|
HC NICU BACK TRANSPORT PER HOUR
|
Facility
IP
|
$5,615.00
|
|
| Hospital Charge Code |
905200004
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$5,238.00 |
| Rate for Payer: Blue Shield of California Commercial |
$5,238.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,750.00
|
| Rate for Payer: Cash Price |
$2,526.75
|
| Rate for Payer: Cash Price |
$2,526.75
|
| Rate for Payer: Cash Price |
$2,526.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,246.00
|
| Rate for Payer: Galaxy Health WC |
$4,772.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,369.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$334.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,745.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,139.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,347.60
|
| Rate for Payer: Multiplan Commercial |
$4,492.00
|
| Rate for Payer: Networks By Design Commercial |
$3,649.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,772.75
|
|
|
HC NICU TRANSPORT CASE RATE
|
Facility
IP
|
$2,142.00
|
|
| Hospital Charge Code |
905200005
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$5,238.00 |
| Rate for Payer: Blue Shield of California Commercial |
$5,238.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,750.00
|
| Rate for Payer: Cash Price |
$963.90
|
| Rate for Payer: Cash Price |
$963.90
|
| Rate for Payer: Cash Price |
$963.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$856.80
|
| Rate for Payer: Galaxy Health WC |
$1,820.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,285.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$334.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,428.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$816.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$514.08
|
| Rate for Payer: Multiplan Commercial |
$1,713.60
|
| Rate for Payer: Networks By Design Commercial |
$1,392.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,820.70
|
|
|
HC NICU TRANSPORT PER HOUR
|
Facility
IP
|
$4,230.00
|
|
| Hospital Charge Code |
905200001
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$5,238.00 |
| Rate for Payer: Blue Shield of California Commercial |
$5,238.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,750.00
|
| Rate for Payer: Cash Price |
$1,903.50
|
| Rate for Payer: Cash Price |
$1,903.50
|
| Rate for Payer: Cash Price |
$1,903.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,692.00
|
| Rate for Payer: Galaxy Health WC |
$3,595.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,538.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$334.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,821.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,611.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,015.20
|
| Rate for Payer: Multiplan Commercial |
$3,384.00
|
| Rate for Payer: Networks By Design Commercial |
$2,749.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,595.50
|
|
|
HC NIPT
|
Facility
IP
|
$532.00
|
|
|
Service Code
|
CPT 81507
|
| Hospital Charge Code |
910401507
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$127.68 |
| Max. Negotiated Rate |
$452.20 |
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$212.80
|
| Rate for Payer: Galaxy Health WC |
$452.20
|
| Rate for Payer: Global Benefits Group Commercial |
$319.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$354.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.68
|
| Rate for Payer: Multiplan Commercial |
$425.60
|
| Rate for Payer: Networks By Design Commercial |
$345.80
|
| Rate for Payer: Prime Health Services Commercial |
$452.20
|
|
|
HC NIPT
|
Facility
OP
|
$532.00
|
|
|
Service Code
|
CPT 81507
|
| Hospital Charge Code |
910401507
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$127.68 |
| Max. Negotiated Rate |
$4,014.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,014.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,192.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$874.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$795.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,566.11
|
| Rate for Payer: BCBS Transplant Transplant |
$319.20
|
| Rate for Payer: Blue Shield of California Commercial |
$343.67
|
| Rate for Payer: Blue Shield of California EPN |
$272.38
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cigna of CA HMO |
$340.48
|
| Rate for Payer: Cigna of CA PPO |
$393.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,192.50
|
| Rate for Payer: Dignity Health Media |
$795.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$874.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,073.25
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$795.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$795.00
|
| Rate for Payer: Galaxy Health WC |
$452.20
|
| Rate for Payer: Global Benefits Group Commercial |
$319.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$399.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,303.80
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,303.80
|
| Rate for Payer: IEHP Medi-Cal |
$1,287.90
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,287.90
|
| Rate for Payer: IEHP Medicare Advantage |
$795.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$354.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,208.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$795.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,001.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,065.30
|
| Rate for Payer: Multiplan Commercial |
$425.60
|
| Rate for Payer: Networks By Design Commercial |
$345.80
|
| Rate for Payer: Prime Health Services Commercial |
$452.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$319.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$319.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$319.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$643.95
|
| Rate for Payer: United Healthcare All Other HMO |
$643.95
|
| Rate for Payer: United Healthcare HMO Rider |
$643.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,192.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$874.50
|
| Rate for Payer: Vantage Medical Group Senior |
$795.00
|
|
|
HC NITRIC OXIDE/HELIOX THRPY PER DAY
|
Facility
OP
|
$4,376.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800400
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$3,719.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,870.22
|
| 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 |
$2,607.22
|
| Rate for Payer: BCBS Transplant Transplant |
$2,625.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,586.22
|
| Rate for Payer: Blue Shield of California EPN |
$2,052.34
|
| Rate for Payer: Cash Price |
