|
HC DVLP TEST PHYS/QHP PT 1ST HR
|
Facility
IP
|
$1,042.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
900400020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$250.08 |
| Max. Negotiated Rate |
$885.70 |
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.80
|
| Rate for Payer: Galaxy Health WC |
$885.70
|
| Rate for Payer: Global Benefits Group Commercial |
$625.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$695.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$397.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.08
|
| Rate for Payer: Multiplan Commercial |
$833.60
|
| Rate for Payer: Networks By Design Commercial |
$677.30
|
| Rate for Payer: Prime Health Services Commercial |
$885.70
|
|
|
HC DVLP TEST PHYS/QHP ST 1ST HR
|
Facility
IP
|
$1,042.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
905601811
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$250.08 |
| Max. Negotiated Rate |
$885.70 |
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.80
|
| Rate for Payer: Galaxy Health WC |
$885.70
|
| Rate for Payer: Global Benefits Group Commercial |
$625.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$695.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$397.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.08
|
| Rate for Payer: Multiplan Commercial |
$833.60
|
| Rate for Payer: Networks By Design Commercial |
$677.30
|
| Rate for Payer: Prime Health Services Commercial |
$885.70
|
|
|
HC DVLP TEST PHYS/QHP ST 1ST HR
|
Facility
OP
|
$1,042.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
905601811
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$885.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$852.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$625.20
|
| 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 |
$468.90
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cigna of CA HMO |
$666.88
|
| Rate for Payer: Cigna of CA PPO |
$771.08
|
| 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 |
$885.70
|
| Rate for Payer: Global Benefits Group Commercial |
$625.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$781.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.08
|
| Rate for Payer: Heritage Provider Network Transplant |
$320.08
|
| Rate for Payer: IEHP Medi-Cal |
$316.18
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$316.18
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$695.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.08
|
| 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 |
$833.60
|
| Rate for Payer: Networks By Design Commercial |
$677.30
|
| Rate for Payer: Prime Health Services Commercial |
$885.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$625.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$234.20
|
| 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 |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC DVL TST PHY/QHP PT EA ADD 30 MIN
|
Facility
IP
|
$317.00
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
900496113
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$76.08 |
| Max. Negotiated Rate |
$269.45 |
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.80
|
| Rate for Payer: Galaxy Health WC |
$269.45
|
| Rate for Payer: Global Benefits Group Commercial |
$190.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$211.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.08
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: Networks By Design Commercial |
$206.05
|
| Rate for Payer: Prime Health Services Commercial |
$269.45
|
|
|
HC DVL TST PHY/QHP PT EA ADD 30 MIN
|
Facility
OP
|
$317.00
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
900496113
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$76.08 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$389.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$269.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$174.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$174.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$190.20
|
| 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 |
$142.65
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cigna of CA HMO |
$202.88
|
| Rate for Payer: Cigna of CA PPO |
$234.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$269.45
|
| Rate for Payer: Dignity Health Media |
$269.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$269.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$126.80
|
| Rate for Payer: Galaxy Health WC |
$269.45
|
| Rate for Payer: Global Benefits Group Commercial |
$190.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$237.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$211.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.08
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: Networks By Design Commercial |
$206.05
|
| Rate for Payer: Prime Health Services Commercial |
$269.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$190.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$190.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$190.20
|
| 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 |
$269.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$269.45
|
| Rate for Payer: Vantage Medical Group Senior |
$269.45
|
|
|
HC DVL TST PHY/QHP ST EA ADD 30 MIN
|
Facility
IP
|
$317.00
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
905696113
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$76.08 |
| Max. Negotiated Rate |
$269.45 |
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.80
|
| Rate for Payer: Galaxy Health WC |
$269.45
|
| Rate for Payer: Global Benefits Group Commercial |
$190.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$211.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.08
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: Networks By Design Commercial |
$206.05
|
| Rate for Payer: Prime Health Services Commercial |
$269.45
|
|
|
HC DVL TST PHY/QHP ST EA ADD 30 MIN
|
Facility
OP
|
$317.00
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
905696113
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$76.08 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$389.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$269.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$174.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$174.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$190.20
|
| 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 |
$142.65
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cigna of CA HMO |
$202.88
|
| Rate for Payer: Cigna of CA PPO |
$234.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$269.45
|
| Rate for Payer: Dignity Health Media |
$269.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$269.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$126.80
|
| Rate for Payer: Galaxy Health WC |
$269.45
|
| Rate for Payer: Global Benefits Group Commercial |
$190.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$237.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$211.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.08
