|
HC INSRT TUN CNTRL VAD W/SUB PORT GT 5YR
|
Facility
|
IP
|
$13,590.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
900501569
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,718.00 |
| Max. Negotiated Rate |
$11,551.50 |
| Rate for Payer: Adventist Health Commercial |
$2,718.00
|
| Rate for Payer: Cash Price |
$6,115.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,513.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,436.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,436.00
|
| Rate for Payer: Galaxy Health WC |
$11,551.50
|
| Rate for Payer: Global Benefits Group Commercial |
$8,154.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,629.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,018.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,261.60
|
| Rate for Payer: Multiplan Commercial |
$10,872.00
|
| Rate for Payer: Networks By Design Commercial |
$8,833.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,551.50
|
|
|
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 |
$3,468.20 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$3,468.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,643.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Cash Price |
$7,803.45
|
| Rate for Payer: Cash Price |
$7,803.45
|
| Rate for Payer: Cash Price |
$7,803.45
|
| 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 |
$15,965.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,707.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,643.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,138.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,561.82
|
| Rate for Payer: EPIC Health Plan Senior |
$11,707.88
|
| 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/Senior |
$17,455.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,126.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,643.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,011.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,190.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,900.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,161.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,410.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,262.33
|
| 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 |
$8,670.50
|
| 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 |
$10,643.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Vantage Medical Group Senior |
$10,643.53
|
|
|
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 |
$7,803.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,138.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$11,011.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,231.19
|
| 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 |
$4,123.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,414.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$5,819.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,406.76
|
| 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 |
$165.49 |
| 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 |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,880.54
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$4,123.80
|
| Rate for Payer: Cash Price |
$4,123.80
|
| Rate for Payer: Cash Price |
$4,123.80
|
| Rate for Payer: Cash Price |
$4,123.80
|
| 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 |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,414.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| 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/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,819.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,199.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.76
|
| 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 |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
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 |
$80.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$125.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$113.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.61
|
| 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 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: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.57
|
| 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: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.99
|
| Rate for Payer: Blue Shield of California Commercial |
$22.59
|
| Rate for Payer: Blue Shield of California Commercial |
$124.76
|
| Rate for Payer: Blue Shield of California Commercial |
$34.15
|
| Rate for Payer: Blue Shield of California Commercial |
$82.52
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$80.55
|
| Rate for Payer: Cash Price |
$80.55
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA HMO |
$114.56
|
| Rate for Payer: Cigna of CA PPO |
$132.46
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$125.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.86
|
| Rate for Payer: EPIC Health Plan Senior |
$12.57
|
| Rate for Payer: EPIC Health Plan Senior |
$12.57
|
| Rate for Payer: Galaxy Health WC |
$152.15
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$107.40
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.44
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.32
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Networks By Design Commercial |
$116.35
|
| Rate for Payer: Prime Health Services Commercial |
$152.15
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.26
|
| 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 All Other HMO |
$9.26
|
| Rate for Payer: United Healthcare HMO Rider |
$9.26
|
| Rate for Payer: United Healthcare HMO Rider |
$9.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.26
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.43
|
| 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 Commercial/Exchange |
$17.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.57
|
| Rate for Payer: Vantage Medical Group Senior |
$11.43
|
| Rate for Payer: Vantage Medical Group Senior |
$11.43
|
|
|
HC INTACT PTH
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 83970
|
| Hospital Charge Code |
900910942
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.44 |
| Max. Negotiated Rate |
$426.04 |
| Rate for Payer: Adventist Health Commercial |
$40.40
|
| Rate for Payer: Adventist Health Commercial |
$152.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$343.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$343.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.41
|
| 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: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$426.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$426.04
|
| Rate for Payer: Blue Shield of California Commercial |
$351.74
|
| Rate for Payer: Blue Shield of California Commercial |
$140.79
|
| Rate for Payer: Blue Shield of California Commercial |
$531.81
|
| Rate for Payer: Blue Shield of California Commercial |
$93.12
|
| Rate for Payer: Cash Price |
$343.35
|
| Rate for Payer: Cash Price |
$343.35
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna of CA HMO |
$488.32
|
| Rate for Payer: Cigna of CA HMO |
$129.28
|
| Rate for Payer: Cigna of CA PPO |
$149.48
|
| Rate for Payer: Cigna of CA PPO |
$564.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$141.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$534.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.11
|
| Rate for Payer: EPIC Health Plan Senior |
$45.41
|
| Rate for Payer: EPIC Health Plan Senior |
$45.41
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Galaxy Health WC |
$648.55
