|
HC IV START KIT W/SM BORE EXT SET
|
Facility
|
IP
|
$22.06
|
|
| Hospital Charge Code |
901698434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$4.41
|
| Rate for Payer: Cash Price |
$12.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.29
|
| Rate for Payer: Multiplan Commercial |
$17.65
|
| Rate for Payer: Networks By Design Commercial |
$14.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.75
|
|
|
HC IVU EXCRETORY
|
Facility
|
OP
|
$1,375.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
909001910
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.44 |
| Max. Negotiated Rate |
$1,168.75 |
| Rate for Payer: Adventist Health Commercial |
$275.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$901.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$475.39
|
| Rate for Payer: Blue Shield of California Commercial |
$841.50
|
| Rate for Payer: Blue Shield of California EPN |
$555.50
|
| Rate for Payer: Cash Price |
$756.25
|
| Rate for Payer: Cash Price |
$756.25
|
| Rate for Payer: Cigna of CA HMO |
$880.00
|
| Rate for Payer: Cigna of CA PPO |
$1,017.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$1,168.75
|
| Rate for Payer: Global Benefits Group Commercial |
$825.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$110.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$917.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$1,100.00
|
| Rate for Payer: Networks By Design Commercial |
$893.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,168.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$825.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$825.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC IVU EXCRETORY
|
Facility
|
IP
|
$1,375.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
909001910
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$275.00 |
| Max. Negotiated Rate |
$1,168.75 |
| Rate for Payer: Adventist Health Commercial |
$275.00
|
| Rate for Payer: Cash Price |
$756.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$550.00
|
| Rate for Payer: EPIC Health Plan Senior |
$550.00
|
| Rate for Payer: Galaxy Health WC |
$1,168.75
|
| Rate for Payer: Global Benefits Group Commercial |
$825.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$917.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$523.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$851.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.00
|
| Rate for Payer: Multiplan Commercial |
$1,100.00
|
| Rate for Payer: Networks By Design Commercial |
$893.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,168.75
|
|
|
HC IVU HYPERTENSIVE
|
Facility
|
IP
|
$878.00
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
909001911
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.60 |
| Max. Negotiated Rate |
$746.30 |
| Rate for Payer: Adventist Health Commercial |
$175.60
|
| Rate for Payer: Cash Price |
$482.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$351.20
|
| Rate for Payer: EPIC Health Plan Senior |
$351.20
|
| Rate for Payer: Galaxy Health WC |
$746.30
|
| Rate for Payer: Global Benefits Group Commercial |
$526.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$585.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$334.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$543.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.72
|
| Rate for Payer: Multiplan Commercial |
$702.40
|
| Rate for Payer: Networks By Design Commercial |
$570.70
|
| Rate for Payer: Prime Health Services Commercial |
$746.30
|
|
|
HC IVU HYPERTENSIVE
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
909001911
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$166.86 |
| Max. Negotiated Rate |
$746.30 |
| Rate for Payer: Adventist Health Commercial |
$175.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$575.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$595.48
|
| Rate for Payer: Blue Shield of California Commercial |
$537.34
|
| Rate for Payer: Blue Shield of California EPN |
$354.71
|
| Rate for Payer: Cash Price |
$482.90
|
| Rate for Payer: Cash Price |
$482.90
|
| Rate for Payer: Cigna of CA HMO |
$561.92
|
| Rate for Payer: Cigna of CA PPO |
$649.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$746.30
|
| Rate for Payer: Global Benefits Group Commercial |
$526.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$585.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$702.40
|
| Rate for Payer: Networks By Design Commercial |
$570.70
|
| Rate for Payer: Prime Health Services Commercial |
$746.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$526.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$526.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC IVUS ADD'L VESSEL
|
Facility
|
OP
|
$4,767.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
906811210
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$231.49 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$953.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,051.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,621.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,575.25
|
| 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 |
$2,621.85
|
| Rate for Payer: Cash Price |
$2,621.85
|
| Rate for Payer: Cash Price |
$2,621.85
|
| Rate for Payer: Cigna of CA HMO |
$3,098.55
|
| Rate for Payer: Cigna of CA PPO |
$3,527.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,051.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,051.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,051.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,906.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,906.80
|
| Rate for Payer: Galaxy Health WC |
$4,051.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,860.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$231.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,179.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$261.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,950.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,144.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,336.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,336.90
|
| Rate for Payer: Multiplan Commercial |
$3,813.60
|
| Rate for Payer: Networks By Design Commercial |
$3,098.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,051.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,860.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,860.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,051.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,051.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4,051.95
|
|
|
HC IVUS ADD'L VESSEL
|
Facility
|
IP
|
$7,928.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
906820035
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,585.60 |
| Max. Negotiated Rate |
$6,738.80 |
