|
HC CARDIOLIPIN AB EAC IG CLASS
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
900913559
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.62 |
| Max. Negotiated Rate |
$211.56 |
| Rate for Payer: Adventist Health Commercial |
$44.20
|
| Rate for Payer: Adventist Health Commercial |
$19.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$149.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$149.05
|
| Rate for Payer: Blue Shield of California Commercial |
$45.64
|
| Rate for Payer: Blue Shield of California Commercial |
$101.88
|
| Rate for Payer: Blue Shield of California Commercial |
$69.00
|
| Rate for Payer: Blue Shield of California Commercial |
$154.04
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cigna of CA HMO |
$63.36
|
| Rate for Payer: Cigna of CA HMO |
$141.44
|
| Rate for Payer: Cigna of CA PPO |
$163.54
|
| Rate for Payer: Cigna of CA PPO |
$73.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$154.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$69.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.99
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$187.85
|
| Rate for Payer: Galaxy Health WC |
$84.15
|
| Rate for Payer: Global Benefits Group Commercial |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$59.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$140.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.10
|
| Rate for Payer: Multiplan Commercial |
$79.20
|
| Rate for Payer: Multiplan Commercial |
$176.80
|
| Rate for Payer: Networks By Design Commercial |
$64.35
|
| Rate for Payer: Networks By Design Commercial |
$143.65
|
| Rate for Payer: Prime Health Services Commercial |
$187.85
|
| Rate for Payer: Prime Health Services Commercial |
$84.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$132.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$132.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.62
|
| 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 All Other HMO |
$20.62
|
| Rate for Payer: United Healthcare HMO Rider |
$20.62
|
| Rate for Payer: United Healthcare HMO Rider |
$20.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Vantage Medical Group Senior |
$25.45
|
| Rate for Payer: Vantage Medical Group Senior |
$25.45
|
|
|
HC CARDIOLITE PERFUSION SCAN
|
Facility
|
OP
|
$3,036.00
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
909301560
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$339.24 |
| Max. Negotiated Rate |
$2,747.46 |
| Rate for Payer: Adventist Health Commercial |
$607.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,981.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,831.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,665.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,948.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,936.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,278.16
|
| Rate for Payer: Cash Price |
$1,366.20
|
| Rate for Payer: Cash Price |
$1,366.20
|
| Rate for Payer: Cigna of CA HMO |
$1,943.04
|
| Rate for Payer: Cigna of CA PPO |
$2,246.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,831.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,665.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,125.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,747.46
|
| Rate for Payer: EPIC Health Plan Senior |
$1,831.64
|
| Rate for Payer: Galaxy Health WC |
$2,580.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,821.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,730.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$339.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,665.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,927.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$383.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,331.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,098.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,231.27
|
| Rate for Payer: Multiplan Commercial |
$2,428.80
|
| Rate for Payer: Networks By Design Commercial |
$1,973.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,580.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,821.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,821.60
|
| 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: Upland Medical Group Pediatric |
$1,665.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,831.64
|
| Rate for Payer: Vantage Medical Group Senior |
$1,665.13
|
|
|
HC CARDIOLITE PERFUSION SCAN
|
Facility
|
IP
|
$3,036.00
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
909301560
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$607.20 |
| Max. Negotiated Rate |
$2,580.60 |
| Rate for Payer: Adventist Health Commercial |
$607.20
|
| Rate for Payer: Cash Price |
$1,366.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,125.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,214.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,214.40
|
| Rate for Payer: Galaxy Health WC |
$2,580.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,821.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,927.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,791.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.64
|
| Rate for Payer: Multiplan Commercial |
$2,428.80
|
| Rate for Payer: Networks By Design Commercial |
$1,973.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,580.60
|
|
|
HC CARDIOLITE PERFUSION SCAN 1 DY
|
Facility
|
OP
|
$5,966.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
909301562
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$584.84 |
| Max. Negotiated Rate |
$5,071.10 |
| Rate for Payer: Adventist Health Commercial |
$1,193.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,879.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,831.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,665.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,828.38
|
| Rate for Payer: Blue Shield of California Commercial |
$3,806.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2,511.69
|
| Rate for Payer: Cash Price |
$2,684.70
|
| Rate for Payer: Cash Price |
$2,684.70
|
| Rate for Payer: Cigna of CA HMO |
$3,818.24
|
| Rate for Payer: Cigna of CA PPO |
$4,414.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,831.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,665.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,176.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,747.46
|
| Rate for Payer: EPIC Health Plan Senior |
$1,831.64
|
| Rate for Payer: Galaxy Health WC |
