|
HC INS SUBQ CAR RHYTHM MTR W PRGM
|
Facility
|
IP
|
$17,740.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
906813406
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,257.60 |
| Max. Negotiated Rate |
$15,079.00 |
| Rate for Payer: Cash Price |
$7,983.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,096.00
|
| Rate for Payer: Galaxy Health WC |
$15,079.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10,644.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,832.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,758.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,257.60
|
| Rate for Payer: Multiplan Commercial |
$14,192.00
|
| Rate for Payer: Networks By Design Commercial |
$11,531.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,079.00
|
|
|
HC INST WAVE FREE RATIO WO STRESS AGENT
|
Facility
|
IP
|
$9,375.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906803801
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,250.00 |
| Max. Negotiated Rate |
$7,968.75 |
| Rate for Payer: Cash Price |
$4,218.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,750.00
|
| Rate for Payer: Galaxy Health WC |
$7,968.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,625.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,253.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,571.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,250.00
|
| Rate for Payer: Multiplan Commercial |
$7,500.00
|
| Rate for Payer: Networks By Design Commercial |
$6,093.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,968.75
|
|
|
HC INST WAVE FREE RATIO WO STRESS AGENT
|
Facility
|
OP
|
$9,375.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906803801
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$7,968.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,149.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,585.62
|
| Rate for Payer: Blue Distinction Transplant |
$5,625.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$4,218.75
|
| Rate for Payer: Cash Price |
$4,218.75
|
| Rate for Payer: Cash Price |
$4,218.75
|
| Rate for Payer: Cigna of CA HMO |
$6,000.00
|
| Rate for Payer: Cigna of CA PPO |
$6,937.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$7,968.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,625.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,031.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.08
|
| Rate for Payer: Heritage Provider Network Transplant |
$320.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$316.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$316.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,253.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,250.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$7,500.00
|
| Rate for Payer: Networks By Design Commercial |
$6,093.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,968.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,625.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,625.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC INSULIN
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
900912130
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$104.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$95.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.30
|
| 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 |
$17.14
|
| Rate for Payer: Dignity Health Media |
$11.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.43
|
| 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 |
$18.75
|
| Rate for Payer: Heritage Provider Network Transplant |
$18.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$18.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.32
|
| 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 |
$9.26
|
| Rate for Payer: United Healthcare All Other HMO |
$9.26
|
| Rate for Payer: United Healthcare HMO Rider |
$9.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.57
|
| Rate for Payer: Vantage Medical Group Senior |
$11.43
|
|
|
HC INTACT PTH
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 83970
|
| Hospital Charge Code |
900910942
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$376.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$343.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$376.59
|
| Rate for Payer: Blue Distinction Transplant |
$46.80
|
| Rate for Payer: Blue Shield of California Commercial |
$50.39
|
| Rate for Payer: Blue Shield of California EPN |
$39.94
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cigna of CA HMO |
$49.92
|
| Rate for Payer: Cigna of CA PPO |
$57.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.92
|
| Rate for Payer: Dignity Health Media |
$41.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.73
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$41.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$41.28
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$58.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.70
|
| Rate for Payer: Heritage Provider Network Transplant |
$67.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$66.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$66.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.32
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Networks By Design Commercial |
$50.70
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.44
|
| Rate for Payer: United Healthcare All Other HMO |
$33.44
|
| Rate for Payer: United Healthcare HMO Rider |
$33.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.41
|
| Rate for Payer: Vantage Medical Group Senior |
$41.28
|
|
|
HC INT AUDITORY MEATUS
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 70134
|
| Hospital Charge Code |
909001133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$87.10 |
| Max. Negotiated Rate |
$1,130.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$189.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.49
|
| Rate for Payer: Blue Distinction Transplant |
$475.20
|
| Rate for Payer: Blue Shield of California Commercial |
$468.07
|
| Rate for Payer: Blue Shield of California EPN |
$371.45
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna of CA HMO |
$506.88
|
| Rate for Payer: Cigna of CA PPO |
$586.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Dignity Health Media |
$689.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$689.28
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$594.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,130.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,130.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,116.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,116.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$689.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$528.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$689.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$868.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$923.64
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: Networks By Design Commercial |
$514.80
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$475.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$475.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC INT AUDITORY MEATUS
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 70134
|
| Hospital Charge Code |
909001133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$190.08 |
| Max. Negotiated Rate |
$673.20 |
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.80
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$528.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.08
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: Networks By Design Commercial |
$514.80
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
|
|
HC INTENSITY MOD RADIO TX PLAN
