|
HC CARDIOLITE PERFUSION SCAN 1 DY
|
Facility
|
IP
|
$7,019.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
909301562
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,684.56 |
| Max. Negotiated Rate |
$5,966.15 |
| Rate for Payer: Cash Price |
$3,158.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,807.60
|
| Rate for Payer: Galaxy Health WC |
$5,966.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,211.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,681.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,674.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,684.56
|
| Rate for Payer: Multiplan Commercial |
$5,615.20
|
| Rate for Payer: Networks By Design Commercial |
$4,562.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,966.15
|
|
|
HC CARDIOLITE PERFUSION SCAN 1 DY
|
Facility
|
OP
|
$7,019.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
909301562
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$661.43 |
| Max. Negotiated Rate |
$5,966.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,543.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,181.92
|
| Rate for Payer: Blue Distinction Transplant |
$4,211.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,148.23
|
| Rate for Payer: Blue Shield of California EPN |
$3,291.91
|
| Rate for Payer: Cash Price |
$3,158.55
|
| Rate for Payer: Cash Price |
$3,158.55
|
| Rate for Payer: Cigna of CA HMO |
$4,492.16
|
| Rate for Payer: Cigna of CA PPO |
$5,194.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Dignity Health Media |
$1,774.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,395.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,774.15
|
| Rate for Payer: Galaxy Health WC |
$5,966.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,211.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,264.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,909.61
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,909.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,874.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$2,874.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,774.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,681.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,774.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,684.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,235.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,377.36
|
| Rate for Payer: Multiplan Commercial |
$5,615.20
|
| Rate for Payer: Networks By Design Commercial |
$4,562.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,966.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,211.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,211.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,721.55
|
| Rate for Payer: United Healthcare All Other HMO |
$1,721.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,721.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,721.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
|
HC CARDIOPULMONARY RESUSCITATION
|
Facility
|
OP
|
$4,170.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
906812198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$218.50 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,502.00
|
| Rate for Payer: Cash Price |
$1,876.50
|
| Rate for Payer: Cash Price |
$1,876.50
|
| Rate for Payer: Cash Price |
$1,876.50
|
| Rate for Payer: Cigna of CA PPO |
$3,085.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$3,544.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,502.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,127.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,781.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: Networks By Design Commercial |
$2,710.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,544.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,502.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,085.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,085.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,085.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,085.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC CARDIOPULMONARY RESUSCITATION
|
Facility
|
IP
|
$4,170.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
906812198
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,000.80 |
| Max. Negotiated Rate |
$3,544.50 |
| Rate for Payer: Cash Price |
$1,876.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,668.00
|
| Rate for Payer: Galaxy Health WC |
$3,544.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,502.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,781.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,588.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.80
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: Networks By Design Commercial |
$2,710.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,544.50
|
|
|
HC CARDIOPULMONARY RESUSCITATION
|
Facility
|
OP
|
$4,170.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
906812198
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$218.50 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,118.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,502.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$1,876.50
|
| Rate for Payer: Cash Price |
$1,876.50
|
| Rate for Payer: Cash Price |
$1,876.50
|
| Rate for Payer: Cigna of CA HMO |
$2,668.80
|
| Rate for Payer: Cigna of CA PPO |
$3,085.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$3,544.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,502.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,127.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,781.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: Networks By Design Commercial |
$2,710.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,544.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,502.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,502.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC CARDIOPULMONARY RESUSCITATION
|
Facility
|
OP
|
$4,170.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
900802005
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$218.50 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,118.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,502.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$1,876.50
|
| Rate for Payer: Cash Price |
$1,876.50
|
| Rate for Payer: Cash Price |
$1,876.50
|
| Rate for Payer: Cigna of CA HMO |
$2,668.80
|
| Rate for Payer: Cigna of CA PPO |
$3,085.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$3,544.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,502.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,127.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,781.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: Networks By Design Commercial |
$2,710.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,544.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,502.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,502.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC CARDIOPULMONARY RESUSCITATION
|
Facility
|
IP
|
$4,170.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
906812198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,000.80 |
| Max. Negotiated Rate |
$3,544.50 |
| Rate for Payer: Cash Price |
$1,876.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,668.00
|
| Rate for Payer: Galaxy Health WC |