$1,969.20
|
| Rate for Payer: Cash Price |
$1,969.20
|
| Rate for Payer: Cash Price |
$1,969.20
|
| Rate for Payer: Cigna of CA HMO |
$2,800.64
|
| Rate for Payer: Cigna of CA PPO |
$3,238.24
|
| 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 |
$3,719.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,625.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,282.00
|
| 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 |
$2,918.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,050.24
|
| 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 |
$3,500.80
|
| Rate for Payer: Networks By Design Commercial |
$2,844.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,719.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,625.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,625.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,625.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| 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 NITRIC OXIDE/HELIOX THRPY PER DAY
|
Facility
IP
|
$4,376.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800400
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$1,050.24 |
| Max. Negotiated Rate |
$3,719.60 |
| Rate for Payer: Cash Price |
$1,969.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,750.40
|
| Rate for Payer: Galaxy Health WC |
$3,719.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,625.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,918.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,667.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,050.24
|
| Rate for Payer: Multiplan Commercial |
$3,500.80
|
| Rate for Payer: Networks By Design Commercial |
$2,844.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,719.60
|
|
|
HC NK CELLS TOTAL COUNTCD16+56
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
903900106
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$336.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$313.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$56.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$336.66
|
| Rate for Payer: BCBS Transplant Transplant |
$42.60
|
| Rate for Payer: Blue Shield of California Commercial |
$45.87
|
| Rate for Payer: Blue Shield of California EPN |
$36.35
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cigna of CA HMO |
$45.44
|
| Rate for Payer: Cigna of CA PPO |
$52.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.60
|
| Rate for Payer: Dignity Health Media |
$37.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.73
|
| Rate for Payer: Galaxy Health WC |
$60.35
|
| Rate for Payer: Global Benefits Group Commercial |
$42.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$53.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.88
|
| Rate for Payer: Heritage Provider Network Transplant |
$61.88
|
| Rate for Payer: IEHP Medi-Cal |
$61.12
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$61.12
|
| Rate for Payer: IEHP Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$56.80
|
| Rate for Payer: Networks By Design Commercial |
$46.15
|
| Rate for Payer: Prime Health Services Commercial |
$60.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$42.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.56
|
| Rate for Payer: United Healthcare All Other HMO |
$30.56
|
| Rate for Payer: United Healthcare HMO Rider |
$30.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC NK CELLS TOTAL COUNTCD16+56
|
Facility
IP
|
$476.00
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
903900106
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$114.24 |
| Max. Negotiated Rate |
$404.60 |
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.40
|
| Rate for Payer: Galaxy Health WC |
$404.60
|
| Rate for Payer: Global Benefits Group Commercial |
$285.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$317.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.24
|
| Rate for Payer: Multiplan Commercial |
$380.80
|
| Rate for Payer: Networks By Design Commercial |
$309.40
|
| Rate for Payer: Prime Health Services Commercial |
$404.60
|
|
|
HC NM MYCRD IMG PET RST & STRS CT
|
Facility
IP
|
$6,193.00
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
909308431
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,486.32 |
| Max. Negotiated Rate |
$5,264.05 |
| Rate for Payer: Cash Price |
$2,786.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,477.20
|
| Rate for Payer: Galaxy Health WC |
$5,264.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,715.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,359.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,486.32
|
| Rate for Payer: Multiplan Commercial |
$4,954.40
|
| Rate for Payer: Networks By Design Commercial |
$4,025.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,264.05
|
|
|
HC NM MYCRD IMG PET RST & STRS CT
|
Facility
OP
|
$6,193.00
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
909308431
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$152.19 |
| Max. Negotiated Rate |
$10,428.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10,428.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,426.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,246.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,951.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,689.79
|
| Rate for Payer: BCBS Transplant Transplant |
$3,715.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,660.06
|
| Rate for Payer: Blue Shield of California EPN |
$2,904.52
|
| Rate for Payer: Cash Price |
$2,786.85
|
| Rate for Payer: Cash Price |
$2,786.85
|
| Rate for Payer: Cigna of CA HMO |
$3,963.52
|
| Rate for Payer: Cigna of CA PPO |
$4,582.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,426.76
|
| Rate for Payer: Dignity Health Media |
$2,951.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,246.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,984.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,951.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,951.17
|
| Rate for Payer: Galaxy Health WC |
$5,264.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,715.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,644.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,839.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,839.92
|
| Rate for Payer: IEHP Medi-Cal |
$4,780.90
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$4,780.90
|
| Rate for Payer: IEHP Medicare Advantage |
$2,951.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,951.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,486.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,718.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,954.57