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: Networks By Design Commercial |
$206.05
|
| Rate for Payer: Prime Health Services Commercial |
$269.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$190.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$190.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$190.20
|
| 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 |
$269.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$269.45
|
| Rate for Payer: Vantage Medical Group Senior |
$269.45
|
|
|
HC EA ADDL LESION MAMMO
|
Facility
IP
|
$655.00
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
909019282
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$157.20 |
| Max. Negotiated Rate |
$556.75 |
| Rate for Payer: Cash Price |
$294.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.00
|
| Rate for Payer: Galaxy Health WC |
$556.75
|
| Rate for Payer: Global Benefits Group Commercial |
$393.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$436.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.20
|
| Rate for Payer: Multiplan Commercial |
$524.00
|
| Rate for Payer: Networks By Design Commercial |
$425.75
|
| Rate for Payer: Prime Health Services Commercial |
$556.75
|
|
|
HC EA ADDL LESION MAMMO
|
Facility
OP
|
$655.00
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
909019282
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$157.20 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$556.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$360.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$360.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$393.00
|
| Rate for Payer: Blue Shield of California Commercial |
$387.10
|
| Rate for Payer: Blue Shield of California EPN |
$307.20
|
| Rate for Payer: Cash Price |
$294.75
|
| Rate for Payer: Cash Price |
$294.75
|
| Rate for Payer: Cigna of CA HMO |
$419.20
|
| Rate for Payer: Cigna of CA PPO |
$484.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$556.75
|
| Rate for Payer: Dignity Health Media |
$556.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$556.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$262.00
|
| Rate for Payer: Galaxy Health WC |
$556.75
|
| Rate for Payer: Global Benefits Group Commercial |
$393.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$491.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$436.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.20
|
| Rate for Payer: Multiplan Commercial |
$524.00
|
| Rate for Payer: Networks By Design Commercial |
$425.75
|
| Rate for Payer: Prime Health Services Commercial |
$556.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$393.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$393.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$393.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$327.50
|
| Rate for Payer: United Healthcare All Other HMO |
$327.50
|
| Rate for Payer: United Healthcare HMO Rider |
$327.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$327.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$556.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$556.75
|
| Rate for Payer: Vantage Medical Group Senior |
$556.75
|
|
|
HC EA ADDL LESION STEREO
|
Facility
IP
|
$1,752.00
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
909019284
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$420.48 |
| Max. Negotiated Rate |
$1,489.20 |
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.80
|
| Rate for Payer: Galaxy Health WC |
$1,489.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,051.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,168.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$667.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.48
|
| Rate for Payer: Multiplan Commercial |
$1,401.60
|
| Rate for Payer: Networks By Design Commercial |
$1,138.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,489.20
|
|
|
HC EA ADDL LESION STEREO
|
Facility
OP
|
$1,752.00
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
909019284
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$353.68 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,489.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$963.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$963.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,051.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cigna of CA PPO |
$1,296.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,489.20
|
| Rate for Payer: Dignity Health Media |
$1,489.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,489.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$700.80
|
| Rate for Payer: Galaxy Health WC |
$1,489.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,051.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,314.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,168.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.48
|
| Rate for Payer: Multiplan Commercial |
$1,401.60
|
| Rate for Payer: Networks By Design Commercial |
$1,138.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,489.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,051.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,051.20
|
| 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 |
$1,489.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,489.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,489.20
|
|
|
HC EA ADDL MAGNETIC RESONANCE
|
Facility
OP
|
$186.00
|
|
|
Service Code
|
CPT 19288
|
| Hospital Charge Code |
908819288
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$44.64 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$158.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$102.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$102.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$111.60
|
| Rate for Payer: Blue Shield of California Commercial |
$109.93
|
| Rate for Payer: Blue Shield of California EPN |
$87.23
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna of CA HMO |
$119.04
|
| Rate for Payer: Cigna of CA PPO |
$137.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$158.10
|
| Rate for Payer: Dignity Health Media |
$158.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$74.40
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$139.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.64
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.00
|
| Rate for Payer: United Healthcare All Other HMO |
$93.00
|
| Rate for Payer: United Healthcare HMO Rider |
$93.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$158.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.10
|
| Rate for Payer: Vantage Medical Group Senior |
$158.10
|
|
|
HC EA ADDL MAGNETIC RESONANCE
|
Facility
IP
|
$186.00
|
|
|
Service Code
|
CPT 19288
|
| Hospital Charge Code |
908819288
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$44.64 |
| Max. Negotiated Rate |
$158.10 |
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.40
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.64