$3,544.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,502.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,781.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,588.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.80
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: Networks By Design Commercial |
$2,710.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,544.50
|
|
|
HC CARDIOPULMONARY RESUSCITATION
|
Facility
|
OP
|
$4,170.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
906812198
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$218.50 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,118.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,502.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$1,876.50
|
| Rate for Payer: Cash Price |
$1,876.50
|
| Rate for Payer: Cash Price |
$1,876.50
|
| Rate for Payer: Cigna of CA PPO |
$3,085.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$3,544.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,502.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,127.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,781.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: Networks By Design Commercial |
$2,710.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,544.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,502.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,502.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC CARDIOPULMONARY RESUSCITATION
|
Facility
|
IP
|
$4,170.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
906812198
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,000.80 |
| Max. Negotiated Rate |
$3,544.50 |
| Rate for Payer: Cash Price |
$1,876.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,668.00
|
| Rate for Payer: Galaxy Health WC |
$3,544.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,502.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,781.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,588.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.80
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: Networks By Design Commercial |
$2,710.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,544.50
|
|
|
HC CARDIOPULMONARY RESUSCITATION
|
Facility
|
IP
|
$4,170.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
900802005
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,000.80 |
| Max. Negotiated Rate |
$3,544.50 |
| Rate for Payer: Cash Price |
$1,876.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,668.00
|
| Rate for Payer: Galaxy Health WC |
$3,544.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,502.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,781.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,588.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.80
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: Networks By Design Commercial |
$2,710.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,544.50
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
OP
|
$5,256.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900802000
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$232.67 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$841.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$813.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,153.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cigna of CA HMO |
$3,363.84
|
| Rate for Payer: Cigna of CA PPO |
$3,889.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Dignity Health Media |
$813.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,097.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$813.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$813.16
|
| Rate for Payer: Galaxy Health WC |
$4,467.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,153.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,942.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,333.58
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,333.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,317.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,317.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$813.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,505.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$813.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,261.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,024.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,089.63
|
| Rate for Payer: Multiplan Commercial |
$4,204.80
|
| Rate for Payer: Networks By Design Commercial |
$3,416.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,467.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,153.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,153.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Vantage Medical Group Senior |
$813.16
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
IP
|
$5,256.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900802000
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,261.44 |
| Max. Negotiated Rate |
$4,467.60 |
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,102.40
|
| Rate for Payer: Galaxy Health WC |
$4,467.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,153.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,505.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,002.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,261.44
|
| Rate for Payer: Multiplan Commercial |
$4,204.80
|
| Rate for Payer: Networks By Design Commercial |
$3,416.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,467.60
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
IP
|
$5,256.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900802140
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,261.44 |
| Max. Negotiated Rate |
$4,467.60 |
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,102.40
|
| Rate for Payer: Galaxy Health WC |
$4,467.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,153.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,505.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,002.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,261.44
|
| Rate for Payer: Multiplan Commercial |
$4,204.80
|
| Rate for Payer: Networks By Design Commercial |
$3,416.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,467.60
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
OP
|
$5,256.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900200140
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$232.67 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$813.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,153.60
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cigna of CA PPO |
$3,889.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Dignity Health Media |
$813.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,097.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$813.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$813.16
|
| Rate for Payer: Galaxy Health WC |
$4,467.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,153.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,942.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,333.58
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,333.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$813.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,505.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$813.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,261.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,024.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,089.63