|
| Rate for Payer: Multiplan Commercial |
$4,954.40
|
| Rate for Payer: Networks By Design Commercial |
$4,025.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,264.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,715.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,715.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,715.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,761.28
|
| Rate for Payer: United Healthcare All Other HMO |
$5,761.28
|
| Rate for Payer: United Healthcare HMO Rider |
$5,761.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,761.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,426.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,246.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2,951.17
|
|
|
HC NM MYCRD IMG PET RST/STRS W/CT
|
Facility
IP
|
$3,971.00
|
|
|
Service Code
|
CPT 78430
|
| Hospital Charge Code |
909308430
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$953.04 |
| Max. Negotiated Rate |
$3,375.35 |
| Rate for Payer: Cash Price |
$1,786.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,588.40
|
| Rate for Payer: Galaxy Health WC |
$3,375.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,382.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,648.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,512.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$953.04
|
| Rate for Payer: Multiplan Commercial |
$3,176.80
|
| Rate for Payer: Networks By Design Commercial |
$2,581.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,375.35
|
|
|
HC NM MYCRD IMG PET RST/STRS W/CT
|
Facility
OP
|
$3,971.00
|
|
|
Service Code
|
CPT 78430
|
| Hospital Charge Code |
909308430
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$130.68 |
| Max. Negotiated Rate |
$10,428.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10,428.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,954.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,365.92
|
| Rate for Payer: BCBS Transplant Transplant |
$2,382.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,346.86
|
| Rate for Payer: Blue Shield of California EPN |
$1,862.40
|
| Rate for Payer: Cash Price |
$1,786.95
|
| Rate for Payer: Cash Price |
$1,786.95
|
| Rate for Payer: Cigna of CA HMO |
$2,541.44
|
| Rate for Payer: Cigna of CA PPO |
$2,938.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Dignity Health Media |
$1,954.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,638.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,954.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,954.68
|
| Rate for Payer: Galaxy Health WC |
$3,375.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,382.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,978.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,205.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,205.68
|
| Rate for Payer: IEHP Medi-Cal |
$3,166.58
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,166.58
|
| Rate for Payer: IEHP Medicare Advantage |
$1,954.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,648.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,954.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$953.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,462.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,619.27
|
| Rate for Payer: Multiplan Commercial |
$3,176.80
|
| Rate for Payer: Networks By Design Commercial |
$2,581.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,375.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,382.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,382.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,382.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,694.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3,694.08
|
| Rate for Payer: United Healthcare HMO Rider |
$3,694.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,694.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,954.68
|
|
|
HC NM MYOCRD IMG PET 1 STUDY W/CT
|
Facility
OP
|
$3,971.00
|
|
|
Service Code
|
CPT 78429
|
| Hospital Charge Code |
909308429
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$137.75 |
| Max. Negotiated Rate |
$10,428.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10,428.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,954.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,365.92
|
| Rate for Payer: BCBS Transplant Transplant |
$2,382.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,346.86
|
| Rate for Payer: Blue Shield of California EPN |
$1,862.40
|
| Rate for Payer: Cash Price |
$1,786.95
|
| Rate for Payer: Cash Price |
$1,786.95
|
| Rate for Payer: Cigna of CA HMO |
$2,541.44
|
| Rate for Payer: Cigna of CA PPO |
$2,938.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Dignity Health Media |
$1,954.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,638.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,954.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,954.68
|
| Rate for Payer: Galaxy Health WC |
$3,375.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,382.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,978.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,205.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,205.68
|
| Rate for Payer: IEHP Medi-Cal |
$3,166.58
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,166.58
|
| Rate for Payer: IEHP Medicare Advantage |
$1,954.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,648.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,954.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$953.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,462.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,619.27
|
| Rate for Payer: Multiplan Commercial |
$3,176.80
|
| Rate for Payer: Networks By Design Commercial |
$2,581.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,375.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,382.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,382.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,382.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,694.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3,694.08
|
| Rate for Payer: United Healthcare HMO Rider |
$3,694.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,694.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,954.68
|
|
|
HC NM MYOCRD IMG PET 1 STUDY W/CT
|
Facility
IP
|
$3,971.00
|
|
|
Service Code
|
CPT 78429
|
| Hospital Charge Code |
909308429
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$953.04 |
| Max. Negotiated Rate |
$3,375.35 |
| Rate for Payer: Cash Price |
$1,786.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,588.40
|
| Rate for Payer: Galaxy Health WC |
