|
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 |
$28.60
|
| 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
|
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 |
$248.60
|
| 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 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 |
$248.60
|
| Rate for Payer: Cash Price |
$248.60
|
| 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 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 |
$134.20
|
| 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 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 |
$134.20
|
| 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 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 |
$1,438.25
|
| Rate for Payer: Cash Price |
$1,438.25
|
| Rate for Payer: Cash Price |
$1,438.25
|
| 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 |
$1,438.25
|
| 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 |
$261.80
|
| 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
|
$476.00
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
903900106
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.56 |
| Max. Negotiated Rate |
$404.60 |
| Rate for Payer: Adventist Health Commercial |
$95.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$312.21
|
| 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 |
$318.44
|
| Rate for Payer: Blue Shield of California EPN |
$210.39
|
| Rate for Payer: Cash Price |
$261.80
|
| Rate for Payer: Cash Price |
$261.80
|
| Rate for Payer: Cigna of CA HMO |
$304.64
|
| Rate for Payer: Cigna of CA PPO |
$352.24
|
| 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 |
$404.60
|
| Rate for Payer: Global Benefits Group Commercial |
$285.60
|
| 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 |
$317.49
|
| 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 |
$114.24
|
| 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 |
$380.80
|
| Rate for Payer: Networks By Design Commercial |
$309.40
|
| Rate for Payer: Prime Health Services Commercial |
$404.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$285.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$285.60
|
| 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
|
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 |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| 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 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 |
$27.50
|
| 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 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 |
$2,895.20
|
| 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 |
$2,895.20
|
| Rate for Payer: Cash Price |
$2,895.20
|
| 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
|
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 |
$1,856.25
|
| Rate for Payer: Cash Price |
$1,856.25
|
| 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 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 |
$1,856.25
|
| 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 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 |
$1,856.25
|
| Rate for Payer: Cash Price |
$1,856.25
|
| 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
|
|
|
HC NM MYOCRD IMG PET 1 STUDY W/CT
|
Facility
|
IP
|
$3,375.00
|
|
|
Service Code
|
CPT 78429
|
| Hospital Charge Code |
909308429
|
|
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 |
$1,856.25
|
| 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 MYOCRD IMG PET DUAL TRCR CT
|
Facility
|
IP
|
$6,434.00
|
|
|
Service Code
|
CPT 78433
|
| Hospital Charge Code |
909308433
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,286.80 |
| Max. Negotiated Rate |
$5,468.90 |
| Rate for Payer: Adventist Health Commercial |
$1,286.80
|
| Rate for Payer: Cash Price |
$3,538.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,573.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,573.60
|
| Rate for Payer: Galaxy Health WC |
$5,468.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,860.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,291.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,451.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,544.16
|
| Rate for Payer: Multiplan Commercial |
$5,147.20
|
| Rate for Payer: Networks By Design Commercial |
$4,182.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,468.90
|
|
|
HC NM MYOCRD IMG PET DUAL TRCR CT
|
Facility
|
OP
|
$6,434.00
|
|
|
Service Code
|
CPT 78433
|
| Hospital Charge Code |
909308433
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$156.39 |
| Max. Negotiated Rate |
$7,041.28 |
| Rate for Payer: Adventist Health Commercial |
$1,286.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,220.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,717.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,726.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,478.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,951.12
|
| Rate for Payer: Blue Shield of California Commercial |
$3,937.61
|
| Rate for Payer: Blue Shield of California EPN |
$2,599.34
|
| Rate for Payer: Cash Price |
$3,538.70
|
| Rate for Payer: Cash Price |
$3,538.70
|
| Rate for Payer: Cigna of CA HMO |
$4,117.76
|
| Rate for Payer: Cigna of CA PPO |
$4,761.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,717.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,726.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,478.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,345.72
|
| Rate for Payer: EPIC Health Plan Senior |
$2,478.31
|
| Rate for Payer: Galaxy Health WC |
$5,468.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,860.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,064.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$156.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,478.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,291.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,478.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,544.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,122.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,320.94
|
| Rate for Payer: Multiplan Commercial |
$5,147.20
|
| Rate for Payer: Networks By Design Commercial |