|
| Rate for Payer: Multiplan Commercial |
$4,204.80
|
| Rate for Payer: Networks By Design Commercial |
$3,416.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,467.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,153.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,628.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,628.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,628.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,628.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Vantage Medical Group Senior |
$813.16
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
OP
|
$5,256.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900802140
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$232.67 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$841.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$813.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,153.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cigna of CA HMO |
$3,363.84
|
| Rate for Payer: Cigna of CA PPO |
$3,889.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Dignity Health Media |
$813.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,097.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$813.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$813.16
|
| Rate for Payer: Galaxy Health WC |
$4,467.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,153.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,942.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,333.58
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,333.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,317.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,317.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$813.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,505.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$813.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,261.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,024.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,089.63
|
| Rate for Payer: Multiplan Commercial |
$4,204.80
|
| Rate for Payer: Networks By Design Commercial |
$3,416.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,467.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,153.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,153.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Vantage Medical Group Senior |
$813.16
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
OP
|
$5,256.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900200140
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$232.67 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$841.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$813.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,153.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cigna of CA HMO |
$3,363.84
|
| Rate for Payer: Cigna of CA PPO |
$3,889.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Dignity Health Media |
$813.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,097.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$813.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$813.16
|
| Rate for Payer: Galaxy Health WC |
$4,467.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,153.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,942.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,333.58
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,333.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,317.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,317.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$813.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,505.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$813.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,261.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,024.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,089.63
|
| Rate for Payer: Multiplan Commercial |
$4,204.80
|
| Rate for Payer: Networks By Design Commercial |
$3,416.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,467.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,153.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,153.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Vantage Medical Group Senior |
$813.16
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
IP
|
$5,256.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900200140
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,261.44 |
| Max. Negotiated Rate |
$4,467.60 |
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,102.40
|
| Rate for Payer: Galaxy Health WC |
$4,467.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,153.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,505.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,002.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,261.44
|
| Rate for Payer: Multiplan Commercial |
$4,204.80
|
| Rate for Payer: Networks By Design Commercial |
$3,416.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,467.60
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
IP
|
$5,256.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900200140
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,261.44 |
| Max. Negotiated Rate |
$4,467.60 |
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,102.40
|
| Rate for Payer: Galaxy Health WC |
$4,467.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,153.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,505.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,002.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,261.44
|
| Rate for Payer: Multiplan Commercial |
$4,204.80
|
| Rate for Payer: Networks By Design Commercial |
$3,416.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,467.60
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT MCAL
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
907000005
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$178.08 |
| Max. Negotiated Rate |
$907.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$458.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$830.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$608.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$553.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$445.20
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cigna of CA HMO |
$474.88
|
| Rate for Payer: Cigna of CA PPO |
$549.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$830.08
|
| Rate for Payer: Dignity Health Media |
$553.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$608.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$553.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$553.39
|
| Rate for Payer: Galaxy Health WC |
$630.70
|
| Rate for Payer: Global Benefits Group Commercial |
$445.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$556.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$907.56
|
| Rate for Payer: Heritage Provider Network Transplant |
$907.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$896.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$896.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$553.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$494.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$553.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$697.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$741.54
