|
HC INS SUBQ CAR RHYTHM MTR W PRGM
|
Facility
|
OP
|
$17,341.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
906813406
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,429.00 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$3,468.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,515.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,490.94
|
| Rate for Payer: Cash Price |
$9,537.55
|
| Rate for Payer: Cash Price |
$9,537.55
|
| Rate for Payer: Cash Price |
$9,537.55
|
| Rate for Payer: Cigna of CA HMO |
$11,098.24
|
| Rate for Payer: Cigna of CA PPO |
$12,832.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,567.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,515.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,195.87
|
| Rate for Payer: EPIC Health Plan Senior |
$10,515.46
|
| Rate for Payer: Galaxy Health WC |
$14,739.85
|
| Rate for Payer: Global Benefits Group Commercial |
$10,404.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,245.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,126.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,515.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,566.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,190.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,515.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,161.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,249.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,090.72
|
| Rate for Payer: Multiplan Commercial |
$13,872.80
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: Networks By Design Commercial |
$11,271.65
|
| Rate for Payer: Prime Health Services Commercial |
$14,739.85
|
| Rate for Payer: Prime Health Services WC |
$16,583.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,404.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$10,515.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Vantage Medical Group Senior |
$10,515.46
|
|
|
HC INS SUBQ CAR RHYTHM MTR W PRGM
|
Facility
|
IP
|
$17,341.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
906813406
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,468.20 |
| Max. Negotiated Rate |
$14,739.85 |
| Rate for Payer: Adventist Health Commercial |
$3,468.20
|
| Rate for Payer: Cash Price |
$9,537.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,936.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,936.40
|
| Rate for Payer: Galaxy Health WC |
$14,739.85
|
| Rate for Payer: Global Benefits Group Commercial |
$10,404.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,566.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,606.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,734.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,161.84
|
| Rate for Payer: Multiplan Commercial |
$13,872.80
|
| Rate for Payer: Networks By Design Commercial |
$11,271.65
|
| Rate for Payer: Prime Health Services Commercial |
$14,739.85
|
|
|
HC INST WAVE FREE RATIO WO STRESS AGENT
|
Facility
|
IP
|
$9,164.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906803801
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,832.80 |
| Max. Negotiated Rate |
$7,789.40 |
| Rate for Payer: Adventist Health Commercial |
$1,832.80
|
| Rate for Payer: Cash Price |
$5,040.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,665.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,665.60
|
| Rate for Payer: Galaxy Health WC |
$7,789.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,498.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,112.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,491.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,672.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,199.36
|
| Rate for Payer: Multiplan Commercial |
$7,331.20
|
| Rate for Payer: Networks By Design Commercial |
$5,956.60
|
| Rate for Payer: Prime Health Services Commercial |
$7,789.40
|
|
|
HC INST WAVE FREE RATIO WO STRESS AGENT
|
Facility
|
OP
|
$9,164.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906803801
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$7,789.40 |
| Rate for Payer: Adventist Health Commercial |
$1,832.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,010.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,627.61
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$5,040.20
|
| Rate for Payer: Cash Price |
$5,040.20
|
| Rate for Payer: Cash Price |
$5,040.20
|
| Rate for Payer: Cigna of CA HMO |
$5,864.96
|
| Rate for Payer: Cigna of CA PPO |
$6,781.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$7,789.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,498.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,112.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,199.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$7,331.20
|
| Rate for Payer: Networks By Design Commercial |
$5,956.60
|
| Rate for Payer: Prime Health Services Commercial |
$7,789.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,498.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,498.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC INST WAVE FREE RATIO WO STRESS AGENT
|
Facility
|
IP
|
$10,781.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820291
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,156.20 |
| Max. Negotiated Rate |
$9,163.85 |
| Rate for Payer: Adventist Health Commercial |
$2,156.20
|
| Rate for Payer: Cash Price |
$5,929.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,312.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,312.40
|
| Rate for Payer: Galaxy Health WC |
$9,163.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,468.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,190.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,107.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,673.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,587.44
|
| Rate for Payer: Multiplan Commercial |
$8,624.80
|
| Rate for Payer: Networks By Design Commercial |
$7,007.65
|
| Rate for Payer: Prime Health Services Commercial |
$9,163.85
|
|
|
HC INST WAVE FREE RATIO WO STRESS AGENT
|
Facility
|
OP
|
$10,781.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820291
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$9,163.85 |
| Rate for Payer: Adventist Health Commercial |