$5,071.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,579.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,730.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$584.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,665.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,788.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$661.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,331.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,098.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,231.27
|
| Rate for Payer: Multiplan Commercial |
$4,772.80
|
| Rate for Payer: Networks By Design Commercial |
$3,877.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,071.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,579.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,579.60
|
| 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: Upland Medical Group Pediatric |
$1,665.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,831.64
|
| Rate for Payer: Vantage Medical Group Senior |
$1,665.13
|
|
|
HC CARDIOLITE PERFUSION SCAN 1 DY
|
Facility
|
IP
|
$5,966.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
909301562
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,193.20 |
| Max. Negotiated Rate |
$5,071.10 |
| Rate for Payer: Adventist Health Commercial |
$1,193.20
|
| Rate for Payer: Cash Price |
$2,684.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,176.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,386.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,386.40
|
| Rate for Payer: Galaxy Health WC |
$5,071.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,579.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,788.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,519.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.84
|
| Rate for Payer: Multiplan Commercial |
$4,772.80
|
| Rate for Payer: Networks By Design Commercial |
$3,877.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,071.10
|
|
|
HC CARDIOPULMONARY RESUSCITATION
|
Facility
|
OP
|
$4,076.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
906812198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$218.50 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$815.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| 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 |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,834.20
|
| Rate for Payer: Cash Price |
$1,834.20
|
| Rate for Payer: Cash Price |
$1,834.20
|
| Rate for Payer: Cigna of CA HMO |
$2,608.64
|
| Rate for Payer: Cigna of CA PPO |
$3,016.24
|
| 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 |
$2,853.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$3,464.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,445.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,588.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$218.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$298.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.24
|
| 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 |
$3,260.80
|
| Rate for Payer: Multiplan WC |
$630.41
|
| Rate for Payer: Networks By Design Commercial |
$2,649.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,464.60
|
| Rate for Payer: Prime Health Services WC |
$623.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,445.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,038.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,038.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,038.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,038.00
|
| 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 CARDIOPULMONARY RESUSCITATION
|
Facility
|
OP
|
$4,076.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
906812198
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$193.20 |
| Max. Negotiated Rate |
$7,196.06 |
| Rate for Payer: Adventist Health Commercial |
$815.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,117.01
|
| 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 |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$1,834.20
|
| Rate for Payer: Cash Price |
$1,834.20
|
| Rate for Payer: Cash Price |
$1,834.20
|
| Rate for Payer: Cash Price |
$1,834.20
|
| Rate for Payer: Cigna of CA HMO |
$2,608.64
|
| Rate for Payer: Cigna of CA PPO |
$3,016.24
|
| 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 |
$2,853.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$3,464.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,445.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$193.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,588.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$218.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.24
|
| 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 |
$3,260.80
|
| Rate for Payer: Networks By Design Commercial |
$2,649.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,464.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,445.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,445.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| 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 CARDIOPULMONARY RESUSCITATION
|
Facility
|
IP
|
$4,076.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
906812198
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$815.20 |
| Max. Negotiated Rate |
$3,464.60 |
| Rate for Payer: Adventist Health Commercial |
$815.20
|
| Rate for Payer: Cash Price |
$1,834.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,853.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,630.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,630.40
|
| Rate for Payer: Galaxy Health WC |
$3,464.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,445.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,588.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,404.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.24
|
| Rate for Payer: Multiplan Commercial |
$3,260.80
|
| Rate for Payer: Networks By Design Commercial |
$2,649.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,464.60
|
|
|
HC CARDIOPULMONARY RESUSCITATION
|
Facility
|
OP
|
$4,076.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
906812198
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$193.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$815.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$1,834.20
|
| Rate for Payer: Cash Price |
$1,834.20
|
| Rate for Payer: Cash Price |
$1,834.20
|
| Rate for Payer: Cigna of CA HMO |
$2,649.40
|
| Rate for Payer: Cigna of CA PPO |
$3,016.24
|
| 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 |
$2,853.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$3,464.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,445.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$193.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,588.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$218.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.24
|