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
|
|
HC EA ADDL ULTRASOUND
|
Facility
IP
|
$221.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
906619286
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$187.85 |
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: Galaxy Health WC |
$187.85
|
| Rate for Payer: Global Benefits Group Commercial |
$132.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$147.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.04
|
| Rate for Payer: Multiplan Commercial |
$176.80
|
| Rate for Payer: Networks By Design Commercial |
$143.65
|
| Rate for Payer: Prime Health Services Commercial |
$187.85
|
|
|
HC EA ADDL ULTRASOUND
|
Facility
OP
|
$221.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
906619286
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$187.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$121.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$121.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$132.60
|
| Rate for Payer: Blue Shield of California Commercial |
$130.61
|
| Rate for Payer: Blue Shield of California EPN |
$103.65
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cigna of CA HMO |
$141.44
|
| Rate for Payer: Cigna of CA PPO |
$163.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$187.85
|
| Rate for Payer: Dignity Health Media |
$187.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$187.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.40
|
| Rate for Payer: Galaxy Health WC |
$187.85
|
| Rate for Payer: Global Benefits Group Commercial |
$132.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$165.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$147.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$794.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.04
|
| Rate for Payer: Multiplan Commercial |
$176.80
|
| Rate for Payer: Networks By Design Commercial |
$143.65
|
| Rate for Payer: Prime Health Services Commercial |
$187.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$132.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$132.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$132.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.50
|
| Rate for Payer: United Healthcare All Other HMO |
$110.50
|
| Rate for Payer: United Healthcare HMO Rider |
$110.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$187.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$187.85
|
| Rate for Payer: Vantage Medical Group Senior |
$187.85
|
|
|
HC EBNA IGG
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
900913537
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$141.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$127.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.64
|
| Rate for Payer: BCBS Transplant Transplant |
$15.00
|
| Rate for Payer: Blue Shield of California Commercial |
$16.15
|
| Rate for Payer: Blue Shield of California EPN |
$12.80
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.94
|
| Rate for Payer: Dignity Health Media |
$15.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.64
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.29
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.08
|
| Rate for Payer: Heritage Provider Network Transplant |
$25.08
|
| Rate for Payer: IEHP Medi-Cal |
$24.77
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$24.77
|
| Rate for Payer: IEHP Medicare Advantage |
$15.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.49
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.38
|
| Rate for Payer: United Healthcare All Other HMO |
$12.38
|
| Rate for Payer: United Healthcare HMO Rider |
$12.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.82
|
| Rate for Payer: Vantage Medical Group Senior |
$15.29
|
|
|
HC EBOL SPINAL ART FOR AVM
|
Facility
IP
|
$2,067.00
|
|
|
Service Code
|
CPT 62294
|
| Hospital Charge Code |
909080025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$496.08 |
| Max. Negotiated Rate |
$1,756.95 |
| Rate for Payer: Cash Price |
$930.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$826.80
|
| Rate for Payer: Galaxy Health WC |
$1,756.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,240.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,378.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$787.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.08
|
| Rate for Payer: Multiplan Commercial |
$1,653.60
|
| Rate for Payer: Networks By Design Commercial |
$1,343.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,756.95
|
|
|
HC EBOL SPINAL ART FOR AVM
|
Facility
OP
|
$2,067.00
|
|
|
Service Code
|
CPT 62294
|
| Hospital Charge Code |
909080025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$496.08 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: IEHP Medicare Advantage |
$1,138.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,240.20
|
| 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 |
$930.15
|
| Rate for Payer: Cash Price |
$930.15
|
| Rate for Payer: Cigna of CA PPO |
$1,529.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Media |
$1,138.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Galaxy Health WC |
$1,756.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,240.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,550.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,867.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,867.68
|
| Rate for Payer: IEHP Medi-Cal |
$1,844.90
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,844.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,378.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,172.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Multiplan Commercial |
$1,653.60
|
| Rate for Payer: Networks By Design Commercial |
$1,343.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,756.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,240.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,240.20
|
| 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 |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC EBV IGG EARLY AB
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
900913538
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$120.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$109.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.33
|
| Rate for Payer: BCBS Transplant Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.92
|
| Rate for Payer: Blue Shield of California EPN |
$10.24
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.68
|
| Rate for Payer: Dignity Health Media |
$13.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.12
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.52
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.52
|
| Rate for Payer: IEHP Medi-Cal |
$21.25
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$21.25
|
| Rate for Payer: IEHP Medicare Advantage |
$13.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.58
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.63
|
| Rate for Payer: United Healthcare All Other HMO |
