|
HC CAP NEWBORN MED 15IN PINK
|
Facility
|
IP
|
$481.40
|
|
| Hospital Charge Code |
901608013
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$96.28 |
| Max. Negotiated Rate |
$409.19 |
| Rate for Payer: Adventist Health Commercial |
$96.28
|
| Rate for Payer: Cash Price |
$216.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$336.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.56
|
| Rate for Payer: EPIC Health Plan Senior |
$192.56
|
| Rate for Payer: Galaxy Health WC |
$409.19
|
| Rate for Payer: Global Benefits Group Commercial |
$288.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$305.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.54
|
| Rate for Payer: Multiplan Commercial |
$385.12
|
| Rate for Payer: Networks By Design Commercial |
$312.91
|
| Rate for Payer: Prime Health Services Commercial |
$409.19
|
|
|
HC CAP NEWBORN MED 15IN PINK
|
Facility
|
OP
|
$481.40
|
|
| Hospital Charge Code |
901608013
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$96.28 |
| Max. Negotiated Rate |
$409.19 |
| Rate for Payer: Adventist Health Commercial |
$96.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$315.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$409.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$264.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$361.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$308.91
|
| Rate for Payer: Cash Price |
$216.63
|
| Rate for Payer: Cigna of CA HMO |
$308.10
|
| Rate for Payer: Cigna of CA PPO |
$356.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$409.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$409.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$409.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$336.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.56
|
| Rate for Payer: EPIC Health Plan Senior |
$192.56
|
| Rate for Payer: Galaxy Health WC |
$409.19
|
| Rate for Payer: Global Benefits Group Commercial |
$288.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$305.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$174.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$336.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$336.98
|
| Rate for Payer: Multiplan Commercial |
$385.12
|
| Rate for Payer: Networks By Design Commercial |
$312.91
|
| Rate for Payer: Prime Health Services Commercial |
$409.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$288.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$288.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.70
|
| Rate for Payer: United Healthcare All Other HMO |
$240.70
|
| Rate for Payer: United Healthcare HMO Rider |
$240.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$409.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$409.19
|
| Rate for Payer: Vantage Medical Group Senior |
$409.19
|
|
|
HC CAPTOPRIL RENOGRAM
|
Facility
|
OP
|
$3,531.00
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
909301431
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$261.39 |
| Max. Negotiated Rate |
$3,001.35 |
| Rate for Payer: Adventist Health Commercial |
$706.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$871.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,265.84
|
| Rate for Payer: Blue Shield of California Commercial |
$2,252.78
|
| Rate for Payer: Blue Shield of California Commercial |
$1,486.55
|
| Rate for Payer: Cash Price |
$1,588.95
|
| Rate for Payer: Cash Price |
$1,588.95
|
| Rate for Payer: Cigna of CA HMO |
$2,259.84
|
| Rate for Payer: Cigna of CA PPO |
$2,612.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,471.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.28
|
| Rate for Payer: EPIC Health Plan Senior |
$768.18
|
| Rate for Payer: Galaxy Health WC |
$3,001.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,118.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,145.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$261.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,242.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$295.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$847.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$879.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$2,824.80
|
| Rate for Payer: Networks By Design Commercial |
$2,295.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,001.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,118.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,118.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.78
|
| Rate for Payer: United Healthcare All Other HMO |
$815.78
|
| Rate for Payer: United Healthcare HMO Rider |
$815.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$815.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$698.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
HC CAPTOPRIL RENOGRAM
|
Facility
|
IP
|
$3,531.00
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
909301431
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$706.20 |
| Max. Negotiated Rate |
$3,001.35 |
| Rate for Payer: Adventist Health Commercial |
$706.20
|
| Rate for Payer: Cash Price |
$1,588.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,471.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,412.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,412.40
|
| Rate for Payer: Galaxy Health WC |
$3,001.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,118.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,242.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,083.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$847.44
|
| Rate for Payer: Multiplan Commercial |
$2,824.80
|
| Rate for Payer: Networks By Design Commercial |
$2,295.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,001.35
|
|
|
HC CARBA5
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 87185
|
| Hospital Charge Code |
900913012
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC CARBA5
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 87185
|
| Hospital Charge Code |
900913012
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$29.74 |
| Rate for Payer: Adventist Health Commercial |
$6.60
|
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.74
|
| Rate for Payer: Blue Shield of California Commercial |