| Rate for Payer: Adventist Health Commercial |
$1,585.60
|
| Rate for Payer: Cash Price |
$4,360.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,171.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,171.20
|
| Rate for Payer: Galaxy Health WC |
$6,738.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,756.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,287.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,020.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,907.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,902.72
|
| Rate for Payer: Multiplan Commercial |
$6,342.40
|
| Rate for Payer: Networks By Design Commercial |
$5,153.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,738.80
|
|
|
HC IVUS ADD'L VESSEL
|
Facility
|
OP
|
$7,928.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
906820035
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$231.49 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,585.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,738.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,360.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,946.00
|
| 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 |
$4,360.40
|
| Rate for Payer: Cash Price |
$4,360.40
|
| Rate for Payer: Cash Price |
$4,360.40
|
| Rate for Payer: Cigna of CA HMO |
$5,153.20
|
| Rate for Payer: Cigna of CA PPO |
$5,866.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,738.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,738.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,738.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,171.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,171.20
|
| Rate for Payer: Galaxy Health WC |
$6,738.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,756.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$231.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,287.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$261.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,907.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,902.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,549.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,549.60
|
| Rate for Payer: Multiplan Commercial |
$6,342.40
|
| Rate for Payer: Networks By Design Commercial |
$5,153.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,738.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,756.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,756.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,738.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,738.80
|
| Rate for Payer: Vantage Medical Group Senior |
$6,738.80
|
|
|
HC IVUS ADD'L VESSEL
|
Facility
|
IP
|
$4,767.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
906811210
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$953.40 |
| Max. Negotiated Rate |
$4,051.95 |
| Rate for Payer: Adventist Health Commercial |
$953.40
|
| Rate for Payer: Cash Price |
$2,621.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,906.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,906.80
|
| Rate for Payer: Galaxy Health WC |
$4,051.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,860.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,179.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,816.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,950.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,144.08
|
| Rate for Payer: Multiplan Commercial |
$3,813.60
|
| Rate for Payer: Networks By Design Commercial |
$3,098.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,051.95
|
|
|
HC IVUS INITIAL VESSEL
|
Facility
|
OP
|
$11,144.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
906820034
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$378.32 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,228.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,472.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,129.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,358.00
|
| 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 |
$6,129.20
|
| Rate for Payer: Cash Price |
$6,129.20
|
| Rate for Payer: Cash Price |
$6,129.20
|
| Rate for Payer: Cigna of CA HMO |
$7,243.60
|
| Rate for Payer: Cigna of CA PPO |
$8,246.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,472.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,472.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,472.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,457.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,457.60
|
| Rate for Payer: Galaxy Health WC |
$9,472.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,686.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$378.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,433.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$427.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,898.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,674.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,800.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,800.80
|
| Rate for Payer: Multiplan Commercial |
$8,915.20
|
| Rate for Payer: Networks By Design Commercial |
$7,243.60
|
| Rate for Payer: Prime Health Services Commercial |
$9,472.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,686.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,686.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,472.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,472.40
|
| Rate for Payer: Vantage Medical Group Senior |
$9,472.40
|
|
|
HC IVUS INITIAL VESSEL
|
Facility
|
OP
|
$10,932.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
906811200
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$378.32 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,186.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,292.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,012.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,199.00
|
| 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 |
$6,012.60
|
| Rate for Payer: Cash Price |
$6,012.60
|
| Rate for Payer: Cash Price |
$6,012.60
|
| Rate for Payer: Cigna of CA HMO |
$7,105.80
|
| Rate for Payer: Cigna of CA PPO |
$8,089.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,292.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,292.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,292.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,372.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,372.80
|
| Rate for Payer: Galaxy Health WC |
$9,292.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,559.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$378.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,291.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$427.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,766.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,623.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,652.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,652.40
