|
HC LITHOTRIPSY STENT ATHERECTOMY
|
Facility
|
IP
|
$46,704.00
|
|
|
Service Code
|
CPT C9767
|
| Hospital Charge Code |
906820315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,340.80 |
| Max. Negotiated Rate |
$39,698.40 |
| Rate for Payer: Adventist Health Commercial |
$9,340.80
|
| Rate for Payer: Cash Price |
$25,687.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,681.60
|
| Rate for Payer: EPIC Health Plan Senior |
$18,681.60
|
| Rate for Payer: Galaxy Health WC |
$39,698.40
|
| Rate for Payer: Global Benefits Group Commercial |
$28,022.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,151.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,794.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,909.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,208.96
|
| Rate for Payer: Multiplan Commercial |
$37,363.20
|
| Rate for Payer: Networks By Design Commercial |
$30,357.60
|
| Rate for Payer: Prime Health Services Commercial |
$39,698.40
|
|
|
HC LIVER BIOPSY PERCUTANEOUS
|
Facility
|
OP
|
$4,895.00
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
909000140
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$282.71 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$979.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| 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 |
$2,692.25
|
| Rate for Payer: Cash Price |
$2,692.25
|
| Rate for Payer: Cash Price |
$2,692.25
|
| Rate for Payer: Cigna of CA HMO |
$3,132.80
|
| Rate for Payer: Cigna of CA PPO |
$3,622.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$4,160.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,937.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$282.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,264.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,174.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$3,916.00
|
| Rate for Payer: Networks By Design Commercial |
$3,181.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,160.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,937.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,470.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC LIVER BIOPSY PERCUTANEOUS
|
Facility
|
IP
|
$4,895.00
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
909000140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$979.00 |
| Max. Negotiated Rate |
$4,160.75 |
| Rate for Payer: Adventist Health Commercial |
$979.00
|
| Rate for Payer: Cash Price |
$2,692.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,958.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,958.00
|
| Rate for Payer: Galaxy Health WC |
$4,160.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,937.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,264.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,864.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,030.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,174.80
|
| Rate for Payer: Multiplan Commercial |
$3,916.00
|
| Rate for Payer: Networks By Design Commercial |
$3,181.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,160.75
|
|
|
HC LIVER BIOPSY PERCUTANEOUS
|
Facility
|
IP
|
$4,895.00
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
909000140
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$979.00 |
| Max. Negotiated Rate |
$4,160.75 |
| Rate for Payer: Adventist Health Commercial |
$979.00
|
| Rate for Payer: Cash Price |
$2,692.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,958.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,958.00
|
| Rate for Payer: Galaxy Health WC |
$4,160.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,937.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,264.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,864.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,030.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,174.80
|
| Rate for Payer: Multiplan Commercial |
$3,916.00
|
| Rate for Payer: Networks By Design Commercial |
$3,181.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,160.75
|
|
|
HC LIVER BIOPSY PERCUTANEOUS
|
Facility
|
OP
|
$4,895.00
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
909000140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$282.71 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$979.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,995.74
|
| Rate for Payer: Blue Shield of California EPN |
$1,977.58
|
| Rate for Payer: Cash Price |
$2,692.25
|
| Rate for Payer: Cash Price |
$2,692.25
|
| Rate for Payer: Cash Price |
$2,692.25
|
| Rate for Payer: Cigna of CA HMO |
$3,132.80
|
| Rate for Payer: Cigna of CA PPO |
$3,622.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$4,160.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,937.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$282.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,264.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,174.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$3,916.00
|
| Rate for Payer: Networks By Design Commercial |
$3,181.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,160.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,937.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,937.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,447.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,447.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,447.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,447.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC LIVER BIOPSY W OTHER PROC
|
Facility
|
IP
|
$507.00
|
|
|
Service Code
|
CPT 47001
|
| Hospital Charge Code |
909000141
|
|
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 LIVER BIOPSY W OTHER PROC
|
Facility
|
OP
|
$507.00
|
|
|
Service Code
|
CPT 47001
|
| Hospital Charge Code |
909000141
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.93 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$101.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 |
$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 |
$278.85
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$81.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$338.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.66
|
| 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 |
$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 |
$430.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$430.95
|
| Rate for Payer: Vantage Medical Group Senior |
$430.95
|
|
|
HC LIVER ELASTOGRAPHY
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT 91200
|
| Hospital Charge Code |
906743912
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$352.75 |
| Rate for Payer: Adventist Health Commercial |
$83.00
|
| Rate for Payer: Cash Price |
$228.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.00
|
| Rate for Payer: EPIC Health Plan Senior |
$166.00
|
