|
HC DEVELOP TEST EXT W/RPT OT
|
Facility
|
OP
|
$1,370.00
|
|
|
Service Code
|
CPT 96111
|
| Hospital Charge Code |
905104362
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$1,233.00 |
| Rate for Payer: Adventist Health Commercial |
$561.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$832.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,164.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$753.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,027.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$753.50
|
| Rate for Payer: Cash Price |
$753.50
|
| Rate for Payer: Cash Price |
$753.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,096.00
|
| Rate for Payer: Cigna of CA HMO |
$876.80
|
| Rate for Payer: Cigna of CA PPO |
$1,013.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,164.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,164.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.00
|
| Rate for Payer: EPIC Health Plan Senior |
$548.00
|
| Rate for Payer: Galaxy Health WC |
$1,164.50
|
| Rate for Payer: Global Benefits Group Commercial |
$822.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,233.00
|
| Rate for Payer: InnovAge PACE Commercial |
$685.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$913.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$521.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$959.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$959.00
|
| Rate for Payer: Multiplan Commercial |
$1,027.50
|
| Rate for Payer: Networks By Design Commercial |
$890.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,164.50
|
| Rate for Payer: Riverside University Health System MISP |
$548.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$822.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$822.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,164.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,164.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,164.50
|
|
|
HC DEVELOP TEST EXT W/RPT PT
|
Facility
|
OP
|
$1,370.00
|
|
|
Service Code
|
CPT 96111
|
| Hospital Charge Code |
905103401
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$1,233.00 |
| Rate for Payer: Adventist Health Commercial |
$561.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$832.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,164.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$753.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,027.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$753.50
|
| Rate for Payer: Cash Price |
$753.50
|
| Rate for Payer: Cash Price |
$753.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,096.00
|
| Rate for Payer: Cigna of CA HMO |
$876.80
|
| Rate for Payer: Cigna of CA PPO |
$1,013.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,164.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,164.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.00
|
| Rate for Payer: EPIC Health Plan Senior |
$548.00
|
| Rate for Payer: Galaxy Health WC |
$1,164.50
|
| Rate for Payer: Global Benefits Group Commercial |
$822.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,233.00
|
| Rate for Payer: InnovAge PACE Commercial |
$685.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$913.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$521.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$959.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$959.00
|
| Rate for Payer: Multiplan Commercial |
$1,027.50
|
| Rate for Payer: Networks By Design Commercial |
$890.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,164.50
|
| Rate for Payer: Riverside University Health System MISP |
$548.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$822.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$822.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,164.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,164.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,164.50
|
|
|
HC DEVELOP TEST EXT W/RPT PT
|
Facility
|
IP
|
$1,370.00
|
|
|
Service Code
|
CPT 96111
|
| Hospital Charge Code |
905103401
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$274.00 |
| Max. Negotiated Rate |
$1,233.00 |
| Rate for Payer: Adventist Health Commercial |
$274.00
|
| Rate for Payer: Cash Price |
$753.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,096.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.00
|
| Rate for Payer: EPIC Health Plan Senior |
$548.00
|
| Rate for Payer: Galaxy Health WC |
$1,164.50
|
| Rate for Payer: Global Benefits Group Commercial |
$822.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,233.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$913.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$521.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.00
|
| Rate for Payer: Multiplan Commercial |
$1,027.50
|
| Rate for Payer: Networks By Design Commercial |
$890.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,164.50
|
|
|
HC DEVELOP TEST EXT W/RPT ST MCAL
|
Facility
|
OP
|
$1,370.00
|
|
|
Service Code
|
CPT 96111
|
| Hospital Charge Code |
907000007
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$1,233.00 |
| Rate for Payer: Adventist Health Commercial |
$561.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$832.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,164.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$753.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,027.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$753.50
|
| Rate for Payer: Cash Price |
$753.50
|
| Rate for Payer: Cash Price |
$753.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,096.00
|
| Rate for Payer: Cigna of CA HMO |
$876.80
|
| Rate for Payer: Cigna of CA PPO |
$1,013.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,164.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,164.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.00
|
| Rate for Payer: EPIC Health Plan Senior |
$548.00
|
| Rate for Payer: Galaxy Health WC |
$1,164.50
|
| Rate for Payer: Global Benefits Group Commercial |
$822.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,233.00
|
| Rate for Payer: InnovAge PACE Commercial |
$685.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$913.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$521.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$959.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$959.00
|
| Rate for Payer: Multiplan Commercial |
$1,027.50
|
| Rate for Payer: Networks By Design Commercial |