$10.63
|
| Rate for Payer: United Healthcare HMO Rider |
$10.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.43
|
| Rate for Payer: Vantage Medical Group Senior |
$13.12
|
|
|
HC EBV PCR
|
Facility
OP
|
$125.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912315
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$356.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$356.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.05
|
| Rate for Payer: BCBS Transplant Transplant |
$75.00
|
| Rate for Payer: Blue Shield of California Commercial |
$80.75
|
| Rate for Payer: Blue Shield of California EPN |
$64.00
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cigna of CA HMO |
$80.00
|
| Rate for Payer: Cigna of CA PPO |
$92.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Media |
$42.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$42.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$93.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.26
|
| Rate for Payer: Heritage Provider Network Transplant |
$70.26
|
| Rate for Payer: IEHP Medi-Cal |
$69.40
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$69.40
|
| Rate for Payer: IEHP Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$75.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC EBV-VCA IGG/IGM
|
Facility
OP
|
$28.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913535
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$150.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$150.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.11
|
| Rate for Payer: BCBS Transplant Transplant |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$18.09
|
| Rate for Payer: Blue Shield of California EPN |
$14.34
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.21
|
| Rate for Payer: Dignity Health Media |
$18.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.49
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.14
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.75
|
| Rate for Payer: Heritage Provider Network Transplant |
$29.75
|
| Rate for Payer: IEHP Medi-Cal |
$29.39
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$29.39
|
| Rate for Payer: IEHP Medicare Advantage |
$18.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.31
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.70
|
| Rate for Payer: United Healthcare All Other HMO |
$14.70
|
| Rate for Payer: United Healthcare HMO Rider |
$14.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: Vantage Medical Group Senior |
$18.14
|
|
|
HC ECG TRACING ONLY
|
Facility
OP
|
$881.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
905493005
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$31.16 |
| Max. Negotiated Rate |
$748.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$73.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$524.90
|
| Rate for Payer: BCBS Transplant Transplant |
$528.60
|
| Rate for Payer: Blue Shield of California Commercial |
$520.67
|
| Rate for Payer: Blue Shield of California EPN |
$413.19
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cigna of CA HMO |
$563.84
|
| Rate for Payer: Cigna of CA PPO |
$651.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$748.85
|
| Rate for Payer: Global Benefits Group Commercial |
$528.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$660.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.33
|
| Rate for Payer: IEHP Medi-Cal |
$123.80
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$123.80
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$587.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$704.80
|
| Rate for Payer: Networks By Design Commercial |
$572.65
|
| Rate for Payer: Prime Health Services Commercial |
$748.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$528.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$528.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$528.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$656.00
|
| Rate for Payer: United Healthcare All Other HMO |
$399.00
|
| Rate for Payer: United Healthcare HMO Rider |
$302.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC ECG TRACING ONLY
|
Facility
IP
|
$881.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
941093005
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$211.44 |
| Max. Negotiated Rate |
$748.85 |
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.40
|
| Rate for Payer: Galaxy Health WC |
$748.85
|
| Rate for Payer: Global Benefits Group Commercial |
$528.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$587.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.44
|
| Rate for Payer: Multiplan Commercial |
$704.80
|
| Rate for Payer: Networks By Design Commercial |
$572.65
|
| Rate for Payer: Prime Health Services Commercial |
$748.85
|
|
|
HC ECG TRACING ONLY
|
Facility
IP
|
$881.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900200101
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$211.44 |
| Max. Negotiated Rate |
$748.85 |
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.40
|
| Rate for Payer: Galaxy Health WC |
$748.85
|
| Rate for Payer: Global Benefits Group Commercial |
$528.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$587.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.44
|
| Rate for Payer: Multiplan Commercial |
$704.80
|
| Rate for Payer: Networks By Design Commercial |
$572.65
|
| Rate for Payer: Prime Health Services Commercial |
$748.85
|
|
|
HC ECG TRACING ONLY
|
Facility
OP
|
$881.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
941093005
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$31.16 |
| Max. Negotiated Rate |
$748.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$73.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$524.90
|
| Rate for Payer: BCBS Transplant Transplant |
$528.60
|
| Rate for Payer: Blue Shield of California Commercial |
$520.67
|
| Rate for Payer: Blue Shield of California EPN |
$413.19
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cigna of CA HMO |
$563.84
|
| Rate for Payer: Cigna of CA PPO |
$651.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$748.85
|
| Rate for Payer: Global Benefits Group Commercial |
$528.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$660.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.33
|
| Rate for Payer: IEHP Medi-Cal |
$123.80
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$123.80
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$587.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$704.80
|
| Rate for Payer: Networks By Design Commercial |
$572.65
|
| Rate for Payer: Prime Health Services Commercial |
$748.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$528.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$528.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$528.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$656.00
|
| Rate for Payer: United Healthcare All Other HMO |
$399.00
|
| Rate for Payer: United Healthcare HMO Rider |
$302.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