| Rate for Payer: Galaxy Health WC |
$352.75
|
| Rate for Payer: Global Benefits Group Commercial |
$249.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$276.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$256.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.60
|
| Rate for Payer: Multiplan Commercial |
$332.00
|
| Rate for Payer: Networks By Design Commercial |
$269.75
|
| Rate for Payer: Prime Health Services Commercial |
$352.75
|
|
|
HC LIVER ELASTOGRAPHY
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
CPT 91200
|
| Hospital Charge Code |
906743912
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$53.84 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$83.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$254.85
|
| 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 |
$228.25
|
| Rate for Payer: Cash Price |
$228.25
|
| Rate for Payer: Cash Price |
$228.25
|
| Rate for Payer: Cigna of CA HMO |
$265.60
|
| Rate for Payer: Cigna of CA PPO |
$307.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$352.75
|
| Rate for Payer: Global Benefits Group Commercial |
$249.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$53.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$276.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$332.00
|
| Rate for Payer: Networks By Design Commercial |
$269.75
|
| Rate for Payer: Prime Health Services Commercial |
$352.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$249.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$238.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$207.50
|
| Rate for Payer: United Healthcare All Other HMO |
$207.50
|
| Rate for Payer: United Healthcare HMO Rider |
$207.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC LIVER SPECT
|
Facility
|
OP
|
$2,376.00
|
|
|
Service Code
|
CPT 78205
|
| Hospital Charge Code |
909301350
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$475.20 |
| Max. Negotiated Rate |
$2,019.60 |
| Rate for Payer: Adventist Health Commercial |
$475.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,558.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,019.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,306.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,782.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,459.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1,454.11
|
| Rate for Payer: Blue Shield of California EPN |
$959.90
|
| Rate for Payer: Cash Price |
$1,306.80
|
| Rate for Payer: Cigna of CA HMO |
$1,520.64
|
| Rate for Payer: Cigna of CA PPO |
$1,758.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,019.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,019.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,019.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$950.40
|
| Rate for Payer: EPIC Health Plan Senior |
$950.40
|
| Rate for Payer: Galaxy Health WC |
$2,019.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,425.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,584.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$905.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,470.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$570.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,663.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,663.20
|
| Rate for Payer: Multiplan Commercial |
$1,900.80
|
| Rate for Payer: Networks By Design Commercial |
$1,544.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,019.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,425.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,425.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,188.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,188.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,019.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,019.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,019.60
|
|
|
HC LIVER SPECT
|
Facility
|
IP
|
$2,376.00
|
|
|
Service Code
|
CPT 78205
|
| Hospital Charge Code |
909301350
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$475.20 |
| Max. Negotiated Rate |
$2,019.60 |
| Rate for Payer: Adventist Health Commercial |
$475.20
|
| Rate for Payer: Cash Price |
$1,306.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$950.40
|
| Rate for Payer: EPIC Health Plan Senior |
$950.40
|
| Rate for Payer: Galaxy Health WC |
$2,019.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,425.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,584.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$905.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,470.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$570.24
|
| Rate for Payer: Multiplan Commercial |
$1,900.80
|
| Rate for Payer: Networks By Design Commercial |
$1,544.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,019.60
|
|
|
HC LIVER/SPLEEN SCAN
|
Facility
|
OP
|
$1,803.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
909301351
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$145.35 |
| Max. Negotiated Rate |
$1,532.55 |
| Rate for Payer: Adventist Health Commercial |
$360.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,182.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,107.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,103.44
|
| Rate for Payer: Blue Shield of California EPN |
$728.41
|
| Rate for Payer: Cash Price |
$991.65
|
| Rate for Payer: Cash Price |
$991.65
|
| Rate for Payer: Cigna of CA HMO |
$1,153.92
|
| Rate for Payer: Cigna of CA PPO |
$1,334.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$1,532.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,081.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$145.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,202.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$1,442.40
|
| Rate for Payer: Networks By Design Commercial |
$1,171.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,532.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,081.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,081.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$751.01
|
| Rate for Payer: United Healthcare All Other HMO |
$751.01
|
| Rate for Payer: United Healthcare HMO Rider |
$751.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$751.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC LIVER/SPLEEN SCAN
|
Facility
|
IP
|
$1,803.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
909301351
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$360.60 |
| Max. Negotiated Rate |
$1,532.55 |
| Rate for Payer: Adventist Health Commercial |
$360.60
|
| Rate for Payer: Cash Price |
$991.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$721.20
|
| Rate for Payer: EPIC Health Plan Senior |
$721.20
|
| Rate for Payer: Galaxy Health WC |