|
| Rate for Payer: Multiplan Commercial |
$8,745.60
|
| Rate for Payer: Networks By Design Commercial |
$7,105.80
|
| Rate for Payer: Prime Health Services Commercial |
$9,292.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,559.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,559.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,292.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,292.20
|
| Rate for Payer: Vantage Medical Group Senior |
$9,292.20
|
|
|
HC IVUS INITIAL VESSEL
|
Facility
|
IP
|
$11,144.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
906820034
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,228.80 |
| Max. Negotiated Rate |
$9,472.40 |
| Rate for Payer: Adventist Health Commercial |
$2,228.80
|
| Rate for Payer: Cash Price |
$6,129.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,457.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,457.60
|
| Rate for Payer: Galaxy Health WC |
$9,472.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,686.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,433.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,245.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,898.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,674.56
|
| Rate for Payer: Multiplan Commercial |
$8,915.20
|
| Rate for Payer: Networks By Design Commercial |
$7,243.60
|
| Rate for Payer: Prime Health Services Commercial |
$9,472.40
|
|
|
HC IVUS INITIAL VESSEL
|
Facility
|
IP
|
$10,932.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
906811200
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,186.40 |
| Max. Negotiated Rate |
$9,292.20 |
| Rate for Payer: Adventist Health Commercial |
$2,186.40
|
| Rate for Payer: Cash Price |
$6,012.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,372.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,372.80
|
| Rate for Payer: Galaxy Health WC |
$9,292.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,559.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,291.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,165.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,766.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,623.68
|
| Rate for Payer: Multiplan Commercial |
$8,745.60
|
| Rate for Payer: Networks By Design Commercial |
$7,105.80
|
| Rate for Payer: Prime Health Services Commercial |
$9,292.20
|
|
|
HC JEJUNOSTOMY PERC
|
Facility
|
IP
|
$1,174.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
909001868
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.80 |
| Max. Negotiated Rate |
$997.90 |
| Rate for Payer: Adventist Health Commercial |
$234.80
|
| Rate for Payer: Cash Price |
$645.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.60
|
| Rate for Payer: EPIC Health Plan Senior |
$469.60
|
| Rate for Payer: Galaxy Health WC |
$997.90
|
| Rate for Payer: Global Benefits Group Commercial |
$704.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$783.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$447.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$726.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.76
|
| Rate for Payer: Multiplan Commercial |
$939.20
|
| Rate for Payer: Networks By Design Commercial |
$763.10
|
| Rate for Payer: Prime Health Services Commercial |
$997.90
|
|
|
HC JEJUNOSTOMY PERC
|
Facility
|
OP
|
$1,174.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
909001868
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$173.14 |
| Max. Negotiated Rate |
$997.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$770.03
|
| Rate for Payer: Adventist Health Commercial |
$234.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$997.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$645.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$880.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$740.64
|
| Rate for Payer: Blue Shield of California Commercial |
$718.49
|
| Rate for Payer: Blue Shield of California EPN |
$474.30
|
| Rate for Payer: Cash Price |
$645.70
|
| Rate for Payer: Cash Price |
$645.70
|
| Rate for Payer: Cigna of CA HMO |
$751.36
|
| Rate for Payer: Cigna of CA PPO |
$868.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$997.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$997.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$997.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.60
|
| Rate for Payer: EPIC Health Plan Senior |
$469.60
|
| Rate for Payer: Galaxy Health WC |
$997.90
|
| Rate for Payer: Global Benefits Group Commercial |
$704.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$173.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$783.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$726.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$821.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$821.80
|
| Rate for Payer: Multiplan Commercial |
$939.20
|
| Rate for Payer: Networks By Design Commercial |
$763.10
|
| Rate for Payer: Prime Health Services Commercial |
$997.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$704.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$704.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$587.00
|
| Rate for Payer: United Healthcare All Other HMO |
$587.00
|
| Rate for Payer: United Healthcare HMO Rider |
$587.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$587.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$997.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$997.90
|
| Rate for Payer: Vantage Medical Group Senior |
$997.90
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
OP
|
$507.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$101.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$430.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$278.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$380.25
|
| 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 |
$278.85
|
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: Cigna of CA HMO |
$324.48
|
| Rate for Payer: Cigna of CA PPO |
$375.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$430.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$430.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$430.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.80
|
| Rate for Payer: EPIC Health Plan Senior |
$202.80
|
| Rate for Payer: Galaxy Health WC |
$430.95
|
| Rate for Payer: Global Benefits Group Commercial |
$304.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$338.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$313.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$354.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$354.90
|
| Rate for Payer: Multiplan Commercial |
$405.60
|
| Rate for Payer: Networks By Design Commercial |