$2,156.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,071.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,620.61
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$5,929.55
|
| Rate for Payer: Cash Price |
$5,929.55
|
| Rate for Payer: Cash Price |
$5,929.55
|
| Rate for Payer: Cigna of CA HMO |
$6,899.84
|
| Rate for Payer: Cigna of CA PPO |
$7,977.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$9,163.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,468.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,190.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,587.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$8,624.80
|
| Rate for Payer: Networks By Design Commercial |
$7,007.65
|
| Rate for Payer: Prime Health Services Commercial |
$9,163.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,468.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,468.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC INSULIN
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
900912130
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$152.15 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.91
|
| Rate for Payer: Blue Shield of California Commercial |
$119.75
|
| Rate for Payer: Blue Shield of California EPN |
$79.12
|
| Rate for Payer: Cash Price |
$98.45
|
| Rate for Payer: Cash Price |
$98.45
|
| Rate for Payer: Cigna of CA HMO |
$114.56
|
| Rate for Payer: Cigna of CA PPO |
$132.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.43
|
| Rate for Payer: EPIC Health Plan Senior |
$11.43
|
| Rate for Payer: Galaxy Health WC |
$152.15
|
| Rate for Payer: Global Benefits Group Commercial |
$107.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.32
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: Networks By Design Commercial |
$116.35
|
| Rate for Payer: Prime Health Services Commercial |
$152.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.26
|
| Rate for Payer: United Healthcare All Other HMO |
$9.26
|
| Rate for Payer: United Healthcare HMO Rider |
$9.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.26
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.57
|
| Rate for Payer: Vantage Medical Group Senior |
$11.43
|
|
|
HC INSULIN
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
900912130
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.80 |
| Max. Negotiated Rate |
$152.15 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Cash Price |
$98.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.60
|
| Rate for Payer: EPIC Health Plan Senior |
$71.60
|
| Rate for Payer: Galaxy Health WC |
$152.15
|
| Rate for Payer: Global Benefits Group Commercial |
$107.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.96
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: Networks By Design Commercial |
$116.35
|
| Rate for Payer: Prime Health Services Commercial |
$152.15
|
|
|
HC INTACT PTH
|
Facility
|
IP
|
$763.00
|
|
|
Service Code
|
CPT 83970
|
| Hospital Charge Code |
900910942
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$152.60 |
| Max. Negotiated Rate |
$648.55 |
| Rate for Payer: Adventist Health Commercial |
$152.60
|
| Rate for Payer: Cash Price |
$419.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.20
|
| Rate for Payer: EPIC Health Plan Senior |
$305.20
|
| Rate for Payer: Galaxy Health WC |
$648.55
|
| Rate for Payer: Global Benefits Group Commercial |
$457.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$508.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.12
|
| Rate for Payer: Multiplan Commercial |
$610.40
|
| Rate for Payer: Networks By Design Commercial |
$495.95
|
| Rate for Payer: Prime Health Services Commercial |
$648.55
|
|
|
HC INTACT PTH
|
Facility
|
OP
|
$763.00
|
|
|
Service Code
|
CPT 83970
|
| Hospital Charge Code |
900910942
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.44 |
| Max. Negotiated Rate |
$648.55 |
| Rate for Payer: Adventist Health Commercial |
$152.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$500.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$407.69
|
| Rate for Payer: Blue Shield of California Commercial |
$510.45
|
| Rate for Payer: Blue Shield of California EPN |
$337.25
|
| Rate for Payer: Cash Price |
$419.65
|
| Rate for Payer: Cash Price |
$419.65
|
| Rate for Payer: Cigna of CA HMO |
$488.32
|
| Rate for Payer: Cigna of CA PPO |
$564.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.73
|
| Rate for Payer: EPIC Health Plan Senior |
$41.28
|
| Rate for Payer: Galaxy Health WC |
$648.55
|
| Rate for Payer: Global Benefits Group Commercial |
$457.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$508.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.32
|
| Rate for Payer: Multiplan Commercial |
$610.40
|
| Rate for Payer: Networks By Design Commercial |
$495.95
|
| Rate for Payer: Prime Health Services Commercial |
$648.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$457.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$457.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.44
|
| Rate for Payer: United Healthcare All Other HMO |
$33.44
|
| Rate for Payer: United Healthcare HMO Rider |
$33.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$41.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.41
|
| Rate for Payer: Vantage Medical Group Senior |
$41.28
|
|
|
HC INT AUDITORY MEATUS
|
Facility
|
IP
|
$673.00
|
|
|
Service Code
|
CPT 70134
|
| Hospital Charge Code |
909001133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$134.60 |
| Max. Negotiated Rate |
$572.05 |
| Rate for Payer: Adventist Health Commercial |
$134.60
|
| Rate for Payer: Cash Price |
$370.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$269.20
|
| Rate for Payer: EPIC Health Plan Senior |
$269.20
|
| Rate for Payer: Galaxy Health WC |
$572.05
|
| Rate for Payer: Global Benefits Group Commercial |
$403.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$448.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$416.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.52
|
| Rate for Payer: Multiplan Commercial |
$538.40
|
| Rate for Payer: Networks By Design Commercial |
$437.45
|
| Rate for Payer: Prime Health Services Commercial |
$572.05
|
|
|
HC INT AUDITORY MEATUS
|
Facility
|
OP
|
$673.00
|
|
|
Service Code
|
CPT 70134
|
| Hospital Charge Code |
909001133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$77.01 |
