|
HC CARDIAC STRESS TEST
|
Facility
IP
|
$3,288.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
900800405
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$789.12 |
| Max. Negotiated Rate |
$2,794.80 |
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,315.20
|
| Rate for Payer: Galaxy Health WC |
$2,794.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,972.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,193.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,252.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$789.12
|
| Rate for Payer: Multiplan Commercial |
$2,630.40
|
| Rate for Payer: Networks By Design Commercial |
$2,137.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,794.80
|
|
|
HC CARDIAC STRESS TEST
|
Facility
OP
|
$3,288.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
900802004
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$2,794.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$371.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,958.99
|
| Rate for Payer: BCBS Transplant Transplant |
$1,972.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,943.21
|
| Rate for Payer: Blue Shield of California EPN |
$1,542.07
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cigna of CA HMO |
$2,104.32
|
| Rate for Payer: Cigna of CA PPO |
$2,433.12
|
| 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 |
$2,794.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,972.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,466.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: IEHP Medi-Cal |
$635.32
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$635.32
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,193.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$789.12
|
| 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 |
$2,630.40
|
| Rate for Payer: Networks By Design Commercial |
$2,137.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,794.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,972.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,972.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,972.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| 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 CARDIAC STRESS TEST
|
Facility
OP
|
$3,288.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
906811397
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$2,794.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$371.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,958.99
|
| Rate for Payer: BCBS Transplant Transplant |
$1,972.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,943.21
|
| Rate for Payer: Blue Shield of California EPN |
$1,542.07
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cigna of CA HMO |
$2,104.32
|
| Rate for Payer: Cigna of CA PPO |
$2,433.12
|
| 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 |
$2,794.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,972.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,466.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: IEHP Medi-Cal |
$635.32
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$635.32
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,193.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$789.12
|
| 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 |
$2,630.40
|
| Rate for Payer: Networks By Design Commercial |
$2,137.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,794.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,972.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,972.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,972.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,320.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,304.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$975.00
|
| 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 CARDIAC STRESS TEST
|
Facility
IP
|
$3,288.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
900802004
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$789.12 |
| Max. Negotiated Rate |
$2,794.80 |
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,315.20
|
| Rate for Payer: Galaxy Health WC |
$2,794.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,972.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,193.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,252.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$789.12
|
| Rate for Payer: Multiplan Commercial |
$2,630.40
|
| Rate for Payer: Networks By Design Commercial |
$2,137.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,794.80
|
|
|
HC CARDIAC STRESS TEST
|
Facility
IP
|
$3,288.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
906811397
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$789.12 |
| Max. Negotiated Rate |
$2,794.80 |
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,315.20
|
| Rate for Payer: Galaxy Health WC |
$2,794.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,972.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,193.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,252.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$789.12
|
| Rate for Payer: Multiplan Commercial |
$2,630.40
|
| Rate for Payer: Networks By Design Commercial |
$2,137.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,794.80
|
|
|
HC CARDIAC STRESS TEST
|
Facility
OP
|
$3,288.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
900800405
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$2,794.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$371.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,958.99
|
| Rate for Payer: BCBS Transplant Transplant |
$1,972.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,943.21
|
| Rate for Payer: Blue Shield of California EPN |
$1,542.07
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cigna of CA HMO |
$2,104.32
|
| Rate for Payer: Cigna of CA PPO |
$2,433.12
|
| 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 |
$2,794.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,972.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,466.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: IEHP Medi-Cal |
$635.32
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$635.32
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,193.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$789.12
|
| 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 |
$2,630.40
|
| Rate for Payer: Networks By Design Commercial |
$2,137.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,794.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,972.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,972.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,972.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,320.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,304.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$975.00
|
| 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 CARDIOLIPIN AB EAC IG CLASS
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
900913559
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$211.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$211.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.75
|
| Rate for Payer: BCBS Transplant Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$32.30
|
| Rate for Payer: Blue Shield of California EPN |
$25.60
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.18
|
| Rate for Payer: Dignity Health Media |
$25.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.45
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$41.74
|
| Rate for Payer: IEHP Medi-Cal |
$41.23
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$41.23
|
| Rate for Payer: IEHP Medicare Advantage |
$25.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.10
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.62
|
| Rate for Payer: United Healthcare All Other HMO |
$20.62
|
| Rate for Payer: United Healthcare HMO Rider |
$20.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Vantage Medical Group Senior |
$25.45
|
|
|
HC CARDIOLITE PERFUSION SCAN
|
Facility
IP
|
$3,572.00
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
909301560
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$857.28 |
| Max. Negotiated Rate |
$3,036.20 |
| Rate for Payer: Cash Price |
$1,607.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,428.80
|
| Rate for Payer: Galaxy Health WC |
$3,036.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,143.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,382.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,360.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$857.28
|
| Rate for Payer: Multiplan Commercial |
$2,857.60
|
| Rate for Payer: Networks By Design Commercial |
$2,321.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,036.20
|
|
|
HC CARDIOLITE PERFUSION SCAN
|
Facility
OP
|
$3,572.00
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
909301560
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$383.67 |
| Max. Negotiated Rate |
$3,036.20 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,749.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,128.20
|
| Rate for Payer: BCBS Transplant Transplant |
$2,143.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,111.05
|
| Rate for Payer: Blue Shield of California EPN |
$1,675.27
|
| Rate for Payer: Cash Price |
$1,607.40
|
| Rate for Payer: Cash Price |
$1,607.40
|
| Rate for Payer: Cigna of CA HMO |
$2,286.08
|
| Rate for Payer: Cigna of CA PPO |
$2,643.28
|
| 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 |
$3,036.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,143.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,679.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,909.61
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,909.61
|
| Rate for Payer: IEHP Medi-Cal |
$2,874.12
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2,874.12
|
| Rate for Payer: IEHP Medicare Advantage |
$1,774.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,382.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$383.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,774.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$857.28
|
| 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 |
$2,857.60
|
| Rate for Payer: Networks By Design Commercial |
$2,321.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,036.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,143.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,143.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,143.20
|
| 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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$2,874.12
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2,874.12
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$4,211.40
|
| 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
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
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
|
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: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$2,502.00
|
| 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
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: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$635.32
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$635.32
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$2,502.00
|
| 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
|
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
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: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$635.32
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$635.32
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$2,502.00
|
| 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 |
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 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: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$635.32
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$635.32
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$2,502.00
|
| 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 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
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: AlphaCare Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$813.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$3,153.60
|
| 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
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 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: AlphaCare Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$813.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$1,317.32
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,317.32
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$3,153.60
|
| 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 |
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 |
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: AlphaCare Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$813.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$1,317.32
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,317.32
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$3,153.60
|
| 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
|
|
