|
HC INC & REM F/B SUBQ TIS COMPL
|
Facility
|
OP
|
$8,211.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
900501004
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$178.43 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,926.60
|
| Rate for Payer: Cash Price |
$3,694.95
|
| Rate for Payer: Cash Price |
$3,694.95
|
| Rate for Payer: Cash Price |
$3,694.95
|
| Rate for Payer: Cigna of CA PPO |
$6,076.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$6,979.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,926.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,158.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$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 |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,476.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,970.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$6,568.80
|
| Rate for Payer: Networks By Design Commercial |
$5,337.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,979.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,926.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,105.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,105.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,105.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,105.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC INC & REM F/B SUBQ TIS COMPL
|
Facility
|
IP
|
$8,211.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
900501004
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,970.64 |
| Max. Negotiated Rate |
$6,979.35 |
| Rate for Payer: Cash Price |
$3,694.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,284.40
|
| Rate for Payer: Galaxy Health WC |
$6,979.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,926.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,476.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,128.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,970.64
|
| Rate for Payer: Multiplan Commercial |
$6,568.80
|
| Rate for Payer: Networks By Design Commercial |
$5,337.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,979.35
|
|
|
HC INC & REM FB SUBQ TISSUE
|
Facility
|
OP
|
$1,843.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
900501003
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.32 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,105.80
|
| Rate for Payer: Cash Price |
$829.35
|
| Rate for Payer: Cash Price |
$829.35
|
| Rate for Payer: Cash Price |
$829.35
|
| Rate for Payer: Cigna of CA PPO |
$1,363.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$1,566.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,105.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,382.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$817.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$817.05
|
| 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 |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,229.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$1,474.40
|
| Rate for Payer: Networks By Design Commercial |
$1,197.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,566.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,105.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$921.50
|
| Rate for Payer: United Healthcare All Other HMO |
$921.50
|
| Rate for Payer: United Healthcare HMO Rider |
$921.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$921.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC INC & REM FB SUBQ TISSUE
|
Facility
|
IP
|
$1,843.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
900501003
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$442.32 |
| Max. Negotiated Rate |
$1,566.55 |
| Rate for Payer: Cash Price |
$829.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$737.20
|
| Rate for Payer: Galaxy Health WC |
$1,566.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,105.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,229.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$702.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.32
|
| Rate for Payer: Multiplan Commercial |
$1,474.40
|
| Rate for Payer: Networks By Design Commercial |
$1,197.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,566.55
|
|
|
HC INCSNAL BX SKIN EA SEP/ADD LSN
|
Facility
|
IP
|
$582.00
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
900511107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$139.68 |
| Max. Negotiated Rate |
$494.70 |
| Rate for Payer: Cash Price |
$261.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.80
|
| Rate for Payer: Galaxy Health WC |
$494.70
|
| Rate for Payer: Global Benefits Group Commercial |
$349.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$388.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.68
|
| Rate for Payer: Multiplan Commercial |
$465.60
|
| Rate for Payer: Networks By Design Commercial |
$378.30
|
| Rate for Payer: Prime Health Services Commercial |
$494.70
|
|
|
HC INCSNAL BX SKIN EA SEP/ADD LSN
|
Facility
|
OP
|
$582.00
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
900511107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$126.96 |
| 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 |
$494.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$320.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$320.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$349.20
|
| 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 |
$261.90
|
| Rate for Payer: Cash Price |
$261.90
|
| Rate for Payer: Cash Price |
$261.90
|
| Rate for Payer: Cigna of CA PPO |
$430.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$494.70
|
| Rate for Payer: Dignity Health Media |
$494.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$494.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$232.80
|
| Rate for Payer: Galaxy Health WC |
$494.70
|
| Rate for Payer: Global Benefits Group Commercial |
$349.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$436.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$388.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.68
|
| Rate for Payer: Multiplan Commercial |
$465.60
|
| Rate for Payer: Networks By Design Commercial |
$378.30
|
| Rate for Payer: Prime Health Services Commercial |
$494.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$349.20
|
| 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 |
$494.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$494.70
|
| Rate for Payer: Vantage Medical Group Senior |
$494.70
|
|
|
HC IND ABTN GT 1 IA INJ INCL HA
|
Facility
|
IP
|
$7,704.00
|
|
|
Service Code
|
CPT 59850
|
| Hospital Charge Code |
909009850
