|
HC INTACT PTH
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 83970
|
| Hospital Charge Code |
900910942
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$366.27 |
| Rate for Payer: Adventist Health Medi-Cal |
$41.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$302.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$300.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$366.27
|
| Rate for Payer: Blue Distinction Transplant |
$46.80
|
| Rate for Payer: Blue Shield of California Commercial |
$48.20
|
| Rate for Payer: Blue Shield of California EPN |
$37.91
|
| Rate for Payer: Caremore Medicare Advantage |
$41.28
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Central Health Plan Commercial |
$62.40
|
| Rate for Payer: Cigna of CA HMO |
$49.92
|
| Rate for Payer: Cigna of CA PPO |
$57.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.92
|
| Rate for Payer: Dignity Health Media |
$41.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.73
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$41.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$41.28
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$58.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$67.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$68.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41.28
|
| Rate for Payer: InnovAge PACE Commercial |
$61.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.32
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: Networks By Design Commercial |
$50.70
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
| Rate for Payer: Prime Health Services Medicare |
$43.76
|
| Rate for Payer: Riverside University Health System MISP |
$45.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.44
|
| Rate for Payer: United Healthcare All Other HMO |
$33.44
|
| Rate for Payer: United Healthcare HMO Rider |
$33.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.41
|
| Rate for Payer: Vantage Medical Group Senior |
$41.28
|
|
|
HC INTACT PTH
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
CPT 83970
|
| Hospital Charge Code |
900910942
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Central Health Plan Commercial |
$552.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$276.00
|
| Rate for Payer: Galaxy Health WC |
$586.50
|
| Rate for Payer: Global Benefits Group Commercial |
$414.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$621.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$460.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.00
|
| Rate for Payer: Multiplan Commercial |
$517.50
|
| Rate for Payer: Networks By Design Commercial |
$448.50
|
| Rate for Payer: Prime Health Services Commercial |
$586.50
|
|
|
HC INT AUDITORY MEATUS
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
CPT 70134
|
| Hospital Charge Code |
909001133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$87.10 |
| Max. Negotiated Rate |
$1,137.31 |
| Rate for Payer: Adventist Health Medi-Cal |
$689.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$167.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$154.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.18
|
| Rate for Payer: Blue Distinction Transplant |
$517.20
|
| Rate for Payer: Blue Shield of California Commercial |
$532.72
|
| Rate for Payer: Blue Shield of California EPN |
$418.93
|
| Rate for Payer: Caremore Medicare Advantage |
$689.28
|
| Rate for Payer: Cash Price |
$387.90
|
| Rate for Payer: Cash Price |
$387.90
|
| Rate for Payer: Central Health Plan Commercial |
$689.60
|
| Rate for Payer: Cigna of CA HMO |
$551.68
|
| Rate for Payer: Cigna of CA PPO |
$637.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Dignity Health Media |
$689.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$689.28
|
| Rate for Payer: Galaxy Health WC |
$732.70
|
| Rate for Payer: Global Benefits Group Commercial |
$517.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$775.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$646.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,130.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,137.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$689.28
|
| Rate for Payer: InnovAge PACE Commercial |
$1,033.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$574.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$689.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$923.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$923.64
|
| Rate for Payer: Multiplan Commercial |
$646.50
|
| Rate for Payer: Networks By Design Commercial |
$560.30
|
| Rate for Payer: Prime Health Services Commercial |
$732.70
|
| Rate for Payer: Prime Health Services Medicare |
$730.64
|
| Rate for Payer: Riverside University Health System MISP |
$758.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$517.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$517.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC INT AUDITORY MEATUS
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
CPT 70134
|
| Hospital Charge Code |
909001133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.40 |
| Max. Negotiated Rate |
$775.80 |
| Rate for Payer: Cash Price |
$387.90
|
| Rate for Payer: Central Health Plan Commercial |
$689.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.80
|
| Rate for Payer: Galaxy Health WC |
$732.70
|
| Rate for Payer: Global Benefits Group Commercial |
$517.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$775.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$574.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$328.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.40