$890.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,164.50
|
| Rate for Payer: Riverside University Health System MISP |
$548.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$822.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$822.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,164.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,164.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,164.50
|
|
|
HC DEVELOP TEST EXT W/RPT ST MCAL
|
Facility
|
IP
|
$1,370.00
|
|
|
Service Code
|
CPT 96111
|
| Hospital Charge Code |
907000007
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$274.00 |
| Max. Negotiated Rate |
$1,233.00 |
| Rate for Payer: Adventist Health Commercial |
$274.00
|
| Rate for Payer: Cash Price |
$753.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,096.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.00
|
| Rate for Payer: EPIC Health Plan Senior |
$548.00
|
| Rate for Payer: Galaxy Health WC |
$1,164.50
|
| Rate for Payer: Global Benefits Group Commercial |
$822.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,233.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$913.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$521.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.00
|
| Rate for Payer: Multiplan Commercial |
$1,027.50
|
| Rate for Payer: Networks By Design Commercial |
$890.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,164.50
|
|
|
HC DEVELOP TESTING W/INTERP & RPT OT
|
Facility
|
IP
|
$1,485.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905104361
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$297.00 |
| Max. Negotiated Rate |
$1,336.50 |
| Rate for Payer: Adventist Health Commercial |
$297.00
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.00
|
| Rate for Payer: EPIC Health Plan Senior |
$594.00
|
| Rate for Payer: Galaxy Health WC |
$1,262.25
|
| Rate for Payer: Global Benefits Group Commercial |
$891.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,336.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$990.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$565.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$919.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.00
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
| Rate for Payer: Networks By Design Commercial |
$965.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,262.25
|
|
|
HC DEVELOP TESTING W/INTERP & RPT OT
|
Facility
|
OP
|
$1,485.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905104361
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$94.43 |
| Max. Negotiated Rate |
$1,336.50 |
| Rate for Payer: Adventist Health Commercial |
$608.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$901.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$816.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,113.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$349.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.00
|
| Rate for Payer: Cigna of CA HMO |
$950.40
|
| Rate for Payer: Cigna of CA PPO |
$1,098.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,262.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,262.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.00
|
| Rate for Payer: EPIC Health Plan Senior |
$594.00
|
| Rate for Payer: Galaxy Health WC |
$1,262.25
|
| Rate for Payer: Global Benefits Group Commercial |
$891.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,336.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$94.43
|
| Rate for Payer: InnovAge PACE Commercial |
$742.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$990.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$919.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,039.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,039.50
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
| Rate for Payer: Networks By Design Commercial |
$965.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,262.25
|
| Rate for Payer: Riverside University Health System MISP |
$594.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$891.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$891.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,262.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,262.25
|
|
|
HC DEVELOP TESTING W/INTERP & RPT PT
|
Facility
|
IP
|
$1,485.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905103400
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$297.00 |
| Max. Negotiated Rate |
$1,336.50 |
| Rate for Payer: Adventist Health Commercial |
$297.00
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.00
|
| Rate for Payer: EPIC Health Plan Senior |
$594.00
|
| Rate for Payer: Galaxy Health WC |
$1,262.25
|
| Rate for Payer: Global Benefits Group Commercial |
$891.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,336.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$990.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$565.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$919.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.00
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
| Rate for Payer: Networks By Design Commercial |
$965.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,262.25
|
|
|
HC DEVELOP TESTING W/INTERP & RPT PT
|
Facility
|
OP
|
$1,485.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905103400
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$94.43 |
| Max. Negotiated Rate |
$1,336.50 |
| Rate for Payer: Adventist Health Commercial |
$608.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$901.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$816.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,113.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$349.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.00
|
| Rate for Payer: Cigna of CA HMO |
$950.40
|
| Rate for Payer: Cigna of CA PPO |
$1,098.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,262.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,262.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.00
|
| Rate for Payer: EPIC Health Plan Senior |
$594.00
|
| Rate for Payer: Galaxy Health WC |
$1,262.25
|
| Rate for Payer: Global Benefits Group Commercial |
$891.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,336.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$94.43
|
| Rate for Payer: InnovAge PACE Commercial |
$742.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$990.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$919.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,039.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,039.50