| Max. Negotiated Rate |
$1,142.54 |
| Rate for Payer: Adventist Health Commercial |
$134.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$441.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$209.47
|
| Rate for Payer: Blue Shield of California Commercial |
$411.88
|
| Rate for Payer: Blue Shield of California EPN |
$271.89
|
| Rate for Payer: Cash Price |
$370.15
|
| Rate for Payer: Cash Price |
$370.15
|
| Rate for Payer: Cigna of CA HMO |
$430.72
|
| Rate for Payer: Cigna of CA PPO |
$498.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$696.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$940.50
|
| Rate for Payer: EPIC Health Plan Senior |
$696.67
|
| Rate for Payer: Galaxy Health WC |
$572.05
|
| Rate for Payer: Global Benefits Group Commercial |
$403.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,142.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$77.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$696.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$448.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$696.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$877.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$933.54
|
| Rate for Payer: Multiplan Commercial |
$538.40
|
| Rate for Payer: Networks By Design Commercial |
$437.45
|
| Rate for Payer: Prime Health Services Commercial |
$572.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$403.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$403.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$696.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Vantage Medical Group Senior |
$696.67
|
|
|
HC INTENSITY MOD RADIO TX PLAN
|
Facility
|
IP
|
$6,270.00
|
|
|
Service Code
|
CPT 77301
|
| Hospital Charge Code |
909100275
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,254.00 |
| Max. Negotiated Rate |
$5,329.50 |
| Rate for Payer: Adventist Health Commercial |
$1,254.00
|
| Rate for Payer: Cash Price |
$3,448.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,508.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,508.00
|
| Rate for Payer: Galaxy Health WC |
$5,329.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,762.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,182.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,388.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,881.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,504.80
|
| Rate for Payer: Multiplan Commercial |
$5,016.00
|
| Rate for Payer: Networks By Design Commercial |
$4,075.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,329.50
|
|
|
HC INTENSITY MOD RADIO TX PLAN
|
Facility
|
OP
|
$6,270.00
|
|
|
Service Code
|
CPT 77301
|
| Hospital Charge Code |
909100275
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,221.00 |
| Max. Negotiated Rate |
$7,523.40 |
| Rate for Payer: Adventist Health Commercial |
$1,254.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,112.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,607.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,912.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,738.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,523.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,837.24
|
| Rate for Payer: Blue Shield of California EPN |
$2,533.08
|
| Rate for Payer: Cash Price |
$3,448.50
|
| Rate for Payer: Cash Price |
$3,448.50
|
| Rate for Payer: Cash Price |
$3,448.50
|
| Rate for Payer: Cigna of CA HMO |
$4,012.80
|
| Rate for Payer: Cigna of CA PPO |
$4,639.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,607.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,912.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,738.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,346.99
|
| Rate for Payer: EPIC Health Plan Senior |
$1,738.51
|
| Rate for Payer: Galaxy Health WC |
$5,329.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,762.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,851.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,078.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,738.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,182.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,350.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,738.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,504.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,190.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,329.60
|
| Rate for Payer: Multiplan Commercial |
$5,016.00
|
| Rate for Payer: Networks By Design Commercial |
$4,075.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,329.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,762.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,738.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,607.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,912.36
|
| Rate for Payer: Vantage Medical Group Senior |
$1,738.51
|
|
|
HC INTERCOSTAL NERVE BLOCK SINGLE
|
Facility
|
IP
|
$1,857.00
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
900501673
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$371.40 |
| Max. Negotiated Rate |
$1,578.45 |
| Rate for Payer: Adventist Health Commercial |
$371.40
|
| Rate for Payer: Cash Price |
$1,021.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$742.80
|
| Rate for Payer: EPIC Health Plan Senior |
$742.80
|
| Rate for Payer: Galaxy Health WC |
$1,578.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,114.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,238.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$707.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,149.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$445.68
|
| Rate for Payer: Multiplan Commercial |
$1,485.60
|
| Rate for Payer: Networks By Design Commercial |
$1,207.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,578.45
|
|
|
HC INTERCOSTAL NERVE BLOCK SINGLE
|
Facility
|
OP
|
$1,857.00
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
900501673
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.18 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$371.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,021.35
|
| Rate for Payer: Cash Price |
$1,021.35
|
| Rate for Payer: Cash Price |
$1,021.35
|
| Rate for Payer: Cigna of CA HMO |
$1,188.48
|
| Rate for Payer: Cigna of CA PPO |
