|
HC CONG RT HEART CONG NML NAT
|
Facility
|
OP
|
$7,034.00
|
|
|
Service Code
|
CPT 93593
|
| Hospital Charge Code |
906811593
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,688.16 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,628.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,220.40
|
| 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 |
$3,165.30
|
| Rate for Payer: Cash Price |
$3,165.30
|
| Rate for Payer: Cash Price |
$3,165.30
|
| Rate for Payer: Cigna of CA PPO |
$5,205.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Media |
$4,071.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,071.36
|
| Rate for Payer: Galaxy Health WC |
$5,978.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,220.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,275.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,677.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,677.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,595.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,595.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,071.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,691.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,688.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,129.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,455.62
|
| Rate for Payer: Multiplan Commercial |
$5,627.20
|
| Rate for Payer: Networks By Design Commercial |
$4,572.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,978.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,220.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,220.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC CONG RT HEART CONG NML NAT
|
Facility
|
IP
|
$7,034.00
|
|
|
Service Code
|
CPT 93593
|
| Hospital Charge Code |
906811593
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,688.16 |
| Max. Negotiated Rate |
$5,978.90 |
| Rate for Payer: Cash Price |
$3,165.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,813.60
|
| Rate for Payer: Galaxy Health WC |
$5,978.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,220.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,691.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,679.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,688.16
|
| Rate for Payer: Multiplan Commercial |
$5,627.20
|
| Rate for Payer: Networks By Design Commercial |
$4,572.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,978.90
|
|
|
HC CONSULT WITH SLIDE PREP
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 88323
|
| Hospital Charge Code |
903800034
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.08 |
| Max. Negotiated Rate |
$373.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$373.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.75
|
| Rate for Payer: Blue Distinction Transplant |
$100.20
|
| Rate for Payer: Blue Shield of California Commercial |
$107.88
|
| Rate for Payer: Blue Shield of California EPN |
$85.50
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Cigna of CA HMO |
$106.88
|
| Rate for Payer: Cigna of CA PPO |
$123.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.55
|
| Rate for Payer: Dignity Health Media |
$67.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$67.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$67.70
|
| Rate for Payer: Galaxy Health WC |
$141.95
|
| Rate for Payer: Global Benefits Group Commercial |
$100.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$125.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$111.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$109.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$109.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.72
|
| Rate for Payer: Multiplan Commercial |
$133.60
|
| Rate for Payer: Networks By Design Commercial |
$108.55
|
| Rate for Payer: Prime Health Services Commercial |
$141.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Vantage Medical Group Senior |
$67.70
|
|
|
HC CONSULT WITH SLIDE PREP
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
CPT 88323
|
| Hospital Charge Code |
903800034
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$488.75 |
| Rate for Payer: Cash Price |
$258.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.00
|
| Rate for Payer: Galaxy Health WC |
$488.75
|
| Rate for Payer: Global Benefits Group Commercial |
$345.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$383.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.00
|
| Rate for Payer: Multiplan Commercial |
$460.00
|
| Rate for Payer: Networks By Design Commercial |
$373.75
|
| Rate for Payer: Prime Health Services Commercial |
$488.75
|
|
|
HC CONT GLUC MNTR PT PROV EQP
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 95249
|
| Hospital Charge Code |
900095249
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$383.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.12
|
| Rate for Payer: Blue Distinction Transplant |
$126.00
|
| Rate for Payer: Blue Shield of California Commercial |
$124.11
|
| Rate for Payer: Blue Shield of California EPN |
$98.49
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$157.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$969.00
|
| Rate for Payer: United Healthcare All Other HMO |
$765.00
|
| Rate for Payer: United Healthcare HMO Rider |
$579.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC CONT GLUC MNTR PT PROV EQP
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 95249
|
| Hospital Charge Code |
900095249
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
|
|
HC CONT INHAL TRT W/AERO 1ST HR
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
900800012
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$90.72 |
| Max. Negotiated Rate |
$321.30 |
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.20
|
| Rate for Payer: Galaxy Health WC |
$321.30
|
| Rate for Payer: Global Benefits Group Commercial |
$226.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.72
|
| Rate for Payer: Multiplan Commercial |