|
Facility
|
IP
|
$7,377.00
|
|
|
Service Code
|
CPT 77301
|
| Hospital Charge Code |
909100275
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,770.48 |
| Max. Negotiated Rate |
$6,270.45 |
| Rate for Payer: Cash Price |
$3,319.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,950.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,950.80
|
| Rate for Payer: Galaxy Health WC |
$6,270.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,426.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,920.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,810.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,770.48
|
| Rate for Payer: Multiplan Commercial |
$5,901.60
|
| Rate for Payer: Networks By Design Commercial |
$4,795.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,270.45
|
|
|
HC INTENSITY MOD RADIO TX PLAN
|
Facility
|
OP
|
$7,377.00
|
|
|
Service Code
|
CPT 77301
|
| Hospital Charge Code |
909100275
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,161.00 |
| Max. Negotiated Rate |
$10,720.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10,720.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,596.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,904.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,731.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,949.45
|
| Rate for Payer: Blue Distinction Transplant |
$4,426.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,359.81
|
| Rate for Payer: Blue Shield of California EPN |
$3,459.81
|
| Rate for Payer: Cash Price |
$3,319.65
|
| Rate for Payer: Cash Price |
$3,319.65
|
| Rate for Payer: Cash Price |
$3,319.65
|
| Rate for Payer: Cigna of CA HMO |
$4,721.28
|
| Rate for Payer: Cigna of CA PPO |
$5,458.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,596.86
|
| Rate for Payer: Dignity Health Media |
$1,731.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,904.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,337.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,731.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,731.24
|
| Rate for Payer: Galaxy Health WC |
$6,270.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,426.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,532.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,839.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,839.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,804.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$2,804.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,731.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,920.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,350.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,731.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,770.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,181.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,319.86
|
| Rate for Payer: Multiplan Commercial |
$5,901.60
|
| Rate for Payer: Networks By Design Commercial |
$4,795.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,270.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,426.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,596.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,904.36
|
| Rate for Payer: Vantage Medical Group Senior |
$1,731.24
|
|
|
HC INTERCOSTAL NERVE BLOCK SINGLE
|
Facility
|
IP
|
$1,900.00
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
900501673
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.00 |
| Max. Negotiated Rate |
$1,615.00 |
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$760.00
|
| Rate for Payer: Galaxy Health WC |
$1,615.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,140.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,267.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$723.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.00
|
| Rate for Payer: Multiplan Commercial |
$1,520.00
|
| Rate for Payer: Networks By Design Commercial |
$1,235.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,615.00
|
|
|
HC INTERCOSTAL NERVE BLOCK SINGLE
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
900501673
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.18 |
| 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 |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,140.00
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Cigna of CA PPO |
$1,406.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$1,615.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,140.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,425.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,417.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,417.03
|
| 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 |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,267.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$1,520.00
|
| Rate for Payer: Networks By Design Commercial |
$1,235.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,615.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,140.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC INTERDENTAL WIRING,OTH THN FRX
|
Facility
|
IP
|
$10,496.00
|
|
|
Service Code
|
CPT 21497
|
| Hospital Charge Code |
900501322
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,519.04 |
| Max. Negotiated Rate |
$8,921.60 |
| Rate for Payer: Cash Price |
$4,723.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,198.40
|
| Rate for Payer: Galaxy Health WC |
$8,921.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,297.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,000.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,998.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,519.04
|
| Rate for Payer: Multiplan Commercial |
$8,396.80
|
| Rate for Payer: Networks By Design Commercial |
$6,822.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,921.60
|
|
|
HC INTERDENTAL WIRING,OTH THN FRX
|
Facility
|
OP
|
$10,496.00
|
|
|
Service Code
|
CPT 21497
|
| Hospital Charge Code |
900501322
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.16 |
| Max. Negotiated Rate |
$8,921.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,297.60
|
| Rate for Payer: Cash Price |
$4,723.20
|
| Rate for Payer: Cash Price |
$4,723.20
|
| Rate for Payer: Cash Price |
$4,723.20
|
| Rate for Payer: Cigna of CA PPO |
$7,767.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Media |
$1,905.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Galaxy Health WC |
$8,921.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,297.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,872.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,124.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,124.92
|
| 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 |
$1,905.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,000.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,519.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,400.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Multiplan Commercial |
$8,396.80
|
| Rate for Payer: Networks By Design Commercial |
$6,822.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,921.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,297.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,248.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,248.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,248.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC INTERNAL CARDIOVERSION, ELECTR
|
Facility
|
IP
|
$1,222.00
|
|
|
Service Code
|
CPT 92961
|
| Hospital Charge Code |
906812074
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$293.28 |
| Max. Negotiated Rate |
$1,038.70 |
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$488.80
|
| Rate for Payer: Galaxy Health WC |
$1,038.70
|
