|
HC NEWBORN HEARING SCREENING OP
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100101
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$157.25 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.00
|
| Rate for Payer: EPIC Health Plan Senior |
$74.00
|
| Rate for Payer: Galaxy Health WC |
$157.25
|
| Rate for Payer: Global Benefits Group Commercial |
$111.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$114.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: Networks By Design Commercial |
$120.25
|
| Rate for Payer: Prime Health Services Commercial |
$157.25
|
|
|
HC NEWBORN SCREENING PANEL
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT S3620
|
| Hospital Charge Code |
903100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$400.90 |
| Rate for Payer: Adventist Health Commercial |
$46.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.47
|
| Rate for Payer: Blue Shield of California Commercial |
$155.21
|
| Rate for Payer: Blue Shield of California EPN |
$102.54
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna of CA HMO |
$148.48
|
| Rate for Payer: Cigna of CA PPO |
$171.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.80
|
| Rate for Payer: EPIC Health Plan Senior |
$92.80
|
| Rate for Payer: Galaxy Health WC |
$197.20
|
| Rate for Payer: Global Benefits Group Commercial |
$139.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$354.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.40
|
| Rate for Payer: Multiplan Commercial |
$185.60
|
| Rate for Payer: Networks By Design Commercial |
$150.80
|
| Rate for Payer: Prime Health Services Commercial |
$197.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.00
|
| Rate for Payer: United Healthcare All Other HMO |
$116.00
|
| Rate for Payer: United Healthcare HMO Rider |
$116.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.20
|
| Rate for Payer: Vantage Medical Group Senior |
$197.20
|
|
|
HC NEWBORN SCREENING PANEL
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT S3620
|
| Hospital Charge Code |
903100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$197.20 |
| Rate for Payer: Adventist Health Commercial |
$46.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.80
|
| Rate for Payer: EPIC Health Plan Senior |
$92.80
|
| Rate for Payer: Galaxy Health WC |
$197.20
|
| Rate for Payer: Global Benefits Group Commercial |
$139.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.68
|
| Rate for Payer: Multiplan Commercial |
$185.60
|
| Rate for Payer: Networks By Design Commercial |
$150.80
|
| Rate for Payer: Prime Health Services Commercial |
$197.20
|
|
|
HC N GONNORHOEAE AMPLIFICATION
|
Facility
|
OP
|
$115.04
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912305
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.01 |
| Max. Negotiated Rate |
$335.41 |
| Rate for Payer: Adventist Health Commercial |
$23.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.41
|
| Rate for Payer: Blue Shield of California Commercial |
$76.96
|
| Rate for Payer: Blue Shield of California EPN |
$50.85
|
| Rate for Payer: Cash Price |
$51.77
|
| Rate for Payer: Cash Price |
$51.77
|
| Rate for Payer: Cigna of CA HMO |
$73.63
|
| Rate for Payer: Cigna of CA PPO |
$85.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$97.78
|
| Rate for Payer: Global Benefits Group Commercial |
$69.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$92.03
|
| Rate for Payer: Networks By Design Commercial |
$74.78
|
| Rate for Payer: Prime Health Services Commercial |
$97.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC N GONNORHOEAE AMPLIFICATION
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912305
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Adventist Health Commercial |
$44.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.00
|
| Rate for Payer: EPIC Health Plan Senior |
$88.00
|
| Rate for Payer: Galaxy Health WC |
$187.00
|
| Rate for Payer: Global Benefits Group Commercial |
$132.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$146.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.80
|
| Rate for Payer: Multiplan Commercial |
$176.00
|
| Rate for Payer: Networks By Design Commercial |
$143.00
|
| Rate for Payer: Prime Health Services Commercial |
$187.00
|
|
|
HC NICU BACK TRANSPORT PER HOUR
|
Facility
|
IP
|
$7,426.00
|
|
| Hospital Charge Code |
905200004
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$6,312.10 |
| Rate for Payer: Adventist Health Commercial |
$1,485.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,425.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,562.00
|
| Rate for Payer: Cash Price |
$3,341.70
|
| Rate for Payer: Cash Price |
$3,341.70
|
| Rate for Payer: Cash Price |
$3,341.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,970.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,970.40
|
| Rate for Payer: Galaxy Health WC |
$6,312.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,455.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$334.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,953.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,829.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,596.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,782.24
|
| Rate for Payer: Multiplan Commercial |
$5,940.80
|
| Rate for Payer: Networks By Design Commercial |
$4,826.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,312.10
|
|
|
HC NICU TRANSPORT CASE RATE
|
Facility
|
IP
|
$2,832.00
|
|
| Hospital Charge Code |
905200005
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$5,425.00 |
| Rate for Payer: Adventist Health Commercial |
$566.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,425.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,562.00
|
| Rate for Payer: Cash Price |
$1,274.40
|
| Rate for Payer: Cash Price |
$1,274.40
|
| Rate for Payer: Cash Price |
$1,274.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,132.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,132.80
|
| Rate for Payer: Galaxy Health WC |
$2,407.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,699.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$334.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,888.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,078.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,753.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$679.68