|
| Rate for Payer: Multiplan Commercial |
$646.50
|
| Rate for Payer: Networks By Design Commercial |
$560.30
|
| Rate for Payer: Prime Health Services Commercial |
$732.70
|
|
|
HC INTENSITY MOD RADIO TX PLAN
|
Facility
|
IP
|
$8,930.00
|
|
|
Service Code
|
CPT 77301
|
| Hospital Charge Code |
909100275
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,786.00 |
| Max. Negotiated Rate |
$8,037.00 |
| Rate for Payer: Cash Price |
$4,018.50
|
| Rate for Payer: Central Health Plan Commercial |
$7,144.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,572.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,572.00
|
| Rate for Payer: Galaxy Health WC |
$7,590.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,358.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,037.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,956.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,402.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,786.00
|
| Rate for Payer: Multiplan Commercial |
$6,697.50
|
| Rate for Payer: Networks By Design Commercial |
$5,804.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,590.50
|
|
|
HC INTENSITY MOD RADIO TX PLAN
|
Facility
|
OP
|
$8,930.00
|
|
|
Service Code
|
CPT 77301
|
| Hospital Charge Code |
909100275
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,161.00 |
| Max. Negotiated Rate |
$9,461.49 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,731.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,461.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,596.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,904.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,731.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,541.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,758.92
|
| Rate for Payer: Blue Distinction Transplant |
$5,358.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,518.74
|
| Rate for Payer: Blue Shield of California EPN |
$4,339.98
|
| Rate for Payer: Caremore Medicare Advantage |
$1,731.24
|
| Rate for Payer: Cash Price |
$4,018.50
|
| Rate for Payer: Cash Price |
$4,018.50
|
| Rate for Payer: Cash Price |
$4,018.50
|
| Rate for Payer: Central Health Plan Commercial |
$7,144.00
|
| Rate for Payer: Cigna of CA HMO |
$5,715.20
|
| Rate for Payer: Cigna of CA PPO |
$6,608.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,596.86
|
| Rate for Payer: Dignity Health Media |
$1,731.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,904.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,337.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,731.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,731.24
|
| Rate for Payer: Galaxy Health WC |
$7,590.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,358.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,037.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,697.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,839.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,856.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,731.24
|
| Rate for Payer: InnovAge PACE Commercial |
$2,596.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,956.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,350.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,731.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,786.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,319.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,319.86
|
| Rate for Payer: Multiplan Commercial |
$6,697.50
|
| Rate for Payer: Networks By Design Commercial |
$5,804.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,590.50
|
| Rate for Payer: Prime Health Services Medicare |
$1,835.11
|
| Rate for Payer: Riverside University Health System MISP |
$1,904.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,358.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,596.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,904.36
|
| Rate for Payer: Vantage Medical Group Senior |
$1,731.24
|
|
|
HC INTERACTIVE COMPLEXITY
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 90785
|
| Hospital Charge Code |
900100714
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$25.38 |
| Max. Negotiated Rate |
$1,510.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$98.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$97.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.75
|
| Rate for Payer: Blue Distinction Transplant |
$120.60
|
| Rate for Payer: Blue Shield of California Commercial |
$126.43
|
| Rate for Payer: Blue Shield of California EPN |
$98.29
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Central Health Plan Commercial |
$160.80
|
| Rate for Payer: Cigna of CA HMO |
$128.64
|
| Rate for Payer: Cigna of CA PPO |
$148.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.85
|
| Rate for Payer: Dignity Health Media |
$170.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.40
|
| Rate for Payer: Galaxy Health WC |
$170.85
|
| Rate for Payer: Global Benefits Group Commercial |
$120.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$150.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$70.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.20
|
| Rate for Payer: Multiplan Commercial |
$150.75
|
| Rate for Payer: Networks By Design Commercial |
$130.65
|
| Rate for Payer: Prime Health Services Commercial |
$170.85
|
| Rate for Payer: Riverside University Health System MISP |