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Global Benefits Group Commercial |
$457.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$67.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$67.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.53
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$128.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$484.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.48
|
| 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 Medi-Cal |
$52.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.32
|
| Rate for Payer: Multiplan Commercial |
$610.40
|
| Rate for Payer: Multiplan Commercial |
$161.60
|
| Rate for Payer: Networks By Design Commercial |
$495.95
|
| Rate for Payer: Networks By Design Commercial |
$131.30
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
| Rate for Payer: Prime Health Services Commercial |
$648.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$121.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$457.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$121.20
|
| 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 Commercial |
$33.44
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$33.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$41.28
|
| 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 Commercial/Exchange |
$61.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.41
|
| Rate for Payer: Vantage Medical Group Senior |
$41.28
|
| Rate for Payer: Vantage Medical Group Senior |
$41.28
|
|
|
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 |
$343.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$534.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$484.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$450.17
|
| 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 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: Galaxy Health WC |
$572.05
|
| Rate for Payer: Adventist Health Commercial |
$134.60
|
| Rate for Payer: Cash Price |
$302.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$471.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$269.20
|
| Rate for Payer: EPIC Health Plan Senior |
$269.20
|
| Rate for Payer: Global Benefits Group Commercial |
$403.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$427.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$397.07
|
| 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 |
$1,159.59 |
| Rate for Payer: Adventist Health Commercial |
$134.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$214.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.89
|
| Rate for Payer: Blue Shield of California Commercial |
$283.33
|
| Rate for Payer: Blue Shield of California Commercial |
$429.37
|
| Rate for Payer: Cash Price |
$302.85
|
| Rate for Payer: Cash Price |
$302.85
|
| 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 |
$1,054.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$773.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$471.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,159.59
|
| Rate for Payer: EPIC Health Plan Senior |
$773.06
|
| Rate for Payer: Galaxy Health WC |
$572.05
|
| Rate for Payer: Global Benefits Group Commercial |
$403.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,152.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$77.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$702.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$427.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$983.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$885.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$941.73
|
| 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 |
$702.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Vantage Medical Group Senior |
$702.78
|
|
|
HC INT DEV EVAL CRTD SNS BAT MOD SYS WO PRGMG
|
Facility
|
IP
|
$403.00
|
|
|
Service Code
|
CPT 93145
|
| Hospital Charge Code |
906811868
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$342.55 |
| Rate for Payer: Adventist Health Commercial |
$80.60
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$282.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.20
|
| Rate for Payer: EPIC Health Plan Senior |
$161.20
|
| Rate for Payer: Galaxy Health WC |
$342.55
|
| Rate for Payer: Global Benefits Group Commercial |
$241.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$255.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$237.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.72
|
| Rate for Payer: Multiplan Commercial |
$322.40
|
| Rate for Payer: Networks By Design Commercial |
$261.95
|
| Rate for Payer: Prime Health Services Commercial |
$342.55
|
|
|
HC INT DEV EVAL CRTD SNS BAT MOD SYS WO PRGMG
|
Facility
|
OP
|
$403.00
|
|
|
Service Code
|
CPT 93145
|
| Hospital Charge Code |
906811868
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$80.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$258.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cigna of CA HMO |
$261.95
|
| Rate for Payer: Cigna of CA PPO |
$298.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$282.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$342.55
|
| Rate for Payer: Global Benefits Group Commercial |
$241.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$255.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$146.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$322.40
|
| Rate for Payer: Networks By Design Commercial |
$261.95
|
| Rate for Payer: Prime Health Services Commercial |
$342.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$241.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$241.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$201.50
|
| Rate for Payer: United Healthcare All Other HMO |
$201.50
|
| Rate for Payer: United Healthcare HMO Rider |
$201.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$201.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC INT DEV EVAL CRTD SNS BAT MOD SYS W PRGMG
|
Facility
|
OP
|
$403.00
|
|
|
Service Code
|
CPT 93146
|
| Hospital Charge Code |
906811869
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$80.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$258.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cigna of CA HMO |
$261.95
|
| Rate for Payer: Cigna of CA PPO |
$298.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$282.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$342.55
|
| Rate for Payer: Global Benefits Group Commercial |
$241.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$255.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$146.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$322.40
|
| Rate for Payer: Networks By Design Commercial |
$261.95
|
| Rate for Payer: Prime Health Services Commercial |
$342.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$241.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$241.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$201.50
|
| Rate for Payer: United Healthcare All Other HMO |
$201.50
|
| Rate for Payer: United Healthcare HMO Rider |
$201.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$201.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC INT DEV EVAL CRTD SNS BAT MOD SYS W PRGMG
|
Facility
|
IP
|
$403.00
|
|
|
Service Code
|
CPT 93146
|
| Hospital Charge Code |
906811869
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$342.55 |
| Rate for Payer: Adventist Health Commercial |
$80.60
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$282.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.20
|
| Rate for Payer: EPIC Health Plan Senior |
$161.20
|
| Rate for Payer: Galaxy Health WC |
$342.55
|