$1,532.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,081.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,202.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$686.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,116.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.72
|
| Rate for Payer: Multiplan Commercial |
$1,442.40
|
| Rate for Payer: Networks By Design Commercial |
$1,171.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,532.55
|
|
|
HC LIVER/SPLEEN VAS FLO
|
Facility
|
IP
|
$2,383.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
909301352
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$476.60 |
| Max. Negotiated Rate |
$2,025.55 |
| Rate for Payer: Adventist Health Commercial |
$476.60
|
| Rate for Payer: Cash Price |
$1,310.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$953.20
|
| Rate for Payer: EPIC Health Plan Senior |
$953.20
|
| Rate for Payer: Galaxy Health WC |
$2,025.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,429.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,589.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$907.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,475.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$571.92
|
| Rate for Payer: Multiplan Commercial |
$1,906.40
|
| Rate for Payer: Networks By Design Commercial |
$1,548.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,025.55
|
|
|
HC LIVER/SPLEEN VAS FLO
|
Facility
|
OP
|
$2,383.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
909301352
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$191.18 |
| Max. Negotiated Rate |
$2,025.55 |
| Rate for Payer: Adventist Health Commercial |
$476.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,563.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,463.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,458.40
|
| Rate for Payer: Blue Shield of California EPN |
$962.73
|
| Rate for Payer: Cash Price |
$1,310.65
|
| Rate for Payer: Cash Price |
$1,310.65
|
| Rate for Payer: Cigna of CA HMO |
$1,525.12
|
| Rate for Payer: Cigna of CA PPO |
$1,763.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$2,025.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,429.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$191.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,589.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$571.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$1,906.40
|
| Rate for Payer: Networks By Design Commercial |
$1,548.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,025.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,429.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$751.01
|
| Rate for Payer: United Healthcare All Other HMO |
$751.01
|
| Rate for Payer: United Healthcare HMO Rider |
$751.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$751.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC LIVNG FUNCT RESTRTN UE
|
Facility
|
IP
|
$11,750.00
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
915380024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,350.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,350.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$6,462.50
|
| Rate for Payer: Cash Price |
$6,462.50
|
| Rate for Payer: Cigna of CA HMO |
$8,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,225.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,700.00
|
| Rate for Payer: Galaxy Health WC |
$9,987.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,050.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,837.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,476.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,273.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,820.00
|
| Rate for Payer: Multiplan Commercial |
$9,400.00
|
| Rate for Payer: Networks By Design Commercial |
$5,875.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,987.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,409.77
|
| Rate for Payer: United Healthcare All Other HMO |
$4,292.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4,199.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,848.12
|
|
|
HC LIVNG FUNCT RESTRTN UE
|
Facility
|
OP
|
$11,750.00
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
915380024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,820.00 |
| Max. Negotiated Rate |
$9,987.50 |
| Rate for Payer: Adventist Health Commercial |
$4,817.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,987.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,462.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,812.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,805.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,671.50
|
| Rate for Payer: Blue Shield of California EPN |
$5,710.50
|
| Rate for Payer: Cash Price |
$6,462.50
|
| Rate for Payer: Cigna of CA HMO |
$8,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,225.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,987.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,987.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,987.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,700.00
|
| Rate for Payer: Galaxy Health WC |
$9,987.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,050.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,837.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,476.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,273.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,820.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,225.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,225.00
|
| Rate for Payer: Multiplan Commercial |
$9,400.00
|
| Rate for Payer: Networks By Design Commercial |
$5,875.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,987.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,050.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,050.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,409.77
|
| Rate for Payer: United Healthcare All Other HMO |
$4,292.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4,199.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,848.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,987.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,987.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,987.50
|
|
|
HC LIVNG FUNCT RESTRTN UE
|
Facility
|
OP
|
$11,750.00
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
905380024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,820.00 |
| Max. Negotiated Rate |
$9,987.50 |
| Rate for Payer: Adventist Health Commercial |
$4,817.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,987.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,462.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,812.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,805.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,671.50
|
| Rate for Payer: Blue Shield of California EPN |
$5,710.50
|