$302.40
|
| Rate for Payer: Networks By Design Commercial |
$245.70
|
| Rate for Payer: Prime Health Services Commercial |
$321.30
|
|
|
HC CONT INHAL TRT W/AERO 1ST HR
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
900800012
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$32.30 |
| Max. Negotiated Rate |
$509.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$275.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$226.80
|
| 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 |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna of CA HMO |
$241.92
|
| Rate for Payer: Cigna of CA PPO |
$279.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$321.30
|
| Rate for Payer: Global Benefits Group Commercial |
$226.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$283.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$258.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$258.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$302.40
|
| Rate for Payer: Networks By Design Commercial |
$245.70
|
| Rate for Payer: Prime Health Services Commercial |
$321.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC CONT INHAL TRT W/AERO ADD HR
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
900800013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$67.68 |
| Max. Negotiated Rate |
$239.70 |
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
|
|
HC CONT INHAL TRT W/AERO ADD HR
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
900800013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$23.56 |
| Max. Negotiated Rate |
$509.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$99.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$155.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$155.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$169.20
|
| 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 |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna of CA HMO |
$180.48
|
| Rate for Payer: Cigna of CA PPO |
$208.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.70
|
| Rate for Payer: Dignity Health Media |
$239.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$211.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.70
|
| Rate for Payer: Vantage Medical Group Senior |
$239.70
|
|
|
HC CONTINOUS RENAL REPLACE THERAPY
|
Facility
|
IP
|
$1,064.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
948000105
|
|
Hospital Revenue Code
|
880
|
| Min. Negotiated Rate |
$255.36 |
| Max. Negotiated Rate |
$904.40 |
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.60
|
| Rate for Payer: Galaxy Health WC |
$904.40
|
| Rate for Payer: Global Benefits Group Commercial |
$638.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$709.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$405.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.36
|
| Rate for Payer: Multiplan Commercial |
$851.20
|
| Rate for Payer: Networks By Design Commercial |
$691.60
|
| Rate for Payer: Prime Health Services Commercial |
$904.40
|
|
|
HC CONTINOUS RENAL REPLACE THERAPY
|
Facility
|
OP
|
$1,064.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
948000105
|
|
Hospital Revenue Code
|
880
|
| Min. Negotiated Rate |
$137.10 |
| Max. Negotiated Rate |
$907.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$539.00
|
| 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 |
$633.93
|
| Rate for Payer: Blue Distinction Transplant |
$638.40
|
| Rate for Payer: Blue Shield of California Commercial |
$784.17
|
| Rate for Payer: Blue Shield of California EPN |
$621.38
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: Cigna of CA HMO |
$680.96
|
| Rate for Payer: Cigna of CA PPO |
$787.36
|
| 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 |
$904.40
|
| Rate for Payer: Global Benefits Group Commercial |
$638.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$798.00
|
| 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 |
$709.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$553.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.36
|
| 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 |
$851.20
|
| Rate for Payer: Networks By Design Commercial |
$691.60
|
| Rate for Payer: Prime Health Services Commercial |
$904.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$638.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$638.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$532.00
|
| Rate for Payer: United Healthcare All Other HMO |
$532.00
|
| Rate for Payer: United Healthcare HMO Rider |
$532.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$532.00
|
| 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 CONT OROPHARYN HEMOR, SIMPLE
|
Facility
|
IP
|
$1,021.00
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
900501252
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$245.04 |
| Max. Negotiated Rate |
$867.85 |
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$408.40
|
| Rate for Payer: Galaxy Health WC |
$867.85
|
| Rate for Payer: Global Benefits Group Commercial |
$612.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$681.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.04
|
| Rate for Payer: Multiplan Commercial |
$816.80
|
| Rate for Payer: Networks By Design Commercial |
$663.65
|
| Rate for Payer: Prime Health Services Commercial |
$867.85
|
|
|
HC CONT OROPHARYN HEMOR, SIMPLE
|
Facility
|
OP
|
$1,021.00
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
900501252
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.77 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$612.60
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Cigna of CA PPO |
$755.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Media |
$687.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.44
|
| Rate for Payer: Galaxy Health WC |
$867.85
|
| Rate for Payer: Global Benefits Group Commercial |
$612.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$765.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,127.40