$3,375.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,382.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,648.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,512.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$953.04
|
| Rate for Payer: Multiplan Commercial |
$3,176.80
|
| Rate for Payer: Networks By Design Commercial |
$2,581.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,375.35
|
|
|
HC NM MYOCRD IMG PET DUAL TRCR CT
|
Facility
OP
|
$7,570.00
|
|
|
Service Code
|
CPT 78433
|
| Hospital Charge Code |
909308433
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$176.95 |
| Max. Negotiated Rate |
$10,428.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10,428.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,836.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,813.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,557.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,510.21
|
| Rate for Payer: BCBS Transplant Transplant |
$4,542.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,473.87
|
| Rate for Payer: Blue Shield of California EPN |
$3,550.33
|
| Rate for Payer: Cash Price |
$3,406.50
|
| Rate for Payer: Cash Price |
$3,406.50
|
| Rate for Payer: Cigna of CA HMO |
$4,844.80
|
| Rate for Payer: Cigna of CA PPO |
$5,601.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,836.66
|
| Rate for Payer: Dignity Health Media |
$2,557.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,813.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,452.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,557.77
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,557.77
|
| Rate for Payer: Galaxy Health WC |
$6,434.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,542.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,677.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,194.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,194.74
|
| Rate for Payer: IEHP Medi-Cal |
$4,143.59
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$4,143.59
|
| Rate for Payer: IEHP Medicare Advantage |
$2,557.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,049.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,557.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,816.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,222.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,427.41
|
| Rate for Payer: Multiplan Commercial |
$6,056.00
|
| Rate for Payer: Networks By Design Commercial |
$4,920.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,434.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,542.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,542.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,542.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,041.28
|
| Rate for Payer: United Healthcare All Other HMO |
$7,041.28
|
| Rate for Payer: United Healthcare HMO Rider |
$7,041.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,041.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,836.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,813.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,557.77
|
|
|
HC NM MYOCRD IMG PET DUAL TRCR CT
|
Facility
IP
|
$7,570.00
|
|
|
Service Code
|
CPT 78433
|
| Hospital Charge Code |
909308433
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,816.80 |
| Max. Negotiated Rate |
$6,434.50 |
| Rate for Payer: Cash Price |
$3,406.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,028.00
|
| Rate for Payer: Galaxy Health WC |
$6,434.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,542.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,049.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,884.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,816.80
|
| Rate for Payer: Multiplan Commercial |
$6,056.00
|
| Rate for Payer: Networks By Design Commercial |
$4,920.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,434.50
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 1
|
Facility
IP
|
$3,501.00
|
|
|
Service Code
|
CPT 78830
|
| Hospital Charge Code |
909308830
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$840.24 |
| Max. Negotiated Rate |
$2,975.85 |
| Rate for Payer: Cash Price |
$1,575.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,400.40
|
| Rate for Payer: Galaxy Health WC |
$2,975.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,100.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,335.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,333.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$840.24
|
| Rate for Payer: Multiplan Commercial |
$2,800.80
|
| Rate for Payer: Networks By Design Commercial |
$2,275.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,975.85
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 1
|
Facility
OP
|
$3,501.00
|
|
|
Service Code
|
CPT 78830
|
| Hospital Charge Code |
909308830
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$821.67 |
| Max. Negotiated Rate |
$3,256.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,085.90
|
| Rate for Payer: BCBS Transplant Transplant |
$2,100.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,069.09
|
| Rate for Payer: Blue Shield of California EPN |
$1,641.97
|
| Rate for Payer: Cash Price |
$1,575.45
|
| Rate for Payer: Cash Price |
$1,575.45
|
| Rate for Payer: Cigna of CA HMO |
$2,240.64
|
| Rate for Payer: Cigna of CA PPO |
$2,590.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Dignity Health Media |
$1,774.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,395.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,774.15
|
| Rate for Payer: Galaxy Health WC |
$2,975.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,100.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,625.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,909.61
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,909.61
|
| Rate for Payer: IEHP Medi-Cal |
$2,874.12
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2,874.12
|
| Rate for Payer: IEHP Medicare Advantage |
$1,774.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,335.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$821.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,774.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$840.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,235.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,377.36
|
| Rate for Payer: Multiplan Commercial |
$2,800.80
|
| Rate for Payer: Networks By Design Commercial |
$2,275.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,975.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,100.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,100.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,100.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,256.45