$80.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,510.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,425.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$984.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.85
|
| Rate for Payer: Vantage Medical Group Senior |
$170.85
|
|
|
HC INTERACTIVE COMPLEXITY
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 90785
|
| Hospital Charge Code |
900100714
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.20 |
| Max. Negotiated Rate |
$180.90 |
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Central Health Plan Commercial |
$160.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.40
|
| Rate for Payer: Galaxy Health WC |
$170.85
|
| Rate for Payer: Global Benefits Group Commercial |
$120.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.20
|
| Rate for Payer: Multiplan Commercial |
$150.75
|
| Rate for Payer: Networks By Design Commercial |
$130.65
|
| Rate for Payer: Prime Health Services Commercial |
$170.85
|
|
|
HC INTERACTIVE COMPLEXITY
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 90785
|
| Hospital Charge Code |
900100714
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.38 |
| Max. Negotiated Rate |
$180.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$98.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$97.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.75
|
| Rate for Payer: Blue Distinction Transplant |
$120.60
|
| Rate for Payer: Blue Shield of California Commercial |
$126.43
|
| Rate for Payer: Blue Shield of California EPN |
$98.29
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Central Health Plan Commercial |
$160.80
|
| Rate for Payer: Cigna of CA HMO |
$128.64
|
| Rate for Payer: Cigna of CA PPO |
$148.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.85
|
| Rate for Payer: Dignity Health Media |
$170.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.40
|
| Rate for Payer: Galaxy Health WC |
$170.85
|
| Rate for Payer: Global Benefits Group Commercial |
$120.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$150.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$70.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.20
|
| Rate for Payer: Multiplan Commercial |
$150.75
|
| Rate for Payer: Networks By Design Commercial |
$130.65
|
| Rate for Payer: Prime Health Services Commercial |
$170.85
|
| Rate for Payer: Riverside University Health System MISP |
$80.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.50
|
| Rate for Payer: United Healthcare All Other HMO |
$100.50
|
| Rate for Payer: United Healthcare HMO Rider |
$100.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.85
|
| Rate for Payer: Vantage Medical Group Senior |
$170.85
|
|
|
HC INTERACTIVE COMPLEXITY
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 90785
|
| Hospital Charge Code |
900100714
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$40.20 |
| Max. Negotiated Rate |
$180.90 |
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Central Health Plan Commercial |
$160.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.40
|
| Rate for Payer: Galaxy Health WC |
$170.85
|
| Rate for Payer: Global Benefits Group Commercial |
$120.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.20
|
| Rate for Payer: Multiplan Commercial |
$150.75
|
| Rate for Payer: Networks By Design Commercial |
$130.65
|
| Rate for Payer: Prime Health Services Commercial |
$170.85
|
|
|
HC INTERACTIVE GROUP THERAPY
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804000
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Central Health Plan Commercial |
$260.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: Galaxy Health WC |
$276.25
|
| Rate for Payer: Global Benefits Group Commercial |
$195.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
| Rate for Payer: Networks By Design Commercial |
$211.25
|
| Rate for Payer: Prime Health Services Commercial |
$276.25
|
|
|
HC INTERACTIVE GROUP THERAPY
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804000
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$45.52 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$111.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$157.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.01
|
| Rate for Payer: Blue Distinction Transplant |
$195.00
|
| Rate for Payer: Blue Shield of California Commercial |
$204.42
|
| Rate for Payer: Blue Shield of California EPN |
$158.92
|
| Rate for Payer: Caremore Medicare Advantage |
$111.37
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Central Health Plan Commercial |
$260.00
|
| Rate for Payer: Cigna of CA HMO |
$208.00
|
| Rate for Payer: Cigna of CA PPO |
$240.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.06
|
| Rate for Payer: Dignity Health Media |
$111.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$111.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$111.37
|
| Rate for Payer: Galaxy Health WC |
$276.25
|
| Rate for Payer: Global Benefits Group Commercial |
$195.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$243.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$182.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$183.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.37
|
| Rate for Payer: InnovAge PACE Commercial |
$167.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Managed Health Network (MHN) Behavioral |
$800.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.24
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
| Rate for Payer: Networks By Design Commercial |
$211.25
|
| Rate for Payer: Prime Health Services Commercial |
