|
HC HSV 1&2 PCR
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
900912307
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$309.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$309.82
|
| Rate for Payer: Blue Distinction Transplant |
$60.00
|
| Rate for Payer: Blue Shield of California Commercial |
$64.60
|
| Rate for Payer: Blue Shield of California EPN |
$51.20
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$64.00
|
| Rate for Payer: Cigna of CA PPO |
$74.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Media |
$35.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$75.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Heritage Provider Network Transplant |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$56.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC HSV 1 IGG
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900913540
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$120.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$109.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.33
|
| Rate for Payer: Blue Distinction Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$32.30
|
| Rate for Payer: Blue Shield of California EPN |
$25.60
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.78
|
| Rate for Payer: Dignity Health Media |
$13.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.81
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.19
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.63
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$21.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.68
|
| Rate for Payer: United Healthcare All Other HMO |
$10.68
|
| Rate for Payer: United Healthcare HMO Rider |
$10.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC HSV 2 IGG
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900913541
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$176.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$160.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.47
|
| Rate for Payer: Blue Distinction Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$32.30
|
| Rate for Payer: Blue Shield of California EPN |
$25.60
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Media |
$19.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$19.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$19.35
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.73
|
| Rate for Payer: Heritage Provider Network Transplant |
$31.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$31.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.93
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.68
|
| Rate for Payer: United Healthcare All Other HMO |
$15.68
|
| Rate for Payer: United Healthcare HMO Rider |
$15.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.28
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC HUMERUS
|
Facility
|
IP
|
$866.00
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
909001508
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.84 |
| Max. Negotiated Rate |
$736.10 |
| Rate for Payer: Cash Price |
$389.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$346.40
|
| Rate for Payer: Galaxy Health WC |
$736.10
|
| Rate for Payer: Global Benefits Group Commercial |
$519.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$577.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$329.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.84
|
| Rate for Payer: Multiplan Commercial |
$692.80
|
| Rate for Payer: Networks By Design Commercial |
$562.90
|
| Rate for Payer: Prime Health Services Commercial |
$736.10
|
|
|
HC HUMERUS
|
Facility
|
OP
|
$866.00
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
909001508
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$736.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$130.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.89
|
| Rate for Payer: Blue Distinction Transplant |
$519.60
|
| Rate for Payer: Blue Shield of California Commercial |
$511.81
|
| Rate for Payer: Blue Shield of California EPN |
$406.15
|
| Rate for Payer: Cash Price |
$389.70
|
| Rate for Payer: Cash Price |
$389.70
|
| Rate for Payer: Cigna of CA HMO |
$554.24
|
| Rate for Payer: Cigna of CA PPO |
$640.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$736.10
|
| Rate for Payer: Global Benefits Group Commercial |
$519.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$649.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$577.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$692.80
|
| Rate for Payer: Networks By Design Commercial |
$562.90
|
| Rate for Payer: Prime Health Services Commercial |
$736.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$519.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$519.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC HYDRATION INFUSION EA ADDL HR
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
910196361
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$27.74 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$103.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.46
|
| Rate for Payer: Blue Distinction Transplant |
$106.20
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Cigna of CA HMO |
$113.28
|
| Rate for Payer: Cigna of CA PPO |
$130.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Media |
$59.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| Rate for Payer: Galaxy Health WC |
$150.45
|
| Rate for Payer: Global Benefits Group Commercial |
$106.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$132.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$97.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: Networks By Design Commercial |
$115.05
|
| Rate for Payer: Prime Health Services Commercial |
$150.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC HYDRATION INFUSION EA ADDL HR
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
910196361
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.74 |
| Max. Negotiated Rate |