$329.55
|
| Rate for Payer: Prime Health Services Commercial |
$430.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$304.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$430.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$430.95
|
| Rate for Payer: Vantage Medical Group Senior |
$430.95
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
IP
|
$507.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$430.95 |
| Rate for Payer: Adventist Health Commercial |
$101.40
|
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.80
|
| Rate for Payer: EPIC Health Plan Senior |
$202.80
|
| Rate for Payer: Galaxy Health WC |
$430.95
|
| Rate for Payer: Global Benefits Group Commercial |
$304.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$338.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$313.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.68
|
| Rate for Payer: Multiplan Commercial |
$405.60
|
| Rate for Payer: Networks By Design Commercial |
$329.55
|
| Rate for Payer: Prime Health Services Commercial |
$430.95
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
IP
|
$507.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$430.95 |
| Rate for Payer: Adventist Health Commercial |
$101.40
|
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.80
|
| Rate for Payer: EPIC Health Plan Senior |
$202.80
|
| Rate for Payer: Galaxy Health WC |
$430.95
|
| Rate for Payer: Global Benefits Group Commercial |
$304.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$338.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$313.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.68
|
| Rate for Payer: Multiplan Commercial |
$405.60
|
| Rate for Payer: Networks By Design Commercial |
$329.55
|
| Rate for Payer: Prime Health Services Commercial |
$430.95
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
OP
|
$507.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$101.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$430.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$278.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$380.25
|
| 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 |
$278.85
|
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: Cigna of CA HMO |
$324.48
|
| Rate for Payer: Cigna of CA PPO |
$375.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$430.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$430.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$430.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.80
|
| Rate for Payer: EPIC Health Plan Senior |
$202.80
|
| Rate for Payer: Galaxy Health WC |
$430.95
|
| Rate for Payer: Global Benefits Group Commercial |
$304.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$338.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$313.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$354.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$354.90
|
| Rate for Payer: Multiplan Commercial |
$405.60
|
| Rate for Payer: Networks By Design Commercial |
$329.55
|
| Rate for Payer: Prime Health Services Commercial |
$430.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$304.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$304.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$430.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$430.95
|
| Rate for Payer: Vantage Medical Group Senior |
$430.95
|
|
|
HC JO-1 AUTO AB
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913526
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
|
|
HC JO-1 AUTO AB
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913526
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$150.42 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.42
|
| Rate for Payer: Blue Shield of California Commercial |
$114.40
|
| Rate for Payer: Blue Shield of California EPN |
$75.58
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cigna of CA HMO |
$109.44
|
| Rate for Payer: Cigna of CA PPO |
$126.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: EPIC Health Plan Senior |
$17.93
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC JOINT ASPIR/INJ-INTER JOINT
|
Facility
|
OP
|
$1,427.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
909000110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.79 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$285.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$784.85
|
| Rate for Payer: Cash Price |
$784.85
|
| Rate for Payer: Cash Price |
$784.85
|
| Rate for Payer: Cigna of CA HMO |
$913.28
|
| Rate for Payer: Cigna of CA PPO |
$1,055.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$1,212.95
|
| Rate for Payer: Global Benefits Group Commercial |
$856.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$951.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$1,141.60
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$927.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,212.95
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$856.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC JOINT ASPIR/INJ-INTER JOINT
|
Facility
|
IP
|
$1,427.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
909000110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$285.40 |
| Max. Negotiated Rate |
$1,212.95 |
| Rate for Payer: Adventist Health Commercial |
$285.40
|
| Rate for Payer: Cash Price |
$784.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$570.80
|
| Rate for Payer: EPIC Health Plan Senior |
$570.80
|
| Rate for Payer: Galaxy Health WC |
$1,212.95
|
| Rate for Payer: Global Benefits Group Commercial |
$856.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$951.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$543.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$883.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.48
|
| Rate for Payer: Multiplan Commercial |
$1,141.60
|
| Rate for Payer: Networks By Design Commercial |
$927.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,212.95
|
|
|
HC JUZO SLPPE GTR DONNG DVC COMP
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$10.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.48
|
| Rate for Payer: Blue Shield of California Commercial |
$18.45
|
| Rate for Payer: Blue Shield of California EPN |
$12.15
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$12.50
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Vantage Medical Group Senior |
$21.25
|
|
|
HC JUZO SLPPE GTR DONNG DVC COMP
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$10.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.48
|
| Rate for Payer: Blue Shield of California Commercial |
$18.45
|
| Rate for Payer: Blue Shield of California EPN |
$12.15
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$12.50
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Vantage Medical Group Senior |
$21.25
|
|