| Rate for Payer: Global Benefits Group Commercial |
$733.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$815.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$465.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.28
|
| Rate for Payer: Multiplan Commercial |
$977.60
|
| Rate for Payer: Networks By Design Commercial |
$794.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,038.70
|
|
|
HC INTERNAL CARDIOVERSION, ELECTR
|
Facility
|
OP
|
$1,222.00
|
|
|
Service Code
|
CPT 92961
|
| Hospital Charge Code |
906812074
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$293.28 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,644.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$813.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$733.20
|
| 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 |
$549.90
|
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Cigna of CA HMO |
$782.08
|
| Rate for Payer: Cigna of CA PPO |
$904.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Dignity Health Media |
$813.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,097.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$813.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$813.16
|
| Rate for Payer: Galaxy Health WC |
$1,038.70
|
| Rate for Payer: Global Benefits Group Commercial |
$733.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$916.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,333.58
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,333.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,317.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,317.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$813.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$815.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$328.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$813.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,024.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,089.63
|
| Rate for Payer: Multiplan Commercial |
$977.60
|
| Rate for Payer: Networks By Design Commercial |
$794.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,038.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$733.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$733.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Vantage Medical Group Senior |
$813.16
|
|
|
HC INTERNAL CAROTID UNI
|
Facility
|
IP
|
$25,095.00
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
909020147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,022.80 |
| Max. Negotiated Rate |
$21,330.75 |
| Rate for Payer: Cash Price |
$11,292.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,038.00
|
| Rate for Payer: Galaxy Health WC |
$21,330.75
|
| Rate for Payer: Global Benefits Group Commercial |
$15,057.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,738.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,561.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,022.80
|
| Rate for Payer: Multiplan Commercial |
$20,076.00
|
| Rate for Payer: Networks By Design Commercial |
$16,311.75
|
| Rate for Payer: Prime Health Services Commercial |
$21,330.75
|
|
|
HC INTERNAL CAROTID UNI
|
Facility
|
OP
|
$25,095.00
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
909020147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$533.35 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$15,057.00
|
| 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 |
$11,292.75
|
| Rate for Payer: Cash Price |
$11,292.75
|
| Rate for Payer: Cigna of CA PPO |
$18,570.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Media |
$6,866.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$21,330.75
|
| Rate for Payer: Global Benefits Group Commercial |
$15,057.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18,821.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,260.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,260.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,123.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11,123.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,738.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$533.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,022.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$20,076.00
|
| Rate for Payer: Networks By Design Commercial |
$16,311.75
|
| Rate for Payer: Prime Health Services Commercial |
$21,330.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,057.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
IP
|
$54.00
|
|
| Hospital Charge Code |
906600075
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
IP
|
$46.00
|
|
| Hospital Charge Code |
909200075
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$39.10 |
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.04
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
OP
|
$42.00
|
|
| Hospital Charge Code |
908100075
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$1,507.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.02
|
| Rate for Payer: Blue Distinction Transplant |
$25.20
|
| Rate for Payer: Blue Shield of California Commercial |
$24.82
|
| Rate for Payer: Blue Shield of California EPN |
$19.70
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.70
|
| Rate for Payer: Dignity Health Media |
$35.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$31.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.70
|
| Rate for Payer: Vantage Medical Group Senior |
$35.70
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
OP
|
$58.00
|
|
| Hospital Charge Code |
909000075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$49.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$38.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.56
|
| Rate for Payer: Blue Distinction Transplant |
$34.80
|
| Rate for Payer: Blue Shield of California Commercial |
$34.28
|
| Rate for Payer: Blue Shield of California EPN |
$27.20
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna of CA HMO |
$37.12
|
| Rate for Payer: Cigna of CA PPO |
$42.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.30
|
| Rate for Payer: Dignity Health Media |
$49.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$43.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.92
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.00
|
| Rate for Payer: United Healthcare All Other HMO |
$29.00
|
| Rate for Payer: United Healthcare HMO Rider |
$29.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.30
|
| Rate for Payer: Vantage Medical Group Senior |
$49.30
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
OP
|
$54.00
|
|
| Hospital Charge Code |
906600075
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.17
|
| Rate for Payer: Blue Distinction Transplant |
$32.40
|
| Rate for Payer: Blue Shield of California Commercial |
$31.91
|
| Rate for Payer: Blue Shield of California EPN |
$25.33
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.90
|
| Rate for Payer: Dignity Health Media |
$45.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27.00
|
| Rate for Payer: United Healthcare HMO Rider |
$27.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.90
|
| Rate for Payer: Vantage Medical Group Senior |
$45.90
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
IP
|
$58.00
|
|
| Hospital Charge Code |
909300075
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$49.30 |
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.92
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
IP
|
$42.00
|
|
| Hospital Charge Code |
908100075
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
IP
|
$58.00
|
|
| Hospital Charge Code |
909000075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$49.30 |
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.92
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
|