$150.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$103.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.46
|
| Rate for Payer: Blue Distinction Transplant |
$106.20
|
| Rate for Payer: Blue Shield of California Commercial |
$130.45
|
| Rate for Payer: Blue Shield of California EPN |
$103.37
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Cigna of CA HMO |
$113.28
|
| Rate for Payer: Cigna of CA PPO |
$130.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Media |
$59.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| Rate for Payer: Galaxy Health WC |
$150.45
|
| Rate for Payer: Global Benefits Group Commercial |
$106.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$132.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$97.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: Networks By Design Commercial |
$115.05
|
| Rate for Payer: Prime Health Services Commercial |
$150.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.50
|
| Rate for Payer: United Healthcare All Other HMO |
$88.50
|
| Rate for Payer: United Healthcare HMO Rider |
$88.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC HYDRATION INFUSION EA ADDL HR
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
910196361
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$27.74 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$106.20
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Cigna of CA PPO |
$130.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Media |
$59.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| Rate for Payer: Galaxy Health WC |
$150.45
|
| Rate for Payer: Global Benefits Group Commercial |
$106.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$132.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$97.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: Networks By Design Commercial |
$115.05
|
| Rate for Payer: Prime Health Services Commercial |
$150.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.50
|
| Rate for Payer: United Healthcare All Other HMO |
$88.50
|
| Rate for Payer: United Healthcare HMO Rider |
$88.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC HYDRATION INFUSION EA ADDL HR
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
910196361
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$42.48 |
| Max. Negotiated Rate |
$150.45 |
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.80
|
| Rate for Payer: Galaxy Health WC |
$150.45
|
| Rate for Payer: Global Benefits Group Commercial |
$106.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.48
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: Networks By Design Commercial |
$115.05
|
| Rate for Payer: Prime Health Services Commercial |
$150.45
|
|
|
HC HYDRATION INFUSION EA ADDL HR
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
910196361
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$42.48 |
| Max. Negotiated Rate |
$150.45 |
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.80
|
| Rate for Payer: Galaxy Health WC |
$150.45
|
| Rate for Payer: Global Benefits Group Commercial |
$106.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.48
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: Networks By Design Commercial |
$115.05
|
| Rate for Payer: Prime Health Services Commercial |
$150.45
|
|
|
HC HYDRATION INFUSION EA ADDL HR
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
910196361
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.48 |
| Max. Negotiated Rate |
$150.45 |
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.80
|
| Rate for Payer: Galaxy Health WC |
$150.45
|
| Rate for Payer: Global Benefits Group Commercial |
$106.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.48
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: Networks By Design Commercial |
$115.05
|
| Rate for Payer: Prime Health Services Commercial |
$150.45
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
IP
|
$942.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$226.08 |
| Max. Negotiated Rate |
$800.70 |
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.80
|
| Rate for Payer: Galaxy Health WC |
$800.70
|
| Rate for Payer: Global Benefits Group Commercial |
$565.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$628.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.08
|
| Rate for Payer: Multiplan Commercial |
$753.60
|
| Rate for Payer: Networks By Design Commercial |
$612.30
|
| Rate for Payer: Prime Health Services Commercial |
$800.70
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
OP
|
$942.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$97.47 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$565.20
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cigna of CA PPO |
$697.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Media |
$267.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$800.70
|
| Rate for Payer: Global Benefits Group Commercial |
$565.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$706.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$439.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$628.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| Rate for Payer: Multiplan Commercial |
$753.60
|
| Rate for Payer: Networks By Design Commercial |
$612.30
|
| Rate for Payer: Prime Health Services Commercial |
$800.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$565.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$471.00
|
| Rate for Payer: United Healthcare All Other HMO |
$471.00
|
| Rate for Payer: United Healthcare HMO Rider |
$471.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$471.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
IP
|
$942.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$226.08 |
| Max. Negotiated Rate |
$800.70 |
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.80
|
| Rate for Payer: Galaxy Health WC |
$800.70
|
| Rate for Payer: Global Benefits Group Commercial |
$565.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$628.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.08
|
| Rate for Payer: Multiplan Commercial |
$753.60