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,848.96 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,081.60
|
| Rate for Payer: Galaxy Health WC |
$6,548.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,622.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,138.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,935.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,848.96
|
| Rate for Payer: Multiplan Commercial |
$6,163.20
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,548.40
|
|
|
HC IND ABTN GT 1 IA INJ INCL HA
|
Facility
|
OP
|
$7,704.00
|
|
|
Service Code
|
CPT 59850
|
| Hospital Charge Code |
909009850
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$623.31 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,548.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,237.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,237.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,622.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Cigna of CA PPO |
$5,700.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,548.40
|
| Rate for Payer: Dignity Health Media |
$6,548.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,548.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,081.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,081.60
|
| Rate for Payer: Galaxy Health WC |
$6,548.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,622.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,778.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,138.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$623.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,848.96
|
| Rate for Payer: Multiplan Commercial |
$6,163.20
|
| Rate for Payer: Networks By Design Commercial |
$5,007.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,548.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,622.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,548.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,548.40
|
| Rate for Payer: Vantage Medical Group Senior |
$6,548.40
|
|
|
HC INDIV BRIEF THERAPY
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
907804005
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$54.72 |
| Max. Negotiated Rate |
$193.80 |
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.20
|
| Rate for Payer: Galaxy Health WC |
$193.80
|
| Rate for Payer: Global Benefits Group Commercial |
$136.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.72
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: Networks By Design Commercial |
$148.20
|
| Rate for Payer: Prime Health Services Commercial |
$193.80
|
|
|
HC INDIV BRIEF THERAPY
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
907804005
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$54.72 |
| 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 |
$298.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$219.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$136.80
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna of CA PPO |
$168.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.82
|
| Rate for Payer: Dignity Health Media |
$199.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$219.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$199.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$199.21
|
| Rate for Payer: Galaxy Health WC |
$193.80
|
| Rate for Payer: Global Benefits Group Commercial |
$136.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$171.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.70
|
| Rate for Payer: Heritage Provider Network Transplant |
$326.70
|
| 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 |
$199.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$199.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$251.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.94
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: Networks By Design Commercial |
$148.20
|
| Rate for Payer: Prime Health Services Commercial |
$193.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.00
|
| Rate for Payer: United Healthcare All Other HMO |
$114.00
|
| Rate for Payer: United Healthcare HMO Rider |
$114.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$219.13
|
| Rate for Payer: Vantage Medical Group Senior |
$199.21
|
|
|
HC INFANT LOWER EXT 2 VIEW
|
Facility
|
IP
|
$544.00
|
|
|
Service Code
|
CPT 73592
|
| Hospital Charge Code |
909001630
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$130.56 |
| Max. Negotiated Rate |
$462.40 |
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.60
|
| Rate for Payer: Galaxy Health WC |
$462.40
|
| Rate for Payer: Global Benefits Group Commercial |
$326.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$362.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.56
|
| Rate for Payer: Multiplan Commercial |
$435.20
|
| Rate for Payer: Networks By Design Commercial |
$353.60
|
| Rate for Payer: Prime Health Services Commercial |
$462.40
|
|
|
HC INFANT LOWER EXT 2 VIEW
|
Facility
|
OP
|
$544.00
|
|
|
Service Code
|
CPT 73592
|
| Hospital Charge Code |
909001630
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$462.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$146.14
|
| 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 |
$128.74
|
| Rate for Payer: Blue Distinction Transplant |
$326.40
|
| Rate for Payer: Blue Shield of California Commercial |
$321.50
|
| Rate for Payer: Blue Shield of California EPN |
$255.14
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna of CA HMO |
$348.16
|
| Rate for Payer: Cigna of CA PPO |
$402.56
|
| 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 |
$462.40
|
| Rate for Payer: Global Benefits Group Commercial |
$326.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$408.00
|
| 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 |
$362.85
|
| 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 |
$130.56
|
| 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 |
$435.20
|
| Rate for Payer: Networks By Design Commercial |
$353.60
|
| Rate for Payer: Prime Health Services Commercial |
$462.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$326.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$326.40
|
| 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 INFANT UPPER EXT 2 VIEW
|
Facility
|
IP
|
$553.00
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
909001555
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.72 |
| Max. Negotiated Rate |
$470.05 |
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.20
|
| Rate for Payer: Galaxy Health WC |
$470.05
|
| Rate for Payer: Global Benefits Group Commercial |
$331.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$368.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.72