|
| Rate for Payer: United Healthcare All Other HMO |
$3,256.45
|
| Rate for Payer: United Healthcare HMO Rider |
$3,256.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,256.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 2
|
Facility
IP
|
$3,971.00
|
|
|
Service Code
|
CPT 78832
|
| Hospital Charge Code |
909308832
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$953.04 |
| Max. Negotiated Rate |
$3,375.35 |
| Rate for Payer: Cash Price |
$1,786.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,588.40
|
| Rate for Payer: Galaxy Health WC |
$3,375.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,382.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,648.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,512.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$953.04
|
| Rate for Payer: Multiplan Commercial |
$3,176.80
|
| Rate for Payer: Networks By Design Commercial |
$2,581.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,375.35
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 2
|
Facility
OP
|
$3,971.00
|
|
|
Service Code
|
CPT 78832
|
| Hospital Charge Code |
909308832
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$953.04 |
| Max. Negotiated Rate |
$3,694.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,954.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,365.92
|
| Rate for Payer: BCBS Transplant Transplant |
$2,382.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,346.86
|
| Rate for Payer: Blue Shield of California EPN |
$1,862.40
|
| Rate for Payer: Cash Price |
$1,786.95
|
| Rate for Payer: Cash Price |
$1,786.95
|
| Rate for Payer: Cigna of CA HMO |
$2,541.44
|
| Rate for Payer: Cigna of CA PPO |
$2,938.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Dignity Health Media |
$1,954.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,638.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,954.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,954.68
|
| Rate for Payer: Galaxy Health WC |
$3,375.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,382.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,978.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,205.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,205.68
|
| Rate for Payer: IEHP Medi-Cal |
$3,166.58
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,166.58
|
| Rate for Payer: IEHP Medicare Advantage |
$1,954.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,648.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,563.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,954.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$953.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,462.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,619.27
|
| Rate for Payer: Multiplan Commercial |
$3,176.80
|
| Rate for Payer: Networks By Design Commercial |
$2,581.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,375.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,382.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,382.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,382.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,694.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3,694.08
|
| Rate for Payer: United Healthcare HMO Rider |
$3,694.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,694.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,954.68
|
|
|
HC NON-GYN FLUID WASH BRUSH PG
|
Facility
IP
|
$90.00
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
903800214
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
|
|
HC NON-GYN FLUID WASH BRUSH PG
|
Facility
OP
|
$90.00
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
903800214
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$239.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$239.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$50.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.86
|
| Rate for Payer: BCBS Transplant Transplant |
$54.00
|
| Rate for Payer: Blue Shield of California Commercial |
$58.14
|
| Rate for Payer: Blue Shield of California EPN |
$46.08
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO |
$57.60
|
| Rate for Payer: Cigna of CA PPO |
$66.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: Dignity Health Media |
$50.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$50.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.11
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$67.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.18
|
| Rate for Payer: Heritage Provider Network Transplant |
$82.18
|
| Rate for Payer: IEHP Medi-Cal |
$81.18
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$81.18
|
| Rate for Payer: IEHP Medicare Advantage |
$50.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.15
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.11
|
|
|
HC NON-GYN THIN-PREP, PG
|
Facility
IP
|
$101.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
903800213
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$24.24 |
| Max. Negotiated Rate |
$85.85 |
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.40
|
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.24
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
|
|
HC NON-GYN THIN-PREP, PG
|
Facility
OP
|
$101.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
903800213
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$24.24 |
| Max. Negotiated Rate |
$403.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$293.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$67.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$403.37
|
| Rate for Payer: BCBS Transplant Transplant |
$60.60
|
| Rate for Payer: Blue Shield of California Commercial |
$65.25
|
| Rate for Payer: Blue Shield of California EPN |
$51.71
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cigna of CA HMO |
$64.64
|
| Rate for Payer: Cigna of CA PPO |
$74.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.55
|
| Rate for Payer: Dignity Health Media |
$67.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$67.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$67.70
|
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$75.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$111.03
|
| Rate for Payer: IEHP Medi-Cal |
$109.67
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$109.67
|
| Rate for Payer: IEHP Medicare Advantage |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.72
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$60.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Vantage Medical Group Senior |
$67.70
|
|