$1,374.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$1,578.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,114.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,238.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$445.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,108.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$1,485.60
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$1,207.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,578.45
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,114.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$928.50
|
| Rate for Payer: United Healthcare All Other HMO |
$928.50
|
| Rate for Payer: United Healthcare HMO Rider |
$928.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$928.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC INTERDENTAL WIRING,OTH THN FRX
|
Facility
|
OP
|
$10,260.00
|
|
|
Service Code
|
CPT 21497
|
| Hospital Charge Code |
900501322
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.16 |
| Max. Negotiated Rate |
$8,721.00 |
| Rate for Payer: Adventist Health Commercial |
$2,052.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$5,643.00
|
| Rate for Payer: Cash Price |
$5,643.00
|
| Rate for Payer: Cash Price |
$5,643.00
|
| Rate for Payer: Cigna of CA HMO |
$6,566.40
|
| Rate for Payer: Cigna of CA PPO |
$7,592.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,882.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.85
|
| Rate for Payer: EPIC Health Plan Senior |
$1,882.11
|
| Rate for Payer: Galaxy Health WC |
$8,721.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,156.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,086.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,843.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,882.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,462.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,371.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,522.03
|
| Rate for Payer: Multiplan Commercial |
$8,208.00
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$6,669.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,721.00
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,156.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,130.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,130.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,130.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,130.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,882.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,882.11
|
|
|
HC INTERDENTAL WIRING,OTH THN FRX
|
Facility
|
IP
|
$10,260.00
|
|
|
Service Code
|
CPT 21497
|
| Hospital Charge Code |
900501322
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,052.00 |
| Max. Negotiated Rate |
$8,721.00 |
| Rate for Payer: Adventist Health Commercial |
$2,052.00
|
| Rate for Payer: Cash Price |
$5,643.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,104.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,104.00
|
| Rate for Payer: Galaxy Health WC |
$8,721.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,156.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,843.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,909.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,350.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,462.40
|
| Rate for Payer: Multiplan Commercial |
$8,208.00
|
| Rate for Payer: Networks By Design Commercial |
$6,669.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,721.00
|
|
|
HC INTERNAL CARDIOVERSION, ELECTR
|
Facility
|
IP
|
$1,161.00
|
|
|
Service Code
|
CPT 92961
|
| Hospital Charge Code |
906820077
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$232.20 |
| Max. Negotiated Rate |
$986.85 |
| Rate for Payer: Adventist Health Commercial |
$232.20
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$464.40
|
| Rate for Payer: EPIC Health Plan Senior |
$464.40
|
| Rate for Payer: Galaxy Health WC |
$986.85
|
| Rate for Payer: Global Benefits Group Commercial |
$696.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$774.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$442.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$718.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$278.64
|
| Rate for Payer: Multiplan Commercial |
$928.80
|
| Rate for Payer: Networks By Design Commercial |
$754.65
|
| Rate for Payer: Prime Health Services Commercial |
$986.85
|
|
|
HC INTERNAL CARDIOVERSION, ELECTR
|
Facility
|
OP
|
$1,194.00
|
|
|
Service Code
|
CPT 92961
|
| Hospital Charge Code |
906812074
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$238.80 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$238.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$783.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,247.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$914.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$831.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$656.70
|
| Rate for Payer: Cash Price |
$656.70
|
| Rate for Payer: Cash Price |
$656.70
|
| Rate for Payer: Cigna of CA HMO |
$764.16
|
| Rate for Payer: Cigna of CA PPO |
$883.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,247.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$914.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$831.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,122.47
|
| Rate for Payer: EPIC Health Plan Senior |
$831.46
|
| Rate for Payer: Galaxy Health WC |
$1,014.90
|
| Rate for Payer: Global Benefits Group Commercial |
$716.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,363.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$290.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$831.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$796.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$328.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$831.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,047.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,114.16
|
| Rate for Payer: Multiplan Commercial |
$955.20
|
| Rate for Payer: Networks By Design Commercial |
$776.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,014.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$716.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$716.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$831.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,247.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$914.61