| 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 |
$3,260.80
|
| Rate for Payer: Networks By Design Commercial |
$2,649.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,464.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,445.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,445.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,038.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| 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 CARDIOPULMONARY RESUSCITATION
|
Facility
|
OP
|
$4,076.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
900802005
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$193.20 |
| Max. Negotiated Rate |
$7,196.06 |
| Rate for Payer: Upland Medical Group Pediatric |
$277.71
|
| Rate for Payer: Adventist Health Commercial |
$815.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,117.01
|
| 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 |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$1,834.20
|
| Rate for Payer: Cash Price |
$1,834.20
|
| Rate for Payer: Cash Price |
$1,834.20
|
| Rate for Payer: Cash Price |
$1,834.20
|
| Rate for Payer: Cigna of CA HMO |
$2,608.64
|
| Rate for Payer: Cigna of CA PPO |
$3,016.24
|
| 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 |
$2,853.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$3,464.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,445.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$193.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,588.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$218.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.24
|
| 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 |
$3,260.80
|
| Rate for Payer: Networks By Design Commercial |
$2,649.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,464.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,445.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,445.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| 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 CARDIOPULMONARY RESUSCITATION
|
Facility
|
IP
|
$4,076.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
906812198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$815.20 |
| Max. Negotiated Rate |
$3,464.60 |
| Rate for Payer: Adventist Health Commercial |
$815.20
|
| Rate for Payer: Cash Price |
$1,834.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,853.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,630.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,630.40
|
| Rate for Payer: Galaxy Health WC |
$3,464.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,445.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,588.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,404.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.24
|
| Rate for Payer: Multiplan Commercial |
$3,260.80
|
| Rate for Payer: Networks By Design Commercial |
$2,649.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,464.60
|
|
|
HC CARDIOPULMONARY RESUSCITATION
|
Facility
|
IP
|
$4,076.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
906812198
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$815.20 |
| Max. Negotiated Rate |
$3,464.60 |
| Rate for Payer: Adventist Health Commercial |
$815.20
|
| Rate for Payer: Cash Price |
$1,834.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,853.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,630.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,630.40
|
| Rate for Payer: Galaxy Health WC |
$3,464.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,445.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,588.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,404.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.24
|
| Rate for Payer: Multiplan Commercial |
$3,260.80
|
| Rate for Payer: Networks By Design Commercial |
$2,649.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,464.60
|
|
|
HC CARDIOPULMONARY RESUSCITATION
|
Facility
|
IP
|
$4,076.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
900802005
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$815.20 |
| Max. Negotiated Rate |
$3,464.60 |
| Rate for Payer: Adventist Health Commercial |
$815.20
|
| Rate for Payer: Cash Price |
$1,834.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,853.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,630.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,630.40
|
| Rate for Payer: Galaxy Health WC |
$3,464.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,445.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,588.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,404.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.24
|
| Rate for Payer: Multiplan Commercial |
$3,260.80
|
| Rate for Payer: Networks By Design Commercial |
$2,649.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,464.60
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
IP
|
$5,137.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900200140
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,027.40 |
| Max. Negotiated Rate |
$4,366.45 |
| Rate for Payer: Adventist Health Commercial |
$1,027.40
|
| Rate for Payer: Cash Price |
$2,311.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,595.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,054.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,054.80
|
| Rate for Payer: Galaxy Health WC |
$4,366.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,082.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,261.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,030.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,232.88
|
| Rate for Payer: Multiplan Commercial |
$4,109.60
|
| Rate for Payer: Networks By Design Commercial |
$3,339.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,366.45
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
IP
|
$5,137.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900200140
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,027.40 |
| Max. Negotiated Rate |
$4,366.45 |
| Rate for Payer: Adventist Health Commercial |
$1,027.40
|
| Rate for Payer: Cash Price |
$2,311.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,595.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,054.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,054.80
|
| Rate for Payer: Galaxy Health WC |
$4,366.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,082.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,261.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,030.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,232.88
|
| Rate for Payer: Multiplan Commercial |
$4,109.60
|
| Rate for Payer: Networks By Design Commercial |
$3,339.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,366.45