|
| Rate for Payer: Multiplan Commercial |
$442.40
|
| Rate for Payer: Networks By Design Commercial |
$359.45
|
| Rate for Payer: Prime Health Services Commercial |
$470.05
|
|
|
HC INFANT UPPER EXT 2 VIEW
|
Facility
|
OP
|
$553.00
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
909001555
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$470.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$143.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.74
|
| Rate for Payer: Blue Distinction Transplant |
$331.80
|
| Rate for Payer: Blue Shield of California Commercial |
$326.82
|
| Rate for Payer: Blue Shield of California EPN |
$259.36
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cigna of CA HMO |
$353.92
|
| Rate for Payer: Cigna of CA PPO |
$409.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$470.05
|
| Rate for Payer: Global Benefits Group Commercial |
$331.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$414.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$368.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$442.40
|
| Rate for Payer: Networks By Design Commercial |
$359.45
|
| Rate for Payer: Prime Health Services Commercial |
$470.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$331.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$331.80
|
| 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 |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC INFLUENZA A ANTIGEN
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87400
|
| Hospital Charge Code |
900911778
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$77.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.38
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.20
|
| Rate for Payer: Dignity Health Media |
$14.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.13
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.17
|
| Rate for Payer: Heritage Provider Network Transplant |
$23.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$22.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.93
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.45
|
| Rate for Payer: United Healthcare All Other HMO |
$11.45
|
| Rate for Payer: United Healthcare HMO Rider |
$11.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14.13
|
|
|
HC INFRARED MCAL
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
901300047
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$38.88 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.88
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
|
|
HC INFRARED MCAL
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
901300047
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$89.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$97.20
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna of CA HMO |
$103.68
|
| Rate for Payer: Cigna of CA PPO |
$119.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.70
|
| Rate for Payer: Dignity Health Media |
$137.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$121.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.88
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.70
|
|
|
HC INFUSION EA ADD HOUR
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
910196366
|
|
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 INFUSION EA ADD HOUR
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
910196366
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.61 |
| 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 |
$36.61
|
| 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 INFUSION EA ADD HOUR
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
910196366
|
|
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 INFUSION EA ADD HOUR
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
910196366
|
|
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 INFUSION EA ADD HOUR
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
910196366
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.61 |
| Max. Negotiated Rate |
$914.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$146.34
|
| 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 |
$914.00
|
| 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: 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 |
$36.61
|
| 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 INFUSION EA ADD HOUR
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
910196366
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$36.61 |
| Max. Negotiated Rate |
$914.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$146.34
|
| 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 |
$914.00
|
| 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 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 |
$36.61
|
| 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 INFUSION INITAL HOUR GT 16MIN
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
940100114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$118.94 |
| Max. Negotiated Rate |
$914.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$483.32
|
| 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 |
$914.00
|
| Rate for Payer: Blue Distinction Transplant |
$544.20
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Cigna of CA HMO |
$580.48
|
| Rate for Payer: Cigna of CA PPO |
$671.18
|
| 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 |
$770.95
|
| Rate for Payer: Global Benefits Group Commercial |
$544.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$680.25
|
| 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 |
$604.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.68
|
| 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 |
$725.60
|
| Rate for Payer: Networks By Design Commercial |
$589.55
|
| Rate for Payer: Prime Health Services Commercial |
$770.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$544.20
|
| 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 INFUSION INITAL HOUR GT 16MIN
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
940100114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$217.68 |
| Max. Negotiated Rate |
$770.95 |
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.80
|
| Rate for Payer: Galaxy Health WC |
$770.95
|
| Rate for Payer: Global Benefits Group Commercial |
$544.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$604.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$345.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.68
|
| Rate for Payer: Multiplan Commercial |
$725.60
|
| Rate for Payer: Networks By Design Commercial |
$589.55
|
| Rate for Payer: Prime Health Services Commercial |
$770.95
|
|