| Rate for Payer: Global Benefits Group Commercial |
$241.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$255.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$237.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.72
|
| Rate for Payer: Multiplan Commercial |
$322.40
|
| Rate for Payer: Networks By Design Commercial |
$261.95
|
| Rate for Payer: Prime Health Services Commercial |
$342.55
|
|
|
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 |
$12,137.36 |
| Rate for Payer: Adventist Health Commercial |
$1,254.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,137.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,670.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,958.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,780.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,861.92
|
| Rate for Payer: Blue Shield of California Commercial |
$4,000.26
|
| Rate for Payer: Blue Shield of California Commercial |
$2,639.67
|
| Rate for Payer: Cash Price |
$2,821.50
|
| Rate for Payer: Cash Price |
$2,821.50
|
| Rate for Payer: Cash Price |
$2,821.50
|
| 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 |
$2,670.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,958.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,780.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,389.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,937.36
|
| Rate for Payer: EPIC Health Plan Senior |
$1,958.24
|
| 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/Senior |
$2,919.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,078.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,780.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,981.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,350.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,492.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,504.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,243.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,385.49
|
| 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 |
$1,780.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,670.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,958.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1,780.22
|
|
|
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 |
$2,821.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,389.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,981.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,699.30
|
| 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 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 |
$835.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,299.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,179.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,095.63
|
| 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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$371.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$835.65
|
| Rate for Payer: Cash Price |
$835.65
|
| Rate for Payer: Cash Price |
$835.65
|
| 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 |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,299.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,498.00
|
| Rate for Payer: EPIC Health Plan Senior |
$998.67
|
| 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/Senior |
$1,488.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,179.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$113.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$975.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$445.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,143.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,216.56
|
| 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 |
$907.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
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 |
$4,617.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,182.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6,515.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,053.40
|
| 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 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 |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$4,617.00
|
| Rate for Payer: Cash Price |
$4,617.00
|
| Rate for Payer: Cash Price |
$4,617.00
|
| 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 |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,182.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,292.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,195.16
|
| 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/Senior |
$3,272.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,515.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$101.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,145.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,462.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,514.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,674.10
|
| 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 |
$1,995.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
HC INTERLEUKIN 6
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912265
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: EPIC Health Plan Senior |
$22.80
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.68
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
|
|
HC INTERLEUKIN 6
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912265
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$133.63 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.63
|
| Rate for Payer: Blue Shield of California Commercial |
$26.28
|
| Rate for Payer: Blue Shield of California Commercial |
$23.05
|
| Rate for Payer: Blue Shield of California Commercial |
$39.73
|
| Rate for Payer: Blue Shield of California Commercial |
$34.85
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$36.48
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Cigna of CA PPO |
$42.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
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 |
$7,196.06 |
| Rate for Payer: Adventist Health Commercial |
$238.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,664.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$935.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$850.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cash Price |
$537.30
|
| 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 |
$1,275.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$850.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$835.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,402.63
|
| Rate for Payer: EPIC Health Plan Senior |
$935.09
|
| 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/Senior |
$1,394.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$290.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$850.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$758.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$328.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,190.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,071.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,139.11
|
| 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 |
$850.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.09
|
| Rate for Payer: Vantage Medical Group Senior |
$850.08
|
|
|
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 |
$537.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$835.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$758.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$704.46
|
| 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
|
|