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
| Rate for Payer: Networks By Design Commercial |
$965.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,262.25
|
| Rate for Payer: Riverside University Health System MISP |
$594.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$891.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$891.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,262.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,262.25
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST
|
Facility
|
OP
|
$1,485.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905601810
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$94.43 |
| Max. Negotiated Rate |
$1,336.50 |
| Rate for Payer: Adventist Health Commercial |
$608.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$901.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$816.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,113.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$349.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.00
|
| Rate for Payer: Cigna of CA HMO |
$950.40
|
| Rate for Payer: Cigna of CA PPO |
$1,098.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,262.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,262.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.00
|
| Rate for Payer: EPIC Health Plan Senior |
$594.00
|
| Rate for Payer: Galaxy Health WC |
$1,262.25
|
| Rate for Payer: Global Benefits Group Commercial |
$891.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,336.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$94.43
|
| Rate for Payer: InnovAge PACE Commercial |
$742.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$990.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$919.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,039.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,039.50
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
| Rate for Payer: Networks By Design Commercial |
$965.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,262.25
|
| Rate for Payer: Riverside University Health System MISP |
$594.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$891.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$891.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,262.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,262.25
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST
|
Facility
|
IP
|
$1,485.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905601810
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$297.00 |
| Max. Negotiated Rate |
$1,336.50 |
| Rate for Payer: Adventist Health Commercial |
$297.00
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.00
|
| Rate for Payer: EPIC Health Plan Senior |
$594.00
|
| Rate for Payer: Galaxy Health WC |
$1,262.25
|
| Rate for Payer: Global Benefits Group Commercial |
$891.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,336.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$990.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$565.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$919.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.00
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
| Rate for Payer: Networks By Design Commercial |
$965.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,262.25
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST MCAL
|
Facility
|
OP
|
$1,485.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
907000009
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$94.43 |
| Max. Negotiated Rate |
$1,336.50 |
| Rate for Payer: Adventist Health Commercial |
$608.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$901.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$816.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,113.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$349.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.00
|
| Rate for Payer: Cigna of CA HMO |
$950.40
|
| Rate for Payer: Cigna of CA PPO |
$1,098.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,262.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,262.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.00
|
| Rate for Payer: EPIC Health Plan Senior |
$594.00
|
| Rate for Payer: Galaxy Health WC |
$1,262.25
|
| Rate for Payer: Global Benefits Group Commercial |
$891.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,336.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$94.43
|
| Rate for Payer: InnovAge PACE Commercial |
$742.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$990.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$919.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,039.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,039.50
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
| Rate for Payer: Networks By Design Commercial |
$965.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,262.25
|
| Rate for Payer: Riverside University Health System MISP |
$594.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$891.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$891.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,262.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,262.25
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST MCAL
|
Facility
|
IP
|
$1,485.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
907000009
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$297.00 |
| Max. Negotiated Rate |
$1,336.50 |
| Rate for Payer: Adventist Health Commercial |
$297.00
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.00
|
| Rate for Payer: EPIC Health Plan Senior |
$594.00
|
| Rate for Payer: Galaxy Health WC |
$1,262.25
|
| Rate for Payer: Global Benefits Group Commercial |
$891.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,336.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$990.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$565.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$919.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.00
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
| Rate for Payer: Networks By Design Commercial |
$965.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,262.25
|
|
|
HC DEVELOP TEST W INTERP & RPT MCAL
|
Facility
|
OP
|
$1,485.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
901300035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$94.43 |
| Max. Negotiated Rate |
$1,336.50 |
| Rate for Payer: Adventist Health Commercial |