|
| Rate for Payer: Multiplan Commercial |
$2,265.60
|
| Rate for Payer: Networks By Design Commercial |
$1,840.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,407.20
|
|
|
HC NICU TRANSPORT PER HOUR
|
Facility
|
IP
|
$5,594.00
|
|
| Hospital Charge Code |
905200001
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$5,425.00 |
| Rate for Payer: Adventist Health Commercial |
$1,118.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,425.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,562.00
|
| Rate for Payer: Cash Price |
$2,517.30
|
| Rate for Payer: Cash Price |
$2,517.30
|
| Rate for Payer: Cash Price |
$2,517.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,237.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,237.60
|
| Rate for Payer: Galaxy Health WC |
$4,754.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,356.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$334.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,731.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,131.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,462.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,342.56
|
| Rate for Payer: Multiplan Commercial |
$4,475.20
|
| Rate for Payer: Networks By Design Commercial |
$3,636.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,754.90
|
|
|
HC NID
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.73
|
| Rate for Payer: Blue Shield of California Commercial |
$34.79
|
| Rate for Payer: Blue Shield of California EPN |
$22.98
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna of CA HMO |
$33.28
|
| Rate for Payer: Cigna of CA PPO |
$38.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC NID
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$44.20 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Senior |
$20.80
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.48
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
|
|
HC NIPT
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT 81507
|
| Hospital Charge Code |
910401507
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$2,778.05 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$296.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,192.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$874.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$795.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,778.05
|
| Rate for Payer: Blue Shield of California Commercial |
$302.39
|
| Rate for Payer: Blue Shield of California EPN |
$199.78
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna of CA HMO |
$289.28
|
| Rate for Payer: Cigna of CA PPO |
$334.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,192.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$874.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$795.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,073.25
|
| Rate for Payer: EPIC Health Plan Senior |
$795.00
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,303.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,068.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$795.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$301.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,208.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$795.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,001.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,065.30
|
| Rate for Payer: Multiplan Commercial |
$361.60
|
| Rate for Payer: Networks By Design Commercial |
$293.80
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$271.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$271.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$643.95
|
| Rate for Payer: United Healthcare All Other HMO |
$643.95
|
| Rate for Payer: United Healthcare HMO Rider |
$643.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$795.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,192.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$874.50
|
| Rate for Payer: Vantage Medical Group Senior |
$795.00
|
|
|
HC NIPT
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT 81507
|
| Hospital Charge Code |
910401507
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$384.20 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.80
|
| Rate for Payer: EPIC Health Plan Senior |
$180.80
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$301.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$279.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.48
|
| Rate for Payer: Multiplan Commercial |
$361.60
|
| Rate for Payer: Networks By Design Commercial |
$293.80
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
|
|
HC NITINAL WIRES/SHORT
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$207.40 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$160.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$207.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$183.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$149.84
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna of CA HMO |
$156.16
|
| Rate for Payer: Cigna of CA PPO |
$180.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$207.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$207.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: EPIC Health Plan Senior |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$151.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.80
|
| Rate for Payer: Multiplan Commercial |
$195.20
|
| Rate for Payer: Networks By Design Commercial |
$158.60
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$146.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$146.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.00
|
| Rate for Payer: United Healthcare All Other HMO |
$122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$122.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$207.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.40
|
| Rate for Payer: Vantage Medical Group Senior |
$207.40
|
|
|
HC NITINAL WIRES/SHORT
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$207.40 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: EPIC Health Plan Senior |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$151.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.56
|
| Rate for Payer: Multiplan Commercial |
$195.20
|
| Rate for Payer: Networks By Design Commercial |