$18.44
|
| Rate for Payer: Blue Shield of California Commercial |
$15.21
|
| Rate for Payer: Blue Shield of California Commercial |
$27.88
|
| Rate for Payer: Blue Shield of California Commercial |
$23.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA HMO |
$21.12
|
| Rate for Payer: Cigna of CA PPO |
$24.42
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.84
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$28.05
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$19.80
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Multiplan Commercial |
$26.40
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Networks By Design Commercial |
$21.45
|
| Rate for Payer: Prime Health Services Commercial |
$28.05
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC CARBAMATES CONF & ID
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 82482
|
| Hospital Charge Code |
900910513
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$218.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Senior |
$124.80
|
| Rate for Payer: Galaxy Health WC |
$265.20
|
| Rate for Payer: Global Benefits Group Commercial |
$187.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$198.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.88
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: Networks By Design Commercial |
$202.80
|
| Rate for Payer: Prime Health Services Commercial |
$265.20
|
|
|
HC CARBAMATES CONF & ID
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 82482
|
| Hospital Charge Code |
900910513
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$220.15 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.79
|
| Rate for Payer: Vantage Medical Group Senior |
$9.81
|
| Rate for Payer: Vantage Medical Group Senior |
$9.81
|
| Rate for Payer: Adventist Health Commercial |
$51.80
|
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.29
|
| Rate for Payer: Blue Shield of California Commercial |
$143.83
|
| Rate for Payer: Blue Shield of California Commercial |
$119.40
|
| Rate for Payer: Blue Shield of California Commercial |
$217.46
|
| Rate for Payer: Blue Shield of California Commercial |
$180.52
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cigna of CA HMO |
$199.68
|
| Rate for Payer: Cigna of CA HMO |
$165.76
|
| Rate for Payer: Cigna of CA PPO |
$191.66
|
| Rate for Payer: Cigna of CA PPO |
$230.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$181.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$218.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.19
|
| Rate for Payer: EPIC Health Plan Senior |
$10.79
|
| Rate for Payer: EPIC Health Plan Senior |
$10.79
|
| Rate for Payer: Galaxy Health WC |
$220.15
|
| Rate for Payer: Galaxy Health WC |
$265.20
|
| Rate for Payer: Global Benefits Group Commercial |
$155.40
|
| Rate for Payer: Global Benefits Group Commercial |
$187.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$164.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$198.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.15
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: Multiplan Commercial |
$207.20
|
| Rate for Payer: Networks By Design Commercial |
$202.80
|
| Rate for Payer: Networks By Design Commercial |
$168.35
|
| Rate for Payer: Prime Health Services Commercial |
$220.15
|
| Rate for Payer: Prime Health Services Commercial |
$265.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$155.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$187.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$155.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$187.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.95
|
| Rate for Payer: United Healthcare All Other HMO |
$7.95
|
| Rate for Payer: United Healthcare All Other HMO |
$7.95
|
| Rate for Payer: United Healthcare HMO Rider |
$7.95
|
| Rate for Payer: United Healthcare HMO Rider |
$7.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.71
|
|
|
HC CARBAMAZEPINE
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
900910396
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Commercial |
$48.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.30
|
| Rate for Payer: Blue Shield of California Commercial |
$111.10
|
| Rate for Payer: Blue Shield of California Commercial |
$55.32
|
| Rate for Payer: Blue Shield of California Commercial |
$167.98
|
| Rate for Payer: Blue Shield of California Commercial |
$83.64
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO |
$154.24
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Cigna of CA PPO |
$178.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$168.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.04
|
| Rate for Payer: EPIC Health Plan Senior |
$16.03
|
| Rate for Payer: EPIC Health Plan Senior |
$16.03
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$204.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Global Benefits Group Commercial |
$144.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.89
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$153.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.52
|
| Rate for Payer: Multiplan Commercial |
$192.80
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$156.65
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Commercial |
$204.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$144.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$144.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.80
|
| Rate for Payer: United Healthcare All Other HMO |
$11.80
|
| Rate for Payer: United Healthcare All Other HMO |
$11.80
|
| Rate for Payer: United Healthcare HMO Rider |
$11.80
|
| Rate for Payer: United Healthcare HMO Rider |
$11.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.57
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.03
|
| Rate for Payer: Vantage Medical Group Senior |
$14.57
|
| Rate for Payer: Vantage Medical Group Senior |
$14.57
|
|
|
HC CARBAMAZEPINE
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
900910396
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$204.85 |
| Rate for Payer: Adventist Health Commercial |
$48.20
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$168.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.40
