|
| Rate for Payer: Blue Shield of California EPN |
$922.23
|
| Rate for Payer: Cash Price |
$1,277.65
|
| Rate for Payer: Cash Price |
$1,277.65
|
| Rate for Payer: Cash Price |
$1,277.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,858.40
|
| Rate for Payer: Cigna of CA HMO |
$1,486.72
|
| Rate for Payer: Cigna of CA PPO |
$1,719.02
|
| 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 |
$1,974.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,393.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,090.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$142.52
|
| 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 |
$1,549.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.60
|
| 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 |
$1,742.25
|
| Rate for Payer: Networks By Design Commercial |
$1,509.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,974.55
|
| 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 |
$1,393.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,393.80
|
| 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 DUPLX UP EXT ARTERY UNI
|
Facility
|
IP
|
$2,323.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
908100120
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$464.60 |
| Max. Negotiated Rate |
$2,090.70 |
| Rate for Payer: Adventist Health Commercial |
$464.60
|
| Rate for Payer: Cash Price |
$1,277.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,858.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.20
|
| Rate for Payer: EPIC Health Plan Senior |
$929.20
|
| Rate for Payer: Galaxy Health WC |
$1,974.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,393.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,090.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,549.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$885.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,437.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.60
|
| Rate for Payer: Multiplan Commercial |
$1,742.25
|
| Rate for Payer: Networks By Design Commercial |
$1,509.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,974.55
|
|
|
HC DUP SCAN EXTRACRANIAL ART COMPLEX
|
Facility
|
IP
|
$1,964.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
908100102
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$392.80 |
| Max. Negotiated Rate |
$1,767.60 |
| Rate for Payer: Adventist Health Commercial |
$392.80
|
| Rate for Payer: Cash Price |
$1,080.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,571.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$785.60
|
| Rate for Payer: EPIC Health Plan Senior |
$785.60
|
| Rate for Payer: Galaxy Health WC |
$1,669.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,178.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,767.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,309.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$748.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,215.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.80
|
| Rate for Payer: Multiplan Commercial |
$1,473.00
|
| Rate for Payer: Networks By Design Commercial |
$1,276.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,669.40
|
|