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,127.40
|
| 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 |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$681.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$921.17
|
| Rate for Payer: Multiplan Commercial |
$816.80
|
| Rate for Payer: Networks By Design Commercial |
$663.65
|
| Rate for Payer: Prime Health Services Commercial |
$867.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$612.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$510.50
|
| Rate for Payer: United Healthcare All Other HMO |
$510.50
|
| Rate for Payer: United Healthcare HMO Rider |
$510.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$510.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC CONTRAST BATHS 15 MIN MCAL
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
900400028
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.04 |
| Max. Negotiated Rate |
$124.10 |
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.40
|
| Rate for Payer: Galaxy Health WC |
$124.10
|
| Rate for Payer: Global Benefits Group Commercial |
$87.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$97.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.04
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: Networks By Design Commercial |
$94.90
|
| Rate for Payer: Prime Health Services Commercial |
$124.10
|
|
|
HC CONTRAST BATHS 15 MIN MCAL
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
900400028
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$76.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$87.60
|
| 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 |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna of CA HMO |
$93.44
|
| Rate for Payer: Cigna of CA PPO |
$108.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.10
|
| Rate for Payer: Dignity Health Media |
$124.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$58.40
|
| Rate for Payer: Galaxy Health WC |
$124.10
|
| Rate for Payer: Global Benefits Group Commercial |
$87.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$109.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$97.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.04
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: Networks By Design Commercial |
$94.90
|
| Rate for Payer: Prime Health Services Commercial |
$124.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.60
|
| 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 |
$124.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.10
|
| Rate for Payer: Vantage Medical Group Senior |
$124.10
|
|
|
HC CONTRAST BATHS 15 MIN MCAL
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
901300051
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$35.04 |
| Max. Negotiated Rate |
$124.10 |
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.40
|
| Rate for Payer: Galaxy Health WC |
$124.10
|
| Rate for Payer: Global Benefits Group Commercial |
$87.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$97.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.04
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: Networks By Design Commercial |
$94.90
|
| Rate for Payer: Prime Health Services Commercial |
$124.10
|
|
|
HC CONTRAST BATHS 15 MIN MCAL
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
901300051
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$76.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$87.60
|
| 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 |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna of CA HMO |
$93.44
|
| Rate for Payer: Cigna of CA PPO |
$108.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.10
|
| Rate for Payer: Dignity Health Media |
$124.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$58.40
|
| Rate for Payer: Galaxy Health WC |
$124.10
|
| Rate for Payer: Global Benefits Group Commercial |
$87.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$109.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$97.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.04
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: Networks By Design Commercial |
$94.90
|
| Rate for Payer: Prime Health Services Commercial |
$124.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.60
|
| 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 |
$124.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.10
|
| Rate for Payer: Vantage Medical Group Senior |
$124.10
|
|
|
HC CONTRAST BATHS 15 MIN MCARE COMM
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
900407034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$76.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$87.60
|
| 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 |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna of CA HMO |
$93.44
|
| Rate for Payer: Cigna of CA PPO |
$108.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.10
|
| Rate for Payer: Dignity Health Media |
$124.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$58.40
|
| Rate for Payer: Galaxy Health WC |
$124.10
|
| Rate for Payer: Global Benefits Group Commercial |
$87.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$109.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$97.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.04
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: Networks By Design Commercial |
$94.90
|
| Rate for Payer: Prime Health Services Commercial |
$124.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.60
|
| 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 |
$124.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.10
|
| Rate for Payer: Vantage Medical Group Senior |
$124.10
|
|
|
HC CONTRAST BATHS 15 MIN MCARE COMM
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
900407034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.04 |
| Max. Negotiated Rate |
$124.10 |
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.40
|