$608.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$901.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$816.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,113.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$349.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.00
|
| Rate for Payer: Cigna of CA HMO |
$950.40
|
| Rate for Payer: Cigna of CA PPO |
$1,098.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,262.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,262.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.00
|
| Rate for Payer: EPIC Health Plan Senior |
$594.00
|
| Rate for Payer: Galaxy Health WC |
$1,262.25
|
| Rate for Payer: Global Benefits Group Commercial |
$891.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,336.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$94.43
|
| Rate for Payer: InnovAge PACE Commercial |
$742.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$990.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$919.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,039.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,039.50
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
| Rate for Payer: Networks By Design Commercial |
$965.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,262.25
|
| Rate for Payer: Riverside University Health System MISP |
$594.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$891.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$891.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,262.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,262.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,262.25
|
|
|
HC DEVELOP TEST W INTERP & RPT MCAL
|
Facility
|
IP
|
$1,485.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
901300035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$297.00 |
| Max. Negotiated Rate |
$1,336.50 |
| Rate for Payer: Adventist Health Commercial |
$297.00
|
| Rate for Payer: Cash Price |
$816.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.00
|
| Rate for Payer: EPIC Health Plan Senior |
$594.00
|
| Rate for Payer: Galaxy Health WC |
$1,262.25
|
| Rate for Payer: Global Benefits Group Commercial |
$891.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,336.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$990.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$565.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$919.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.00
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
| Rate for Payer: Networks By Design Commercial |
$965.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,262.25
|
|
|
HC D EXT PWR MECH ELBW SWITCH CON
|
Facility
|
OP
|
$38,383.00
|
|
|
Service Code
|
CPT L6960
|
| Hospital Charge Code |
915356960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,872.80 |
| Max. Negotiated Rate |
$34,544.70 |
| Rate for Payer: Adventist Health Commercial |
$15,737.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,625.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21,110.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,787.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,542.34
|
| Rate for Payer: Blue Shield of California Commercial |
$29,670.06
|
| Rate for Payer: Blue Shield of California EPN |
$19,345.03
|
| Rate for Payer: Cash Price |
$21,110.65
|
| Rate for Payer: Cash Price |
$21,110.65
|
| Rate for Payer: Central Health Plan Commercial |
$30,706.40
|
| Rate for Payer: Cigna of CA HMO |
$26,868.10
|
| Rate for Payer: Cigna of CA PPO |
$26,868.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,625.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,625.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32,625.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,353.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15,353.20
|
| Rate for Payer: Galaxy Health WC |
$32,625.55
|
| Rate for Payer: Global Benefits Group Commercial |
$23,029.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34,544.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,872.80
|
| Rate for Payer: InnovAge PACE Commercial |
$19,191.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,601.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,906.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,759.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,737.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,868.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26,868.10
|
| Rate for Payer: Multiplan Commercial |
$28,787.25
|
| Rate for Payer: Networks By Design Commercial |
$19,191.50
|
| Rate for Payer: Prime Health Services Commercial |
$32,625.55
|
| Rate for Payer: Riverside University Health System MISP |
$15,353.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23,029.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23,029.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,405.14
|
| Rate for Payer: United Healthcare All Other HMO |
$14,021.31
|
| Rate for Payer: United Healthcare HMO Rider |
$13,718.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,570.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,625.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,625.55
|
| Rate for Payer: Vantage Medical Group Senior |
$32,625.55
|
|
|
HC D EXT PWR MECH ELBW SWITCH CON
|
Facility
|
IP
|
$38,383.00
|
|
|
Service Code
|
CPT L6960
|
| Hospital Charge Code |
915356960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,676.60 |
| Max. Negotiated Rate |
$34,544.70 |
| Rate for Payer: Adventist Health Commercial |
$7,676.60
|
| Rate for Payer: Blue Shield of California Commercial |
$29,670.06
|
| Rate for Payer: Blue Shield of California EPN |
$19,345.03
|
| Rate for Payer: Cash Price |
$21,110.65
|
| Rate for Payer: Central Health Plan Commercial |
$30,706.40
|
| Rate for Payer: Cigna of CA HMO |
$26,868.10
|
| Rate for Payer: Cigna of CA PPO |
$26,868.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,353.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15,353.20
|
| Rate for Payer: Galaxy Health WC |
$32,625.55
|
| Rate for Payer: Global Benefits Group Commercial |
$23,029.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34,544.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,601.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,623.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,759.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,676.60
|
| Rate for Payer: Multiplan Commercial |
$28,787.25
|
| Rate for Payer: Networks By Design Commercial |
$24,948.95
|