$276.25
|
| Rate for Payer: Prime Health Services Medicare |
$118.05
|
| Rate for Payer: Riverside University Health System MISP |
$122.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.50
|
| Rate for Payer: United Healthcare All Other HMO |
$162.50
|
| Rate for Payer: United Healthcare HMO Rider |
$162.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$162.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Vantage Medical Group Senior |
$111.37
|
|
|
HC INTERCOSTAL NERVE BLOCK SINGLE
|
Facility
|
IP
|
$1,652.00
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
900501673
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$330.40 |
| Max. Negotiated Rate |
$1,486.80 |
| Rate for Payer: Cash Price |
$743.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,321.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$660.80
|
| Rate for Payer: Galaxy Health WC |
$1,404.20
|
| Rate for Payer: Global Benefits Group Commercial |
$991.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,486.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,101.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.40
|
| Rate for Payer: Multiplan Commercial |
$1,239.00
|
| Rate for Payer: Networks By Design Commercial |
$1,073.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,404.20
|
|
|
HC INTERCOSTAL NERVE BLOCK SINGLE
|
Facility
|
OP
|
$1,652.00
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
900501673
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.18 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$991.20
|
| Rate for Payer: Caremore Medicare Advantage |
$864.04
|
| Rate for Payer: Cash Price |
$743.40
|
| Rate for Payer: Cash Price |
$743.40
|
| Rate for Payer: Cash Price |
$743.40
|
| Rate for Payer: Cash Price |
$743.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,321.60
|
| Rate for Payer: Cigna of CA PPO |
$1,222.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$1,404.20
|
| Rate for Payer: Global Benefits Group Commercial |
$991.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,486.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,239.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,417.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: InnovAge PACE Commercial |
$1,296.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,101.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,157.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$1,239.00
|
| Rate for Payer: Networks By Design Commercial |
$1,073.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,404.20
|
| Rate for Payer: Prime Health Services Medicare |
$915.88
|
| Rate for Payer: Riverside University Health System MISP |
$950.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$991.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$826.00
|
| Rate for Payer: United Healthcare All Other HMO |
$826.00
|
| Rate for Payer: United Healthcare HMO Rider |
$826.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$826.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC INTERDENTAL WIRING,OTH THN FRX
|
Facility
|
IP
|
$10,496.00
|
|
|
Service Code
|
CPT 21497
|
| Hospital Charge Code |
900501322
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,099.20 |
| Max. Negotiated Rate |
$9,446.40 |
| Rate for Payer: Cash Price |
$4,723.20
|
| Rate for Payer: Central Health Plan Commercial |
$8,396.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,198.40
|
| Rate for Payer: Galaxy Health WC |
$8,921.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,297.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,446.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,000.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,998.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,099.20
|
| Rate for Payer: Multiplan Commercial |
$7,872.00
|
| Rate for Payer: Networks By Design Commercial |
$6,822.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,921.60
|
|
|
HC INTERDENTAL WIRING,OTH THN FRX
|
Facility
|
OP
|
$10,496.00
|
|
|
Service Code
|
CPT 21497
|
| Hospital Charge Code |
900501322
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.16 |
| Max. Negotiated Rate |
$9,446.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,297.60
|
| Rate for Payer: Caremore Medicare Advantage |
$1,905.44
|
| Rate for Payer: Cash Price |
$4,723.20
|
| Rate for Payer: Cash Price |
$4,723.20
|
| Rate for Payer: Cash Price |
$4,723.20
|
| Rate for Payer: Cash Price |
$4,723.20
|
| Rate for Payer: Central Health Plan Commercial |
$8,396.80
|
| Rate for Payer: Cigna of CA PPO |
$7,767.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Media |
$1,905.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Galaxy Health WC |
$8,921.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,297.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,446.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,872.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,124.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,905.44
|
| Rate for Payer: InnovAge PACE Commercial |
$2,858.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,000.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,099.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,553.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Multiplan Commercial |
$7,872.00
|
| Rate for Payer: Networks By Design Commercial |
$6,822.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,921.60
|
| Rate for Payer: Prime Health Services Medicare |
$2,019.77
|
| Rate for Payer: Riverside University Health System MISP |