| Rate for Payer: Galaxy Health WC |
$124.10
|
| Rate for Payer: Global Benefits Group Commercial |
$87.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$97.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.04
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: Networks By Design Commercial |
$94.90
|
| Rate for Payer: Prime Health Services Commercial |
$124.10
|
|
|
HC CORDOCENTESIS INTRAUTERINE PUBS
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400084
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$226.80 |
| Max. Negotiated Rate |
$803.25 |
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.00
|
| Rate for Payer: Galaxy Health WC |
$803.25
|
| Rate for Payer: Global Benefits Group Commercial |
$567.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$630.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.80
|
| Rate for Payer: Multiplan Commercial |
$756.00
|
| Rate for Payer: Networks By Design Commercial |
$614.25
|
| Rate for Payer: Prime Health Services Commercial |
$803.25
|
|
|
HC CORDOCENTESIS INTRAUTERINE PUBS
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400084
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.80 |
| Max. Negotiated Rate |
$803.25 |
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.00
|
| Rate for Payer: Galaxy Health WC |
$803.25
|
| Rate for Payer: Global Benefits Group Commercial |
$567.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$630.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.80
|
| Rate for Payer: Multiplan Commercial |
$756.00
|
| Rate for Payer: Networks By Design Commercial |
$614.25
|
| Rate for Payer: Prime Health Services Commercial |
$803.25
|
|
|
HC CORDOCENTESIS INTRAUTERINE PUBS
|
Facility
|
OP
|
$945.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400084
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$226.80 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,272.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$567.00
|
| Rate for Payer: Blue Shield of California Commercial |
$696.46
|
| Rate for Payer: Blue Shield of California EPN |
$551.88
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Cigna of CA HMO |
$604.80
|
| Rate for Payer: Cigna of CA PPO |
$699.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Media |
$400.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.82
|
| Rate for Payer: Galaxy Health WC |
$803.25
|
| Rate for Payer: Global Benefits Group Commercial |
$567.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$708.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.34
|
| Rate for Payer: Heritage Provider Network Transplant |
$657.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$649.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$649.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$630.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$537.10
|
| Rate for Payer: Multiplan Commercial |
$756.00
|
| Rate for Payer: Networks By Design Commercial |
$614.25
|
| Rate for Payer: Prime Health Services Commercial |
$803.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$567.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$567.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC CORDOCENTESIS INTRAUTERINE PUBS
|
Facility
|
OP
|
$945.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400084
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.80 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,272.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$567.00
|
| Rate for Payer: Blue Shield of California Commercial |
$696.46
|
| Rate for Payer: Blue Shield of California EPN |
$551.88
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Cigna of CA HMO |
$604.80
|
| Rate for Payer: Cigna of CA PPO |
$699.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Media |
$400.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.82
|
| Rate for Payer: Galaxy Health WC |
$803.25
|
| Rate for Payer: Global Benefits Group Commercial |
$567.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$708.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.34
|
| Rate for Payer: Heritage Provider Network Transplant |
$657.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$649.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$649.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$630.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$537.10
|
| Rate for Payer: Multiplan Commercial |
$756.00
|
| Rate for Payer: Networks By Design Commercial |
$614.25
|
| Rate for Payer: Prime Health Services Commercial |
$803.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$567.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$567.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$472.50
|
| Rate for Payer: United Healthcare All Other HMO |
$472.50
|
| Rate for Payer: United Healthcare HMO Rider |
$472.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$472.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC CORE NDL BX PERC INCL IMG GDNC
|
Facility
|
OP
|
$5,252.00
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
909000408
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$542.56 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,151.20
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$2,363.40
|
| Rate for Payer: Cash Price |
$2,363.40
|
| Rate for Payer: Cigna of CA PPO |
$3,886.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$4,464.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,151.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,939.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,503.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,669.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,260.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$4,201.60
|
| Rate for Payer: Networks By Design Commercial |
$3,413.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,464.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,151.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