$4,182.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,468.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,860.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,860.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,041.28
|
| Rate for Payer: United Healthcare All Other HMO |
$7,041.28
|
| Rate for Payer: United Healthcare HMO Rider |
$7,041.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,041.28
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,478.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,717.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,726.14
|
| Rate for Payer: Vantage Medical Group Senior |
$2,478.31
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 1
|
Facility
|
IP
|
$2,976.00
|
|
|
Service Code
|
CPT 78830
|
| Hospital Charge Code |
909308830
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$595.20 |
| Max. Negotiated Rate |
$2,529.60 |
| Rate for Payer: Adventist Health Commercial |
$595.20
|
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,190.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,190.40
|
| Rate for Payer: Galaxy Health WC |
$2,529.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,785.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,984.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,133.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,842.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.24
|
| Rate for Payer: Multiplan Commercial |
$2,380.80
|
| Rate for Payer: Networks By Design Commercial |
$1,934.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,529.60
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 1
|
Facility
|
OP
|
$2,976.00
|
|
|
Service Code
|
CPT 78830
|
| Hospital Charge Code |
909308830
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$595.20 |
| Max. Negotiated Rate |
$3,256.45 |
| Rate for Payer: Adventist Health Commercial |
$595.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,658.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,827.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1,821.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,202.30
|
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: Cigna of CA HMO |
$1,904.64
|
| Rate for Payer: Cigna of CA PPO |
$2,202.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,824.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,658.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,239.30
|
| Rate for Payer: EPIC Health Plan Senior |
$1,658.74
|
| Rate for Payer: Galaxy Health WC |
$2,529.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,785.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,720.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$726.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,658.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,984.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$821.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,658.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,090.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,222.71
|
| Rate for Payer: Multiplan Commercial |
$2,380.80
|
| Rate for Payer: Networks By Design Commercial |
$1,934.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,529.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,785.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,785.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,256.45
|
| Rate for Payer: United Healthcare All Other HMO |
$3,256.45
|
| Rate for Payer: United Healthcare HMO Rider |
$3,256.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,256.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,658.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,658.74
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 2
|
Facility
|
OP
|
$3,375.00
|
|
|
Service Code
|
CPT 78832
|
| Hospital Charge Code |
909308832
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$3,694.08 |
| Rate for Payer: Adventist Health Commercial |
$675.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| 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 |
$1,856.25
|
| Rate for Payer: Cash Price |
$1,856.25
|
| Rate for Payer: Cash Price |
$1,856.25
|
| 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 |
$1,382.54
|
| 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 |
$1,563.59
|
| 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 RP LCLZTN TMR SPECT W/CT 2
|
Facility
|
IP
|
$3,375.00
|
|
|
Service Code
|
CPT 78832
|
| Hospital Charge Code |
909308832
|
|
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 |
$1,856.25
|
| 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 NON-CORROSIVE FINISH PER BAR
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT L2780
|
| Hospital Charge Code |
915352780
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$124.95 |
| Rate for Payer: Adventist Health Commercial |
$60.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.14
|
| Rate for Payer: Blue Shield of California Commercial |
$108.49
|
| Rate for Payer: Blue Shield of California EPN |
$71.44
|
| Rate for Payer: Cash Price |
$80.85
|
| Rate for Payer: Cash Price |
$80.85
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$124.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.90
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: Networks By Design Commercial |
$73.50
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other HMO |
$53.70
|
| Rate for Payer: United Healthcare HMO Rider |
$52.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.95
|
| Rate for Payer: Vantage Medical Group Senior |
$124.95
|
|
|
HC NON-CORROSIVE FINISH PER BAR
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT L2780
|
| Hospital Charge Code |
915352780
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$29.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$80.85
|
| Rate for Payer: Cash Price |
$80.85
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.28
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: Networks By Design Commercial |
$73.50
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other HMO |
$53.70
|
| Rate for Payer: United Healthcare HMO Rider |
$52.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.14
|
|