|
| Rate for Payer: Networks By Design Commercial |
$612.30
|
| Rate for Payer: Prime Health Services Commercial |
$800.70
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
OP
|
$942.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$97.47 |
| Max. Negotiated Rate |
$800.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$387.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$561.24
|
| Rate for Payer: Blue Distinction Transplant |
$565.20
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cigna of CA HMO |
$602.88
|
| Rate for Payer: Cigna of CA PPO |
$697.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Media |
$267.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$800.70
|
| Rate for Payer: Global Benefits Group Commercial |
$565.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$706.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$439.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$433.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$433.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$628.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| Rate for Payer: Multiplan Commercial |
$753.60
|
| Rate for Payer: Networks By Design Commercial |
$612.30
|
| Rate for Payer: Prime Health Services Commercial |
$800.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$565.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC HYSTEROSALPINGOGRAM
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
909000176
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$114.48 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$405.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$262.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$286.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: Cigna of CA PPO |
$352.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$405.45
|
| Rate for Payer: Dignity Health Media |
$405.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$405.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$190.80
|
| Rate for Payer: Galaxy Health WC |
$405.45
|
| Rate for Payer: Global Benefits Group Commercial |
$286.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$357.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.48
|
| Rate for Payer: Multiplan Commercial |
$381.60
|
| Rate for Payer: Networks By Design Commercial |
$310.05
|
| Rate for Payer: Prime Health Services Commercial |
$405.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$286.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$405.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$405.45
|
| Rate for Payer: Vantage Medical Group Senior |
$405.45
|
|
|
HC HYSTEROSALPINGOGRAM
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
909000176
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$114.48 |
| Max. Negotiated Rate |
$405.45 |
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.80
|
| Rate for Payer: Galaxy Health WC |
$405.45
|
| Rate for Payer: Global Benefits Group Commercial |
$286.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.48
|
| Rate for Payer: Multiplan Commercial |
$381.60
|
| Rate for Payer: Networks By Design Commercial |
$310.05
|
| Rate for Payer: Prime Health Services Commercial |
$405.45
|
|
|
HC HYSTEROSALPINGOGRAM EXAM
|
Facility
|
OP
|
$1,310.00
|
|
|
Service Code
|
CPT 74740
|
| Hospital Charge Code |
909001930
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.77 |
| Max. Negotiated Rate |
$1,113.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$386.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$338.32
|
| Rate for Payer: Blue Distinction Transplant |
$786.00
|
| Rate for Payer: Blue Shield of California Commercial |
$774.21
|
| Rate for Payer: Blue Shield of California EPN |
$614.39
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna of CA HMO |
$838.40
|
| Rate for Payer: Cigna of CA PPO |
$969.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$1,113.50
|
| Rate for Payer: Global Benefits Group Commercial |
$786.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$982.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$873.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$1,048.00
|
| Rate for Payer: Networks By Design Commercial |
$851.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,113.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$786.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$786.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC HYSTEROSALPINGOGRAM EXAM
|
Facility
|
IP
|
$1,310.00
|
|
|
Service Code
|
CPT 74740
|
| Hospital Charge Code |
909001930
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$314.40 |
| Max. Negotiated Rate |
$1,113.50 |
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$524.00
|
| Rate for Payer: Galaxy Health WC |
$1,113.50
|
| Rate for Payer: Global Benefits Group Commercial |
$786.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$873.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$499.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.40
|
| Rate for Payer: Multiplan Commercial |
$1,048.00
|
| Rate for Payer: Networks By Design Commercial |
$851.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,113.50
|
|
|
HC I-131 SODIUM IODIDE SOL/MCI TH
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT A9530
|
| Hospital Charge Code |
909301569
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$37.44 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Blue Shield of California Commercial |
$111.07
|
| Rate for Payer: Blue Shield of California EPN |
$79.87
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.44
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.91
|
| Rate for Payer: United Healthcare All Other HMO |
$57.53
|
| Rate for Payer: United Healthcare HMO Rider |
$56.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.48
|
|
|
HC I-131 SODIUM IODIDE SOL/MCI TH
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT A9530
|
| Hospital Charge Code |
909301569
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$146.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$146.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.40