| Rate for Payer: Prime Health Services Commercial |
$32,625.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,405.14
|
| Rate for Payer: United Healthcare All Other HMO |
$14,021.31
|
| Rate for Payer: United Healthcare HMO Rider |
$13,718.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,570.43
|
|
|
HC D EXT PWR MECH ELBW SWITCH CON
|
Facility
|
IP
|
$38,383.00
|
|
|
Service Code
|
CPT L6960
|
| Hospital Charge Code |
905356960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,676.60 |
| Max. Negotiated Rate |
$34,544.70 |
| Rate for Payer: Adventist Health Commercial |
$7,676.60
|
| Rate for Payer: Blue Shield of California Commercial |
$29,670.06
|
| Rate for Payer: Blue Shield of California EPN |
$19,345.03
|
| Rate for Payer: Cash Price |
$21,110.65
|
| Rate for Payer: Central Health Plan Commercial |
$30,706.40
|
| Rate for Payer: Cigna of CA HMO |
$26,868.10
|
| Rate for Payer: Cigna of CA PPO |
$26,868.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,353.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15,353.20
|
| Rate for Payer: Galaxy Health WC |
$32,625.55
|
| Rate for Payer: Global Benefits Group Commercial |
$23,029.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34,544.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,601.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,623.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,759.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,676.60
|
| Rate for Payer: Multiplan Commercial |
$28,787.25
|
| Rate for Payer: Networks By Design Commercial |
$24,948.95
|
| Rate for Payer: Prime Health Services Commercial |
$32,625.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,405.14
|
| Rate for Payer: United Healthcare All Other HMO |
$14,021.31
|
| Rate for Payer: United Healthcare HMO Rider |
$13,718.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,570.43
|
|
|
HC D EXT PWR MECH ELBW SWITCH CON
|
Facility
|
OP
|
$38,383.00
|
|
|
Service Code
|
CPT L6960
|
| Hospital Charge Code |
905356960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,872.80 |
| Max. Negotiated Rate |
$34,544.70 |
| Rate for Payer: Adventist Health Commercial |
$15,737.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,625.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21,110.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,787.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,542.34
|
| Rate for Payer: Blue Shield of California Commercial |
$29,670.06
|
| Rate for Payer: Blue Shield of California EPN |
$19,345.03
|
| Rate for Payer: Cash Price |
$21,110.65
|
| Rate for Payer: Cash Price |
$21,110.65
|
| Rate for Payer: Central Health Plan Commercial |
$30,706.40
|
| Rate for Payer: Cigna of CA HMO |
$26,868.10
|
| Rate for Payer: Cigna of CA PPO |
$26,868.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,625.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,625.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32,625.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,353.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15,353.20
|
| Rate for Payer: Galaxy Health WC |
$32,625.55
|
| Rate for Payer: Global Benefits Group Commercial |
$23,029.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34,544.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,872.80
|
| Rate for Payer: InnovAge PACE Commercial |
$19,191.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,601.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,906.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,759.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,737.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,868.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26,868.10
|
| Rate for Payer: Multiplan Commercial |
$28,787.25
|
| Rate for Payer: Networks By Design Commercial |
$19,191.50
|
| Rate for Payer: Prime Health Services Commercial |
$32,625.55
|
| Rate for Payer: Riverside University Health System MISP |
$15,353.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23,029.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23,029.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,405.14
|
| Rate for Payer: United Healthcare All Other HMO |
$14,021.31
|
| Rate for Payer: United Healthcare HMO Rider |
$13,718.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,570.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,625.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,625.55
|
| Rate for Payer: Vantage Medical Group Senior |
$32,625.55
|
|
|
HC DFIB BIOTRONIK ILIVIA 404623
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,325.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,600.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
|
|
HC DFIB BIOTRONIK ILIVIA 404623
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,415.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,842.50
|
| Rate for Payer: Blue Shield of California Commercial |
$19,325.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,600.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: Riverside University Health System MISP |
$10,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC DFIB BIOTRONIK ILIVIA 404626
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813810
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,415.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,842.50
|
| Rate for Payer: Blue Shield of California Commercial |
$19,325.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,600.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: Riverside University Health System MISP |
$10,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC DFIB BIOTRONIK ILIVIA 404626
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813810
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,325.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,600.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
|
|
HC DFIB BIOTRONIK INVENTRA 7VR 399436
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,325.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,600.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
|
|
HC DFIB BIOTRONIK INVENTRA 7VR 399436
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,415.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,842.50
|
| Rate for Payer: Blue Shield of California Commercial |
$19,325.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,600.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: Riverside University Health System MISP |
$10,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