|
| Rate for Payer: Vantage Medical Group Senior |
$831.46
|
|
|
HC INTERNAL CARDIOVERSION, ELECTR
|
Facility
|
IP
|
$1,194.00
|
|
|
Service Code
|
CPT 92961
|
| Hospital Charge Code |
906812074
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$238.80 |
| Max. Negotiated Rate |
$1,014.90 |
| Rate for Payer: Adventist Health Commercial |
$238.80
|
| Rate for Payer: Cash Price |
$656.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$477.60
|
| Rate for Payer: EPIC Health Plan Senior |
$477.60
|
| Rate for Payer: Galaxy Health WC |
$1,014.90
|
| Rate for Payer: Global Benefits Group Commercial |
$716.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$796.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$454.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$739.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.56
|
| Rate for Payer: Multiplan Commercial |
$955.20
|
| Rate for Payer: Networks By Design Commercial |
$776.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,014.90
|
|
|
HC INTERNAL CARDIOVERSION, ELECTR
|
Facility
|
OP
|
$1,161.00
|
|
|
Service Code
|
CPT 92961
|
| Hospital Charge Code |
906820077
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$232.20 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$232.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$761.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,247.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$914.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$831.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Cigna of CA HMO |
$743.04
|
| Rate for Payer: Cigna of CA PPO |
$859.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,247.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$914.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$831.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,122.47
|
| Rate for Payer: EPIC Health Plan Senior |
$831.46
|
| Rate for Payer: Galaxy Health WC |
$986.85
|
| Rate for Payer: Global Benefits Group Commercial |
$696.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,363.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$290.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$831.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$774.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$328.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$831.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$278.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,047.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,114.16
|
| Rate for Payer: Multiplan Commercial |
$928.80
|
| Rate for Payer: Networks By Design Commercial |
$754.65
|
| Rate for Payer: Prime Health Services Commercial |
$986.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$696.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$696.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$831.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,247.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$914.61
|
| Rate for Payer: Vantage Medical Group Senior |
$831.46
|
|
|
HC INTERNAL CAROTID UNI
|
Facility
|
OP
|
$28,859.00
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
906820222
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$471.59 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$5,771.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$15,872.45
|
| Rate for Payer: Cash Price |
$15,872.45
|
| Rate for Payer: Cash Price |
$15,872.45
|
| Rate for Payer: Cigna of CA HMO |
$18,469.76
|
| Rate for Payer: Cigna of CA PPO |
$21,355.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$24,530.15
|
| Rate for Payer: Global Benefits Group Commercial |
$17,315.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$471.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,248.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$533.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,926.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$23,087.20
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: Networks By Design Commercial |
$18,758.35
|
| Rate for Payer: Prime Health Services Commercial |
$24,530.15
|
| Rate for Payer: Prime Health Services WC |
$10,832.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,315.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC INTERNAL CAROTID UNI
|
Facility
|
IP
|
$28,859.00
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
906820222
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,771.80 |
| Max. Negotiated Rate |
$24,530.15 |
| Rate for Payer: Adventist Health Commercial |
$5,771.80
|
| Rate for Payer: Cash Price |
$15,872.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,543.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11,543.60
|
| Rate for Payer: Galaxy Health WC |
$24,530.15
|
| Rate for Payer: Global Benefits Group Commercial |
$17,315.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,248.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,995.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,863.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,926.16
|
| Rate for Payer: Multiplan Commercial |
$23,087.20
|
| Rate for Payer: Networks By Design Commercial |
$18,758.35
|
| Rate for Payer: Prime Health Services Commercial |
$24,530.15
|
|
|
HC INTERNAL CAROTID UNI
|
Facility
|
IP
|
$21,331.00
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
909020147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,266.20 |
| Max. Negotiated Rate |
$18,131.35 |
| Rate for Payer: Adventist Health Commercial |
$4,266.20
|
| Rate for Payer: Cash Price |
$11,732.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,532.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8,532.40
|
| Rate for Payer: Galaxy Health WC |
$18,131.35
|
| Rate for Payer: Global Benefits Group Commercial |
$12,798.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,227.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,127.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,203.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,119.44
|
| Rate for Payer: Multiplan Commercial |
$17,064.80
|
| Rate for Payer: Networks By Design Commercial |
$13,865.15
|
| Rate for Payer: Prime Health Services Commercial |
$18,131.35
|
|