|
| Rate for Payer: Blue Distinction Transplant |
$93.60
|
| Rate for Payer: Blue Shield of California Commercial |
$92.20
|
| Rate for Payer: Blue Shield of California EPN |
$73.16
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: Dignity Health Media |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$117.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.46
|
| Rate for Payer: Heritage Provider Network Transplant |
$33.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$33.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.34
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.00
|
| Rate for Payer: United Healthcare All Other HMO |
$78.00
|
| Rate for Payer: United Healthcare HMO Rider |
$78.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.44
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC ICD GEN & LEAD TEST @ IMPLANT
|
Facility
|
IP
|
$7,578.00
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
906811333
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,818.72 |
| Max. Negotiated Rate |
$6,441.30 |
| Rate for Payer: Cash Price |
$3,410.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,031.20
|
| Rate for Payer: Galaxy Health WC |
$6,441.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,546.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,054.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,887.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,818.72
|
| Rate for Payer: Multiplan Commercial |
$6,062.40
|
| Rate for Payer: Networks By Design Commercial |
$4,925.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,441.30
|
|
|
HC ICD GEN & LEAD TEST @ IMPLANT
|
Facility
|
OP
|
$7,578.00
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
906811333
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$643.00 |
| Max. Negotiated Rate |
$11,370.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,441.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,167.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,167.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,241.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,546.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$3,410.10
|
| Rate for Payer: Cash Price |
$3,410.10
|
| Rate for Payer: Cash Price |
$3,410.10
|
| Rate for Payer: Cigna of CA HMO |
$4,849.92
|
| Rate for Payer: Cigna of CA PPO |
$5,607.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,441.30
|
| Rate for Payer: Dignity Health Media |
$6,441.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,441.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,031.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,031.20
|
| Rate for Payer: Galaxy Health WC |
$6,441.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,546.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,683.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,054.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,031.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,818.72
|
| Rate for Payer: Multiplan Commercial |
$6,062.40
|
| Rate for Payer: Networks By Design Commercial |
$4,925.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,441.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,546.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,546.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,441.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,441.30
|
| Rate for Payer: Vantage Medical Group Senior |
$6,441.30
|
|
|
HC ICD GEN &/OR LEAD REMOVE, THOR
|
Facility
|
IP
|
$6,270.00
|
|
|
Service Code
|
CPT 33243
|
| Hospital Charge Code |
906811339
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,504.80 |
| Max. Negotiated Rate |
$5,329.50 |
| Rate for Payer: Cash Price |
$2,821.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,508.00
|
| Rate for Payer: Galaxy Health WC |
$5,329.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,762.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,182.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,388.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,504.80
|
| Rate for Payer: Multiplan Commercial |
$5,016.00
|
| Rate for Payer: Networks By Design Commercial |
$4,075.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,329.50
|
|
|
HC ICD GEN &/OR LEAD REMOVE, THOR
|
Facility
|
OP
|
$6,270.00
|
|
|
Service Code
|
CPT 33243
|
| Hospital Charge Code |
906811339
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,504.80 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,331.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,329.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,448.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,448.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,241.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,762.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$2,821.50
|
| Rate for Payer: Cash Price |
$2,821.50
|
| Rate for Payer: Cigna of CA PPO |
$4,639.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,329.50
|
| Rate for Payer: Dignity Health Media |
$5,329.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,329.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,508.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,508.00
|
| Rate for Payer: Galaxy Health WC |
$5,329.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,762.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,702.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,182.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,702.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,504.80
|
| Rate for Payer: Multiplan Commercial |
$5,016.00
|
| Rate for Payer: Networks By Design Commercial |
$4,075.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,329.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,762.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,329.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,329.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,329.50
|
|