$2,095.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,297.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,248.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,248.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,248.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC INTERLEUKIN 6
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912265
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Central Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.80
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.40
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
|
|
HC INTERLEUKIN 6
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912265
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$114.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.88
|
| Rate for Payer: Blue Distinction Transplant |
$14.40
|
| Rate for Payer: Blue Shield of California Commercial |
$14.83
|
| Rate for Payer: Blue Shield of California EPN |
$11.66
|
| Rate for Payer: Caremore Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.90
|
| Rate for Payer: Dignity Health Media |
$17.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: InnovAge PACE Commercial |
$25.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Prime Health Services Medicare |
$18.31
|
| Rate for Payer: Riverside University Health System MISP |
$19.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC INTERNAL CARDIOVERSION, ELECTR
|
Facility
|
IP
|
$1,222.00
|
|
|
Service Code
|
CPT 92961
|
| Hospital Charge Code |
906820077
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$244.40 |
| Max. Negotiated Rate |
$1,099.80 |
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Central Health Plan Commercial |
$977.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$488.80
|
| Rate for Payer: Galaxy Health WC |
$1,038.70
|
| Rate for Payer: Global Benefits Group Commercial |
$733.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,099.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$815.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$465.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.40
|
| Rate for Payer: Multiplan Commercial |
$916.50
|
| Rate for Payer: Networks By Design Commercial |
$794.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,038.70
|
|
|
HC INTERNAL CARDIOVERSION, ELECTR
|
Facility
|
OP
|
$1,222.00
|
|
|
Service Code
|
CPT 92961
|
| Hospital Charge Code |
906812074
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$244.40 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$813.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,451.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$813.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$733.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$813.16
|
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Central Health Plan Commercial |
$977.60
|
| Rate for Payer: Cigna of CA HMO |
$782.08
|
| Rate for Payer: Cigna of CA PPO |
$904.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Dignity Health Media |
$813.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,097.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$813.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$813.16
|
| Rate for Payer: Galaxy Health WC |
$1,038.70
|
| Rate for Payer: Global Benefits Group Commercial |
$733.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,099.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$916.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,333.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,341.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$813.16
|
| Rate for Payer: InnovAge PACE Commercial |
$1,219.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$815.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$328.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$813.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,089.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,089.63
|
| Rate for Payer: Multiplan Commercial |
$916.50
|
| Rate for Payer: Networks By Design Commercial |
$794.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,038.70
|
| Rate for Payer: Prime Health Services Medicare |
$861.95
|
| Rate for Payer: Riverside University Health System MISP |
$894.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$733.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$733.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Vantage Medical Group Senior |
$813.16
|
|
|
HC INTERNAL CARDIOVERSION, ELECTR
|
Facility
|
OP
|
$1,222.00
|
|
|
Service Code
|
CPT 92961
|
| Hospital Charge Code |
906820077
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$244.40 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$813.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,451.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$813.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$733.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$813.16
|
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Central Health Plan Commercial |
$977.60
|
| Rate for Payer: Cigna of CA HMO |
$782.08
|
| Rate for Payer: Cigna of CA PPO |
$904.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Dignity Health Media |
$813.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,097.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$813.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$813.16
|
| Rate for Payer: Galaxy Health WC |
$1,038.70
|
| Rate for Payer: Global Benefits Group Commercial |