|
| Rate for Payer: EPIC Health Plan Senior |
$96.40
|
| Rate for Payer: Galaxy Health WC |
$204.85
|
| Rate for Payer: Global Benefits Group Commercial |
$144.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$153.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$142.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.84
|
| Rate for Payer: Multiplan Commercial |
$192.80
|
| Rate for Payer: Networks By Design Commercial |
$156.65
|
| Rate for Payer: Prime Health Services Commercial |
$204.85
|
|
|
HC CARBA NP
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 87185
|
| Hospital Charge Code |
900913010
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$29.74 |
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA HMO |
$13.44
|
| Rate for Payer: Cigna of CA PPO |
$15.54
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.74
|
| Rate for Payer: Blue Shield of California Commercial |
$10.14
|
| Rate for Payer: Blue Shield of California Commercial |
$14.64
|
| Rate for Payer: Blue Shield of California Commercial |
$15.33
|
| Rate for Payer: Blue Shield of California Commercial |
$9.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.84
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Networks By Design Commercial |
$13.65
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC CARBA NP
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 87185
|
| Hospital Charge Code |
900913010
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
|
|
HC CARBOXYHGB CH
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
900912179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$127.23 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.23
|
| Rate for Payer: Blue Shield of California Commercial |
$12.91
|
| Rate for Payer: Blue Shield of California Commercial |
$19.52
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.33
|
| Rate for Payer: EPIC Health Plan Senior |
$13.55
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.51
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.98
|
| Rate for Payer: United Healthcare All Other HMO |
$9.98
|
| Rate for Payer: United Healthcare HMO Rider |
$9.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.55
|
| Rate for Payer: Vantage Medical Group Senior |
$12.32
|
|
|
HC CARBOXYHGB CH
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
900912179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$23.80 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11.20
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
|
|
HC CARCINOEMBRYONIC ANTIGEN (CEA)
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
900910865
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.35 |
| Max. Negotiated Rate |
$195.47 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.47
|
| Rate for Payer: Blue Shield of California Commercial |
$184.40
|
| Rate for Payer: Blue Shield of California Commercial |
$59.01
|
| Rate for Payer: Blue Shield of California Commercial |
$278.80
|
| Rate for Payer: Blue Shield of California Commercial |
$89.22
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$256.00
|
| Rate for Payer: Cigna of CA HMO |
$81.92
|
| Rate for Payer: Cigna of CA PPO |
$94.72
|
| Rate for Payer: Cigna of CA PPO |
$296.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.28
|
| Rate for Payer: EPIC Health Plan Senior |
$20.86
|
| Rate for Payer: EPIC Health Plan Senior |
$20.86
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$254.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.41
|
| Rate for Payer: Multiplan Commercial |
$320.00
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.35
|
| Rate for Payer: United Healthcare All Other HMO |
$15.35
|
| Rate for Payer: United Healthcare All Other HMO |
$15.35
|
| Rate for Payer: United Healthcare HMO Rider |
$15.35
|
| Rate for Payer: United Healthcare HMO Rider |
$15.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.96
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.86
|
| Rate for Payer: Vantage Medical Group Senior |
$18.96
|
| Rate for Payer: Vantage Medical Group Senior |
$18.96
|
|
|
HC CARCINOEMBRYONIC ANTIGEN (CEA)
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
900910865
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$254.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$236.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$320.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
|
|
HC CARDIAC ANGIO CONG HEART DZ
|
Facility
|
IP
|
$4,284.00
|
|
|
Service Code
|
CPT 75573
|
| Hospital Charge Code |
909201406
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$856.80 |
| Max. Negotiated Rate |
$3,641.40 |
| Rate for Payer: Adventist Health Commercial |
$856.80
|
| Rate for Payer: Cash Price |
$1,927.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,998.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,713.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,713.60
|
| Rate for Payer: Galaxy Health WC |
$3,641.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,570.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,720.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,527.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,028.16
|
| Rate for Payer: Multiplan Commercial |
$3,427.20
|
| Rate for Payer: Networks By Design Commercial |
$2,784.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,641.40
|
|
|
HC CARDIAC ANGIO CONG HEART DZ
|
Facility
|
OP
|
$2,360.00
|
|
|
Service Code
|
CPT 75573
|
| Hospital Charge Code |
909201406
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$448.71 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$472.00
|
| Rate for Payer: Adventist Health Commercial |
$856.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,514.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,749.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,803.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1,505.68
|
| Rate for Payer: Blue Shield of California Commercial |
$993.56
|
| Rate for Payer: Blue Shield of California Commercial |
$2,733.19
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cash Price |
$1,927.80
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cash Price |
$1,927.80
|
| Rate for Payer: Cash Price |
$1,927.80