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
OP
|
$5,137.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900802140
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$205.73 |
| Max. Negotiated Rate |
$7,196.06 |
| Rate for Payer: Adventist Health Commercial |
$1,027.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$852.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$935.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$850.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$2,311.65
|
| Rate for Payer: Cash Price |
$2,311.65
|
| Rate for Payer: Cash Price |
$2,311.65
|
| Rate for Payer: Cash Price |
$2,311.65
|
| Rate for Payer: Cigna of CA HMO |
$3,287.68
|
| Rate for Payer: Cigna of CA PPO |
$3,801.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$850.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,595.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,402.63
|
| Rate for Payer: EPIC Health Plan Senior |
$935.09
|
| Rate for Payer: Galaxy Health WC |
$4,366.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,082.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,394.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$205.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$850.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,261.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$232.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,190.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,232.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,071.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,139.11
|
| Rate for Payer: Multiplan Commercial |
$4,109.60
|
| Rate for Payer: Networks By Design Commercial |
$3,339.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,366.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,082.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,082.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$850.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.09
|
| Rate for Payer: Vantage Medical Group Senior |
$850.08
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
OP
|
$5,137.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900200140
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$205.73 |
| Max. Negotiated Rate |
$7,196.06 |
| Rate for Payer: Adventist Health Commercial |
$1,027.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$852.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$935.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$850.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$2,311.65
|
| Rate for Payer: Cash Price |
$2,311.65
|
| Rate for Payer: Cash Price |
$2,311.65
|
| Rate for Payer: Cash Price |
$2,311.65
|
| Rate for Payer: Cigna of CA HMO |
$3,287.68
|
| Rate for Payer: Cigna of CA PPO |
$3,801.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$850.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,595.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,402.63
|
| Rate for Payer: EPIC Health Plan Senior |
$935.09
|
| Rate for Payer: Galaxy Health WC |
$4,366.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,082.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,394.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$205.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$850.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,261.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$232.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,190.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,232.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,071.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,139.11
|
| Rate for Payer: Multiplan Commercial |
$4,109.60
|
| Rate for Payer: Networks By Design Commercial |
$3,339.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,366.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,082.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,082.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$850.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.09
|
| Rate for Payer: Vantage Medical Group Senior |
$850.08
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
OP
|
$5,137.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900200140
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$232.67 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$2,106.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$852.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$935.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$850.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$2,311.65
|
| Rate for Payer: Cash Price |
$2,311.65
|
| Rate for Payer: Cash Price |
$2,311.65
|
| Rate for Payer: Cigna of CA HMO |
$3,287.68
|
| Rate for Payer: Cigna of CA PPO |
$3,801.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$850.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,595.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,402.63
|
| Rate for Payer: EPIC Health Plan Senior |
$935.09
|
| Rate for Payer: Galaxy Health WC |
$4,366.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,082.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,394.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$850.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,261.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$232.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$913.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,232.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,071.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,139.11
|
| Rate for Payer: Multiplan Commercial |
$4,109.60
|
| Rate for Payer: Multiplan WC |
$1,324.78
|
| Rate for Payer: Networks By Design Commercial |
$3,339.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,366.45
|
| Rate for Payer: Prime Health Services WC |
$1,311.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,082.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,082.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$850.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.09
|
| Rate for Payer: Vantage Medical Group Senior |
$850.08
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
IP
|
$5,137.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900802140
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,027.40 |
| Max. Negotiated Rate |
$4,366.45 |
| Rate for Payer: Adventist Health Commercial |
$1,027.40
|
| Rate for Payer: Cash Price |
$2,311.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,595.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,054.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,054.80
|
| Rate for Payer: Galaxy Health WC |