$158.60
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
|
|
HC NITRIC OXIDE/HELIOX THRPY PER DAY
|
Facility
|
OP
|
$2,615.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800400
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$2,222.75 |
| Rate for Payer: Adventist Health Commercial |
$523.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,715.18
|
| 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 |
$1,605.87
|
| Rate for Payer: Blue Shield of California Commercial |
$1,600.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,056.46
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Cigna of CA HMO |
$1,673.60
|
| Rate for Payer: Cigna of CA PPO |
$1,935.10
|
| 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 |
$2,222.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,569.00
|
| 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 |
$1,744.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$627.60
|
| 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 |
$2,092.00
|
| Rate for Payer: Networks By Design Commercial |
$1,699.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,222.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,569.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,569.00
|
| 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 NITRIC OXIDE/HELIOX THRPY PER DAY
|
Facility
|
IP
|
$2,615.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800400
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$523.00 |
| Max. Negotiated Rate |
$2,222.75 |
| Rate for Payer: Adventist Health Commercial |
$523.00
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,046.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,046.00
|
| Rate for Payer: Galaxy Health WC |
$2,222.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,569.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,744.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$996.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,618.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$627.60
|
| Rate for Payer: Multiplan Commercial |
$2,092.00
|
| Rate for Payer: Networks By Design Commercial |
$1,699.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,222.75
|
|
|
HC NK CELLS TOTAL COUNTCD16+56
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
903900106
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$95.20 |
| Max. Negotiated Rate |
$404.60 |
| Rate for Payer: Adventist Health Commercial |
$95.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.40
|
| Rate for Payer: EPIC Health Plan Senior |
$190.40
|
| Rate for Payer: Galaxy Health WC |
$404.60
|
| Rate for Payer: Global Benefits Group Commercial |
$285.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$317.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.24
|
| Rate for Payer: Multiplan Commercial |
$380.80
|
| Rate for Payer: Networks By Design Commercial |
$309.40
|
| Rate for Payer: Prime Health Services Commercial |
$404.60
|
|
|
HC NK CELLS TOTAL COUNTCD16+56
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
903900106
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$364.47 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$93.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$364.47
|
| Rate for Payer: Blue Shield of California Commercial |
$95.00
|
| Rate for Payer: Blue Shield of California EPN |
$62.76
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna of CA HMO |
$90.88
|
| Rate for Payer: Cigna of CA PPO |
$105.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.94
|
| Rate for Payer: EPIC Health Plan Senior |
$37.73
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.56
|
| Rate for Payer: United Healthcare All Other HMO |
$30.56
|
| Rate for Payer: United Healthcare HMO Rider |
$30.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC NMIC306
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC NMIC306
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.73
|
| Rate for Payer: Blue Shield of California Commercial |
$33.45
|
| Rate for Payer: Blue Shield of California EPN |
$22.10
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC NM MYCRD IMG PET RST & STRS CT
|
Facility
|
IP
|
$5,264.00
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
909308431
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,052.80 |
| Max. Negotiated Rate |
$4,474.40 |
| Rate for Payer: Adventist Health Commercial |
$1,052.80
|
| Rate for Payer: Cash Price |
$2,368.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,105.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,105.60
|
| Rate for Payer: Galaxy Health WC |
$4,474.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,158.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,511.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,005.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,258.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,263.36
|
| Rate for Payer: Multiplan Commercial |
$4,211.20
|
| Rate for Payer: Networks By Design Commercial |
$3,421.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,474.40
|
|
|
HC NM MYCRD IMG PET RST & STRS CT
|
Facility
|
OP
|
$5,264.00
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
909308431
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$134.52 |
| Max. Negotiated Rate |
$5,761.28 |
| Rate for Payer: Adventist Health Commercial |
$1,052.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,452.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,289.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,145.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,859.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,232.62
|
| Rate for Payer: Blue Shield of California Commercial |
$3,221.57
|
| Rate for Payer: Blue Shield of California EPN |
$2,126.66
|
| Rate for Payer: Cash Price |
$2,368.80
|
| Rate for Payer: Cash Price |
$2,368.80
|
| Rate for Payer: Cigna of CA HMO |
$3,368.96
|
| Rate for Payer: Cigna of CA PPO |
$3,895.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,289.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,145.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,859.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,860.31
|
| Rate for Payer: EPIC Health Plan Senior |
$2,859.49
|
| Rate for Payer: Galaxy Health WC |
