|
HC NITRIC OXIDE EXPIRED GAS
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 95012
|
| Hospital Charge Code |
900801050
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.60
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
|
|
HC NITRIC OXIDE/HELIOX THRPY PER DAY
|
Facility
|
IP
|
$3,537.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800400
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$707.40 |
| Max. Negotiated Rate |
$3,183.30 |
| Rate for Payer: Adventist Health Commercial |
$707.40
|
| Rate for Payer: Cash Price |
$1,591.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,829.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,414.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,414.80
|
| Rate for Payer: Galaxy Health WC |
$3,006.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,122.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,183.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,359.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,347.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,189.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.40
|
| Rate for Payer: Multiplan Commercial |
$2,652.75
|
| Rate for Payer: Networks By Design Commercial |
$2,299.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,006.45
|
|
|
HC NITRIC OXIDE/HELIOX THRPY PER DAY
|
Facility
|
OP
|
$3,537.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800400
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$3,183.30 |
| Rate for Payer: Adventist Health Commercial |
$707.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,148.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,712.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,077.28
|
| Rate for Payer: Blue Shield of California Commercial |
$2,146.96
|
| Rate for Payer: Blue Shield of California EPN |
$1,404.19
|
| Rate for Payer: Cash Price |
$1,591.65
|
| Rate for Payer: Cash Price |
$1,591.65
|
| Rate for Payer: Cash Price |
$1,591.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,829.60
|
| Rate for Payer: Cigna of CA HMO |
$2,263.68
|
| Rate for Payer: Cigna of CA PPO |
$2,617.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$3,006.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,122.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,183.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,359.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$2,652.75
|
| Rate for Payer: Networks By Design Commercial |
$2,299.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,006.45
|
| Rate for Payer: Prime Health Services Medicare |
$210.73
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,122.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,122.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC NK CELLS TOTAL COUNTCD16+56
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
903900106
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$95.20 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Adventist Health Commercial |
$95.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Central Health Plan Commercial |
$380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.40
|
| Rate for Payer: EPIC Health Plan Senior |
$190.40
|
| Rate for Payer: Galaxy Health WC |
$404.60
|
| Rate for Payer: Global Benefits Group Commercial |
$285.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$428.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$317.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.20
|
| Rate for Payer: Multiplan Commercial |
$357.00
|
| Rate for Payer: Networks By Design Commercial |
$309.40
|
| Rate for Payer: Prime Health Services Commercial |
$404.60
|
|
|
HC NK CELLS TOTAL COUNTCD16+56
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
903900106
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$268.44 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$86.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$268.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.48
|
| Rate for Payer: Blue Shield of California Commercial |
$86.19
|
| Rate for Payer: Blue Shield of California EPN |
$56.37
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Central Health Plan Commercial |
$113.60
|
| Rate for Payer: Cigna of CA HMO |
$90.88
|
| Rate for Payer: Cigna of CA PPO |
$105.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.94
|
| Rate for Payer: EPIC Health Plan Senior |
$37.73
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: InnovAge PACE Commercial |
$56.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.73
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Prime Health Services Medicare |
$39.99
|
| Rate for Payer: Riverside University Health System MISP |
$41.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.56
|
| Rate for Payer: United Healthcare All Other HMO |
$30.56
|
| Rate for Payer: United Healthcare HMO Rider |
$30.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC NMIC306
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.92
|
| Rate for Payer: Blue Shield of California Commercial |
$30.35
|
| Rate for Payer: Blue Shield of California EPN |
$19.85
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: InnovAge PACE Commercial |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.08
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$8.56
|
| Rate for Payer: Riverside University Health System MISP |
$8.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC NMIC306
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC NM MYCRD IMG PET RST & STRS CT
|
Facility
|
IP
|
$4,751.00
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
909308431
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$950.20 |
| Max. Negotiated Rate |
$4,275.90 |
| Rate for Payer: Adventist Health Commercial |
$950.20
|
| Rate for Payer: Cash Price |
$2,137.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,800.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,900.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,900.40
|
| Rate for Payer: Galaxy Health WC |
$4,038.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,850.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,275.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,168.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,810.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,940.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$950.20
|
| Rate for Payer: Multiplan Commercial |
$3,563.25
|
| Rate for Payer: Networks By Design Commercial |
$3,088.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,038.35
|
|
|
HC NM MYCRD IMG PET RST & STRS CT
|
Facility
|
OP
|
$4,751.00
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
909308431
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$137.72 |
| Max. Negotiated Rate |
$5,761.28 |
| Rate for Payer: Adventist Health Commercial |
$950.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,859.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,885.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,289.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,145.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,859.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$475.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,790.26
|
| Rate for Payer: Blue Shield of California Commercial |
$2,883.86
|
| Rate for Payer: Blue Shield of California EPN |
$1,886.15
|
| Rate for Payer: Cash Price |
$2,137.95
|
| Rate for Payer: Cash Price |
$2,137.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,800.80
|
| Rate for Payer: Cigna of CA HMO |
$3,040.64
|
| Rate for Payer: Cigna of CA PPO |
$3,515.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,289.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,145.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,859.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,860.31
|
| Rate for Payer: EPIC Health Plan Senior |
$2,859.49
|
| Rate for Payer: Galaxy Health WC |
$4,038.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,850.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,275.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,689.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$137.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,859.49
|
| Rate for Payer: InnovAge PACE Commercial |
$4,289.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,168.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,859.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$950.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,831.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,831.72
|
| Rate for Payer: Multiplan Commercial |
$3,563.25
|
| Rate for Payer: Networks By Design Commercial |
$3,088.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,859.49