|
| Rate for Payer: Cigna of CA HMO |
$1,510.40
|
| Rate for Payer: Cigna of CA HMO |
$2,741.76
|
| Rate for Payer: Cigna of CA PPO |
$1,746.40
|
| Rate for Payer: Cigna of CA PPO |
$3,170.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,998.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,652.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: Galaxy Health WC |
$3,641.40
|
| Rate for Payer: Galaxy Health WC |
$2,006.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,416.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,570.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$491.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$491.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,720.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,498.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$555.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$555.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$566.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,028.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$1,888.00
|
| Rate for Payer: Multiplan Commercial |
$3,427.20
|
| Rate for Payer: Networks By Design Commercial |
$2,784.60
|
| Rate for Payer: Networks By Design Commercial |
$1,534.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,006.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,641.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,570.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,416.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,416.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,570.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$669.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$669.92
|
| Rate for Payer: United Healthcare All Other HMO |
$669.92
|
| Rate for Payer: United Healthcare All Other HMO |
$669.92
|
| Rate for Payer: United Healthcare HMO Rider |
$669.92
|
| Rate for Payer: United Healthcare HMO Rider |
$669.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.92
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC CARDIAC ANGIO, STRUCTURE/MORPH
|
Facility
|
OP
|
$2,360.00
|
|
|
Service Code
|
CPT 75572
|
| Hospital Charge Code |
909201405
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$366.51 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$472.00
|
| Rate for Payer: Adventist Health Commercial |
$704.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,514.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,260.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1,482.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,505.68
|
| Rate for Payer: Blue Shield of California Commercial |
$993.56
|
| Rate for Payer: Blue Shield of California Commercial |
$2,247.04
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cash Price |
$1,584.90
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cash Price |
$1,584.90
|
| Rate for Payer: Cash Price |
$1,584.90
|
| Rate for Payer: Cigna of CA HMO |
$1,510.40
|
| Rate for Payer: Cigna of CA HMO |
$2,254.08
|
| Rate for Payer: Cigna of CA PPO |
$1,746.40
|
| Rate for Payer: Cigna of CA PPO |
$2,606.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,465.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,652.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: Galaxy Health WC |
$2,993.70
|
| Rate for Payer: Galaxy Health WC |
$2,006.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,416.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,113.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$366.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$366.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,236.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,498.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$414.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$414.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$566.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$845.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$1,888.00
|
| Rate for Payer: Multiplan Commercial |
$2,817.60
|
| Rate for Payer: Networks By Design Commercial |
$2,289.30
|
| Rate for Payer: Networks By Design Commercial |
$1,534.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,006.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,993.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,113.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,416.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,416.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,113.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$669.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$669.92
|
| Rate for Payer: United Healthcare All Other HMO |
$669.92
|
| Rate for Payer: United Healthcare All Other HMO |
$669.92
|
| Rate for Payer: United Healthcare HMO Rider |
$669.92
|
| Rate for Payer: United Healthcare HMO Rider |
$669.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.92
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC CARDIAC ANGIO, STRUCTURE/MORPH
|
Facility
|
IP
|
$3,522.00
|
|
|
Service Code
|
CPT 75572
|
| Hospital Charge Code |
909201405
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$704.40 |
| Max. Negotiated Rate |
$2,993.70 |
| Rate for Payer: Adventist Health Commercial |
$704.40
|
| Rate for Payer: Cash Price |
$1,584.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,465.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,408.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,408.80
|
| Rate for Payer: Galaxy Health WC |
$2,993.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,113.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,236.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,077.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$845.28
|
| Rate for Payer: Multiplan Commercial |
$2,817.60
|
| Rate for Payer: Networks By Design Commercial |
$2,289.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,993.70
|
|
|
HC CARDIAC MRI VELOCITY FLOW MAPPING
|
Facility
|
IP
|
$1,401.00
|
|
|
Service Code
|
CPT 75565
|
| Hospital Charge Code |
908875565
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$280.20 |
| Max. Negotiated Rate |
$1,190.85 |
| Rate for Payer: Adventist Health Commercial |