| Rate for Payer: Cash Price |
$6,462.50
|
| Rate for Payer: Cigna of CA HMO |
$8,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,225.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,987.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,987.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,987.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,700.00
|
| Rate for Payer: Galaxy Health WC |
$9,987.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,050.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,837.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,476.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,273.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,820.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,225.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,225.00
|
| Rate for Payer: Multiplan Commercial |
$9,400.00
|
| Rate for Payer: Networks By Design Commercial |
$5,875.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,987.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,050.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,050.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,409.77
|
| Rate for Payer: United Healthcare All Other HMO |
$4,292.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4,199.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,848.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,987.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,987.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,987.50
|
|
|
HC LIVNG FUNCT RESTRTN UE
|
Facility
|
IP
|
$11,750.00
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
905380024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,350.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,350.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$6,462.50
|
| Rate for Payer: Cash Price |
$6,462.50
|
| Rate for Payer: Cigna of CA HMO |
$8,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,225.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,700.00
|
| Rate for Payer: Galaxy Health WC |
$9,987.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,050.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,837.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,476.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,273.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,820.00
|
| Rate for Payer: Multiplan Commercial |
$9,400.00
|
| Rate for Payer: Networks By Design Commercial |
$5,875.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,987.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,409.77
|
| Rate for Payer: United Healthcare All Other HMO |
$4,292.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4,199.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,848.12
|
|
|
HC LMA AIRWARY
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800911
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$295.80 |
| Rate for Payer: Adventist Health Commercial |
$69.60
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.20
|
| Rate for Payer: EPIC Health Plan Senior |
$139.20
|
| Rate for Payer: Galaxy Health WC |
$295.80
|
| Rate for Payer: Global Benefits Group Commercial |
$208.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$215.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.52
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: Networks By Design Commercial |
$226.20
|
| Rate for Payer: Prime Health Services Commercial |
$295.80
|
|
|
HC LMA AIRWARY
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800911
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$69.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$228.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.71
|
| Rate for Payer: Blue Shield of California Commercial |
$212.98
|
| Rate for Payer: Blue Shield of California EPN |
$140.59
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cigna of CA HMO |
$222.72
|
| Rate for Payer: Cigna of CA PPO |
$257.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$295.80
|
| Rate for Payer: Global Benefits Group Commercial |
$208.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: Networks By Design Commercial |
$226.20
|
| Rate for Payer: Prime Health Services Commercial |
$295.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$208.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$208.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC LMA FASTRACH CHILD #3
|
Facility
|
IP
|
$336.00
|
|
| Hospital Charge Code |
901698641
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.64
|
| Rate for Payer: Multiplan Commercial |
$268.80
|
| Rate for Payer: Networks By Design Commercial |
$218.40
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
|
|
HC LMA FASTRACH CHILD #3
|
Facility
|
OP
|
$336.00
|
|
| Hospital Charge Code |
901698641
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$220.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$184.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.34
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna of CA HMO |
$215.04
|
| Rate for Payer: Cigna of CA PPO |
$248.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$285.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$285.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.20
|
| Rate for Payer: Multiplan Commercial |
$268.80
|
| Rate for Payer: Networks By Design Commercial |
$218.40
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Other HMO |
$168.00
|
| Rate for Payer: United Healthcare HMO Rider |
$168.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$285.60
|
| Rate for Payer: Vantage Medical Group Senior |
$285.60
|
|
|
HC LMA FASTRACH CHILD #4
|
Facility
|
OP
|
$336.00
|
|
| Hospital Charge Code |
901698642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$220.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$184.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.34
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna of CA HMO |
$215.04
|
| Rate for Payer: Cigna of CA PPO |
$248.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$285.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$285.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.20
|
| Rate for Payer: Multiplan Commercial |
$268.80
|
| Rate for Payer: Networks By Design Commercial |
$218.40
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Other HMO |
$168.00
|
| Rate for Payer: United Healthcare HMO Rider |
$168.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$285.60
|
| Rate for Payer: Vantage Medical Group Senior |
$285.60
|
|
|
HC LMA FASTRACH CHILD #4
|
Facility
|
IP
|
$336.00
|
|
| Hospital Charge Code |
901698642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.64
|
| Rate for Payer: Multiplan Commercial |
$268.80
|
| Rate for Payer: Networks By Design Commercial |
$218.40
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
|