$733.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,099.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$916.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,333.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,341.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$813.16
|
| Rate for Payer: InnovAge PACE Commercial |
$1,219.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$815.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$328.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$813.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,089.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,089.63
|
| Rate for Payer: Multiplan Commercial |
$916.50
|
| Rate for Payer: Networks By Design Commercial |
$794.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,038.70
|
| Rate for Payer: Prime Health Services Medicare |
$861.95
|
| Rate for Payer: Riverside University Health System MISP |
$894.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$733.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$733.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Vantage Medical Group Senior |
$813.16
|
|
|
HC INTERNAL CARDIOVERSION, ELECTR
|
Facility
|
IP
|
$1,222.00
|
|
|
Service Code
|
CPT 92961
|
| Hospital Charge Code |
906812074
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$244.40 |
| Max. Negotiated Rate |
$1,099.80 |
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Central Health Plan Commercial |
$977.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$488.80
|
| Rate for Payer: Galaxy Health WC |
$1,038.70
|
| Rate for Payer: Global Benefits Group Commercial |
$733.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,099.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$815.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$465.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.40
|
| Rate for Payer: Multiplan Commercial |
$916.50
|
| Rate for Payer: Networks By Design Commercial |
$794.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,038.70
|
|
|
HC INTERNAL CAROTID UNI
|
Facility
|
IP
|
$25,095.00
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
909020147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,019.00 |
| Max. Negotiated Rate |
$22,585.50 |
| Rate for Payer: Cash Price |
$11,292.75
|
| Rate for Payer: Central Health Plan Commercial |
$20,076.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,038.00
|
| Rate for Payer: Galaxy Health WC |
$21,330.75
|
| Rate for Payer: Global Benefits Group Commercial |
$15,057.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,585.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,738.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,561.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,019.00
|
| Rate for Payer: Multiplan Commercial |
$18,821.25
|
| Rate for Payer: Networks By Design Commercial |
$16,311.75
|
| Rate for Payer: Prime Health Services Commercial |
$21,330.75
|
|
|
HC INTERNAL CAROTID UNI
|
Facility
|
IP
|
$25,095.00
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
906820222
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,019.00 |
| Max. Negotiated Rate |
$22,585.50 |
| Rate for Payer: Cash Price |
$11,292.75
|
| Rate for Payer: Central Health Plan Commercial |
$20,076.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,038.00
|
| Rate for Payer: Galaxy Health WC |
$21,330.75
|
| Rate for Payer: Global Benefits Group Commercial |
$15,057.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,585.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,738.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,561.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,019.00
|
| Rate for Payer: Multiplan Commercial |
$18,821.25
|
| Rate for Payer: Networks By Design Commercial |
$16,311.75
|
| Rate for Payer: Prime Health Services Commercial |
$21,330.75
|
|
|
HC INTERNAL CAROTID UNI
|
Facility
|
OP
|
$25,095.00
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
909020147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$533.35 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,866.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$15,057.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$6,866.07
|
| Rate for Payer: Cash Price |
$11,292.75
|
| Rate for Payer: Cash Price |
$11,292.75
|
| Rate for Payer: Central Health Plan Commercial |
$20,076.00
|
| Rate for Payer: Cigna of CA PPO |
$18,570.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Media |
$6,866.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$21,330.75
|
| Rate for Payer: Global Benefits Group Commercial |
$15,057.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,585.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18,821.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,260.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,329.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: InnovAge PACE Commercial |
$10,299.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,738.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$533.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,019.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,200.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$18,821.25
|
| Rate for Payer: Networks By Design Commercial |
$16,311.75
|
| Rate for Payer: Prime Health Services Commercial |
$21,330.75
|
| Rate for Payer: Prime Health Services Medicare |
$7,278.03
|
| Rate for Payer: Riverside University Health System MISP |
$7,552.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,057.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