$4,474.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,158.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,689.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$134.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,859.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,511.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,859.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,263.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,602.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,831.72
|
| Rate for Payer: Multiplan Commercial |
$4,211.20
|
| Rate for Payer: Networks By Design Commercial |
$3,421.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,474.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,158.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,158.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,761.28
|
| Rate for Payer: United Healthcare All Other HMO |
$5,761.28
|
| Rate for Payer: United Healthcare HMO Rider |
$5,761.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,761.28
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,859.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,289.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,145.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,859.49
|
|
|
HC NM MYCRD IMG PET RST/STRS W/CT
|
Facility
|
IP
|
$3,375.00
|
|
|
Service Code
|
CPT 78430
|
| Hospital Charge Code |
909308430
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$2,868.75 |
| Rate for Payer: Adventist Health Commercial |
$675.00
|
| Rate for Payer: Cash Price |
$1,518.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,350.00
|
| Rate for Payer: Galaxy Health WC |
$2,868.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,025.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,251.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,285.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,089.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$810.00
|
| Rate for Payer: Multiplan Commercial |
$2,700.00
|
| Rate for Payer: Networks By Design Commercial |
$2,193.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,868.75
|
|
|
HC NM MYCRD IMG PET RST/STRS W/CT
|
Facility
|
OP
|
$3,375.00
|
|
|
Service Code
|
CPT 78430
|
| Hospital Charge Code |
909308430
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$115.52 |
| Max. Negotiated Rate |
$3,694.08 |
| Rate for Payer: Adventist Health Commercial |
$675.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,213.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,853.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,072.59
|
| Rate for Payer: Blue Shield of California Commercial |
$2,065.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,363.50
|
| Rate for Payer: Cash Price |
$1,518.75
|
| Rate for Payer: Cash Price |
$1,518.75
|
| Rate for Payer: Cigna of CA HMO |
$2,160.00
|
| Rate for Payer: Cigna of CA PPO |
$2,497.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,038.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,853.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,501.93
|
| Rate for Payer: EPIC Health Plan Senior |
$1,853.28
|
| Rate for Payer: Galaxy Health WC |
$2,868.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,025.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,039.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,251.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,853.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$810.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,335.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,483.40
|
| Rate for Payer: Multiplan Commercial |
$2,700.00
|
| Rate for Payer: Networks By Design Commercial |
$2,193.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,868.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,025.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,025.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,694.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3,694.08
|
| Rate for Payer: United Healthcare HMO Rider |
$3,694.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,694.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,853.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,853.28
|
|
|
HC NM MYOCRD IMG PET 1 STUDY W/CT
|
Facility
|
OP
|
$3,375.00
|
|
|
Service Code
|
CPT 78429
|
| Hospital Charge Code |
909308429
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$121.75 |
| Max. Negotiated Rate |
$3,694.08 |
| Rate for Payer: Adventist Health Commercial |
$675.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,213.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,853.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,072.59
|
| Rate for Payer: Blue Shield of California Commercial |
$2,065.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,363.50
|
| Rate for Payer: Cash Price |
$1,518.75
|
| Rate for Payer: Cash Price |
$1,518.75
|
| Rate for Payer: Cigna of CA HMO |
$2,160.00
|
| Rate for Payer: Cigna of CA PPO |
$2,497.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,038.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,853.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,501.93
|
| Rate for Payer: EPIC Health Plan Senior |
$1,853.28
|
| Rate for Payer: Galaxy Health WC |
$2,868.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,025.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,039.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$121.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,251.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,853.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$810.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,335.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,483.40
|
| Rate for Payer: Multiplan Commercial |
$2,700.00
|
| Rate for Payer: Networks By Design Commercial |
$2,193.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,868.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,025.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,025.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,694.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3,694.08
|
| Rate for Payer: United Healthcare HMO Rider |
$3,694.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,694.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,853.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,853.28
|
|