$4,366.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,082.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,261.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,030.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,232.88
|
| Rate for Payer: Multiplan Commercial |
$4,109.60
|
| Rate for Payer: Networks By Design Commercial |
$3,339.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,366.45
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
IP
|
$5,137.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900802000
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,027.40 |
| Max. Negotiated Rate |
$4,366.45 |
| Rate for Payer: Adventist Health Commercial |
$1,027.40
|
| Rate for Payer: Cash Price |
$2,311.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,595.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,054.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,054.80
|
| Rate for Payer: Galaxy Health WC |
$4,366.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,082.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,261.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,030.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,232.88
|
| Rate for Payer: Multiplan Commercial |
$4,109.60
|
| Rate for Payer: Networks By Design Commercial |
$3,339.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,366.45
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
OP
|
$5,137.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900802000
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$205.73 |
| Max. Negotiated Rate |
$7,196.06 |
| Rate for Payer: Adventist Health Commercial |
$1,027.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$852.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$935.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$850.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$2,311.65
|
| Rate for Payer: Cash Price |
$2,311.65
|
| Rate for Payer: Cash Price |
$2,311.65
|
| Rate for Payer: Cash Price |
$2,311.65
|
| Rate for Payer: Cigna of CA HMO |
$3,287.68
|
| Rate for Payer: Cigna of CA PPO |
$3,801.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$850.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,595.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,402.63
|
| Rate for Payer: EPIC Health Plan Senior |
$935.09
|
| Rate for Payer: Galaxy Health WC |
$4,366.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,082.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,394.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$205.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$850.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,261.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$232.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,190.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,232.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,071.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,139.11
|
| Rate for Payer: Multiplan Commercial |
$4,109.60
|
| Rate for Payer: Networks By Design Commercial |
$3,339.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,366.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,082.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,082.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$850.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.09
|
| Rate for Payer: Vantage Medical Group Senior |
$850.08
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
IP
|
$5,137.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900200140
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,027.40 |
| Max. Negotiated Rate |
$4,366.45 |
| Rate for Payer: Adventist Health Commercial |
$1,027.40
|
| Rate for Payer: Cash Price |
$2,311.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,595.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,054.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,054.80
|
| Rate for Payer: Galaxy Health WC |
$4,366.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,082.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,261.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,030.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,232.88
|
| Rate for Payer: Multiplan Commercial |
$4,109.60
|
| Rate for Payer: Networks By Design Commercial |
$3,339.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,366.45
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
OP
|
$5,137.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900200140
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$232.67 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$1,402.63
|
| Rate for Payer: EPIC Health Plan Senior |
$935.09
|
| Rate for Payer: Galaxy Health WC |
$4,366.45
|
| Rate for Payer: Adventist Health Commercial |
$1,027.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$935.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$850.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$2,311.65
|
| Rate for Payer: Cash Price |
$2,311.65
|
| Rate for Payer: Cash Price |
$2,311.65
|
| Rate for Payer: Cigna of CA HMO |
$3,287.68
|
| Rate for Payer: Cigna of CA PPO |
$3,801.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$850.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,595.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,082.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,394.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$850.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,261.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$232.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$913.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,232.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,071.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,139.11
|
| Rate for Payer: Multiplan Commercial |
$4,109.60
|
| Rate for Payer: Multiplan WC |
$1,324.78
|
| Rate for Payer: Networks By Design Commercial |
$3,339.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,366.45
|
| Rate for Payer: Prime Health Services WC |
$1,311.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,082.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,568.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,568.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,568.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,568.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$850.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.09
|
| Rate for Payer: Vantage Medical Group Senior |
$850.08
|
|
|
HC CARRY CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8984
|
| Hospital Charge Code |
900018306
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC CARRY CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8984
|
| Hospital Charge Code |
900018306
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