$280.20
|
| Rate for Payer: Cash Price |
$630.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$980.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$560.40
|
| Rate for Payer: EPIC Health Plan Senior |
$560.40
|
| Rate for Payer: Galaxy Health WC |
$1,190.85
|
| Rate for Payer: Global Benefits Group Commercial |
$840.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$889.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$826.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.24
|
| Rate for Payer: Multiplan Commercial |
$1,120.80
|
| Rate for Payer: Networks By Design Commercial |
$910.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,190.85
|
|
|
HC CARDIAC MRI VELOCITY FLOW MAPPING
|
Facility
|
OP
|
$1,401.00
|
|
|
Service Code
|
CPT 75565
|
| Hospital Charge Code |
908875565
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$2,328.99 |
| Rate for Payer: Adventist Health Commercial |
$280.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,190.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$770.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,050.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$899.02
|
| Rate for Payer: Blue Shield of California Commercial |
$893.84
|
| Rate for Payer: Blue Shield of California Commercial |
$589.82
|
| Rate for Payer: Cash Price |
$630.45
|
| Rate for Payer: Cash Price |
$630.45
|
| Rate for Payer: Cigna of CA HMO |
$896.64
|
| Rate for Payer: Cigna of CA PPO |
$1,036.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,190.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,190.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,190.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$980.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$560.40
|
| Rate for Payer: EPIC Health Plan Senior |
$560.40
|
| Rate for Payer: Galaxy Health WC |
$1,190.85
|
| Rate for Payer: Global Benefits Group Commercial |
$840.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$889.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$826.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$980.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$980.70
|
| Rate for Payer: Multiplan Commercial |
$1,120.80
|
| Rate for Payer: Networks By Design Commercial |
$910.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,190.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$840.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$840.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$700.50
|
| Rate for Payer: United Healthcare All Other HMO |
$700.50
|
| Rate for Payer: United Healthcare HMO Rider |
$700.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$700.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,190.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,190.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,190.85
|
|
|
HC CARDIAC STRESS TEST
|
Facility
|
OP
|
$3,214.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
906811397
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$2,731.90 |
| Rate for Payer: Adventist Health Commercial |
$642.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$397.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,062.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1,353.09
|
| Rate for Payer: Blue Shield of California Commercial |
$2,050.53
|
| Rate for Payer: Cash Price |
$1,446.30
|
| Rate for Payer: Cash Price |
$1,446.30
|
| Rate for Payer: Cash Price |
$1,446.30
|
| Rate for Payer: Cigna of CA HMO |
$2,056.96
|
| Rate for Payer: Cigna of CA PPO |
$2,378.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,249.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$2,731.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,928.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$88.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,040.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$771.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$349.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$2,571.20
|
| Rate for Payer: Networks By Design Commercial |
$2,089.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,731.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,928.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,928.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,391.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,369.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,119.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,026.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC CARDIAC STRESS TEST
|
Facility
|
IP
|
$3,214.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
906811397
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$642.80 |
| Max. Negotiated Rate |
$2,731.90 |
| Rate for Payer: Adventist Health Commercial |
$642.80
|
| Rate for Payer: Cash Price |
$1,446.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,249.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,285.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,285.60
|
| Rate for Payer: Galaxy Health WC |
$2,731.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,928.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,040.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,896.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$771.36
|
| Rate for Payer: Multiplan Commercial |
$2,571.20
|
| Rate for Payer: Networks By Design Commercial |
$2,089.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,731.90
|
|
|
HC CARDIOLIPIN AB EAC IG CLASS
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
900913559
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$187.85 |
| Rate for Payer: Adventist Health Commercial |
$44.20
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$154.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: EPIC Health Plan Senior |
$88.40
|
| Rate for Payer: Galaxy Health WC |
$187.85
|
| Rate for Payer: Global Benefits Group Commercial |
$132.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$140.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.04
|
| Rate for Payer: Multiplan Commercial |
$176.80
|
| Rate for Payer: Networks By Design Commercial |
$143.65
|
| Rate for Payer: Prime Health Services Commercial |
$187.85
|
|