|
| Rate for Payer: Multiplan Commercial |
$593.60
|
| Rate for Payer: Networks By Design Commercial |
$482.30
|
| Rate for Payer: Prime Health Services Commercial |
$630.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$445.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$664.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$830.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$608.73
|
| Rate for Payer: Vantage Medical Group Senior |
$553.39
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT MCAL
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
907000005
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$178.08 |
| Max. Negotiated Rate |
$630.70 |
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.80
|
| Rate for Payer: Galaxy Health WC |
$630.70
|
| Rate for Payer: Global Benefits Group Commercial |
$445.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$494.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.08
|
| Rate for Payer: Multiplan Commercial |
$593.60
|
| Rate for Payer: Networks By Design Commercial |
$482.30
|
| Rate for Payer: Prime Health Services Commercial |
$630.70
|
|
|
HC CATECHOLAMINES UR FRACTIONATED
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900910455
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$209.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$230.40
|
| Rate for Payer: Blue Distinction Transplant |
$57.60
|
| Rate for Payer: Blue Shield of California Commercial |
$62.02
|
| Rate for Payer: Blue Shield of California EPN |
$49.15
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna of CA HMO |
$61.44
|
| Rate for Payer: Cigna of CA PPO |
$71.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.88
|
| Rate for Payer: Dignity Health Media |
$25.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.09
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.25
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$72.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.41
|
| Rate for Payer: Heritage Provider Network Transplant |
$41.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$40.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.84
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.46
|
| Rate for Payer: United Healthcare All Other HMO |
$20.46
|
| Rate for Payer: United Healthcare HMO Rider |
$20.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.78
|
| Rate for Payer: Vantage Medical Group Senior |
$25.25
|
|
|
HC CATH DIALYSIS CRCT W STNT PLC
|
Facility
|
OP
|
$34,466.00
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
909036903
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,244.75 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$20,679.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,058.23
|
| Rate for Payer: Blue Shield of California EPN |
$5,244.75
|
| Rate for Payer: Cash Price |
$15,509.70
|
| Rate for Payer: Cash Price |
$15,509.70
|
| Rate for Payer: Cigna of CA PPO |
$25,504.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Media |
$13,745.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$29,296.10
|
| Rate for Payer: Global Benefits Group Commercial |
$20,679.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$25,849.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,542.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$22,542.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22,267.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$22,267.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,988.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,832.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,271.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$27,572.80
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: Networks By Design Commercial |
$22,402.90
|
| Rate for Payer: Prime Health Services Commercial |
$29,296.10
|
| Rate for Payer: Prime Health Services WC |
$18,599.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,679.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC CATH DIALYSIS CRCT W STNT PLC
|
Facility
|
IP
|
$34,466.00
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
909036903
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,271.84 |
| Max. Negotiated Rate |
$29,296.10 |
| Rate for Payer: Cash Price |
$15,509.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,786.40
|
| Rate for Payer: Galaxy Health WC |
$29,296.10
|
| Rate for Payer: Global Benefits Group Commercial |
$20,679.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,988.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,131.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,271.84
|
| Rate for Payer: Multiplan Commercial |
$27,572.80
|
| Rate for Payer: Networks By Design Commercial |
$22,402.90
|
| Rate for Payer: Prime Health Services Commercial |
$29,296.10
|
|
|
HC CATH DIALYSIS CRCT W TRNS BLLN
|
Facility
|
OP
|
$14,959.00
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
909036902
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,112.91 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,975.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,058.23
|
| Rate for Payer: Blue Shield of California EPN |
$5,244.75
|
| Rate for Payer: Cash Price |
$6,731.55
|
| Rate for Payer: Cash Price |
$6,731.55
|
| Rate for Payer: Cigna of CA PPO |
$11,069.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Media |
$7,141.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,640.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,141.35
|
| Rate for Payer: Galaxy Health WC |
$12,715.15
|
| Rate for Payer: Global Benefits Group Commercial |
$8,975.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,219.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,711.81
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,711.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,568.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11,568.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,141.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,977.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,112.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,141.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,590.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,998.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,569.41
|
| Rate for Payer: Multiplan Commercial |
$11,967.20
|
| Rate for Payer: Networks By Design Commercial |
$9,723.35
|
| Rate for Payer: Prime Health Services Commercial |
$12,715.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,975.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC CATH DIALYSIS CRCT W TRNS BLLN
|
Facility
|
IP
|
$14,959.00
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
909036902
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,590.16 |
| Max. Negotiated Rate |
$12,715.15 |
| Rate for Payer: Cash Price |
$6,731.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,983.60
|
| Rate for Payer: Galaxy Health WC |
$12,715.15
|
| Rate for Payer: Global Benefits Group Commercial |
$8,975.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,977.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,699.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,590.16
|
| Rate for Payer: Multiplan Commercial |
$11,967.20
|
| Rate for Payer: Networks By Design Commercial |
$9,723.35
|
| Rate for Payer: Prime Health Services Commercial |
$12,715.15
|
|