|
| Rate for Payer: Prime Health Services Commercial |
$4,038.35
|
| Rate for Payer: Prime Health Services Medicare |
$3,031.06
|
| Rate for Payer: Riverside University Health System MISP |
$3,145.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,850.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,850.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,761.28
|
| Rate for Payer: United Healthcare All Other HMO |
$5,761.28
|
| Rate for Payer: United Healthcare HMO Rider |
$5,761.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,761.28
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,859.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,289.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,145.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,859.49
|
|
|
HC NM MYCRD IMG PET RST/STRS W/CT
|
Facility
|
IP
|
$3,046.00
|
|
|
Service Code
|
CPT 78430
|
| Hospital Charge Code |
909308430
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$609.20 |
| Max. Negotiated Rate |
$2,741.40 |
| Rate for Payer: Adventist Health Commercial |
$609.20
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,436.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,218.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,218.40
|
| Rate for Payer: Galaxy Health WC |
$2,589.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,827.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,741.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,031.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,160.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,885.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$609.20
|
| Rate for Payer: Multiplan Commercial |
$2,284.50
|
| Rate for Payer: Networks By Design Commercial |
$1,979.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,589.10
|
|
|
HC NM MYCRD IMG PET RST/STRS W/CT
|
Facility
|
OP
|
$3,046.00
|
|
|
Service Code
|
CPT 78430
|
| Hospital Charge Code |
909308430
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$118.27 |
| Max. Negotiated Rate |
$3,694.08 |
| Rate for Payer: Adventist Health Commercial |
$609.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,853.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,849.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,853.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$408.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,788.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1,848.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,209.26
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,436.80
|
| Rate for Payer: Cigna of CA HMO |
$1,949.44
|
| Rate for Payer: Cigna of CA PPO |
$2,254.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,038.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,853.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,501.93
|
| Rate for Payer: EPIC Health Plan Senior |
$1,853.28
|
| Rate for Payer: Galaxy Health WC |
$2,589.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,827.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,741.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,039.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$118.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: InnovAge PACE Commercial |
$2,779.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,031.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,853.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$609.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,483.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,483.40
|
| Rate for Payer: Multiplan Commercial |
$2,284.50
|
| Rate for Payer: Networks By Design Commercial |
$1,979.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,853.28
|
| Rate for Payer: Prime Health Services Commercial |
$2,589.10
|
| Rate for Payer: Prime Health Services Medicare |
$1,964.48
|
| Rate for Payer: Riverside University Health System MISP |
$2,038.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,827.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,827.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,694.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3,694.08
|
| Rate for Payer: United Healthcare HMO Rider |
$3,694.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,694.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,853.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,853.28
|
|
|
HC NM MYOCRD IMG PET 1 STUDY W/CT
|
Facility
|
IP
|
$3,046.00
|
|
|
Service Code
|
CPT 78429
|
| Hospital Charge Code |
909308429
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$609.20 |
| Max. Negotiated Rate |
$2,741.40 |
| Rate for Payer: Adventist Health Commercial |
$609.20
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,436.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,218.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,218.40
|
| Rate for Payer: Galaxy Health WC |
$2,589.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,827.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,741.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,031.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,160.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,885.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$609.20
|
| Rate for Payer: Multiplan Commercial |
$2,284.50
|
| Rate for Payer: Networks By Design Commercial |
$1,979.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,589.10
|
|
|
HC NM MYOCRD IMG PET 1 STUDY W/CT
|
Facility
|
OP
|
$3,046.00
|
|
|
Service Code
|
CPT 78429
|
| Hospital Charge Code |
909308429
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$124.65 |
| Max. Negotiated Rate |
$3,694.08 |
| Rate for Payer: Adventist Health Commercial |
$609.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,853.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,849.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,853.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$431.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,788.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1,848.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,209.26
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,436.80
|
| Rate for Payer: Cigna of CA HMO |
$1,949.44
|
| Rate for Payer: Cigna of CA PPO |
$2,254.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,038.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,853.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,501.93
|
| Rate for Payer: EPIC Health Plan Senior |
$1,853.28
|
| Rate for Payer: Galaxy Health WC |
$2,589.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,827.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,741.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,039.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$124.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: InnovAge PACE Commercial |
$2,779.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,031.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,853.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$609.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,483.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,483.40
|
| Rate for Payer: Multiplan Commercial |
$2,284.50
|
| Rate for Payer: Networks By Design Commercial |
$1,979.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,853.28
|
| Rate for Payer: Prime Health Services Commercial |
$2,589.10
|
| Rate for Payer: Prime Health Services Medicare |
$1,964.48
|
| Rate for Payer: Riverside University Health System MISP |
$2,038.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,827.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,827.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,694.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3,694.08
|
| Rate for Payer: United Healthcare HMO Rider |
$3,694.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,694.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,853.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,853.28
|
|
|
HC NM MYOCRD IMG PET DUAL TRCR CT
|
Facility
|
OP
|
$5,807.00
|
|
|
Service Code
|
CPT 78433
|
| Hospital Charge Code |
909308433
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$160.11 |
| Max. Negotiated Rate |
$7,041.28 |
| Rate for Payer: Adventist Health Commercial |
$1,161.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,478.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,526.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,717.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,726.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,478.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$553.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,410.45
|
| Rate for Payer: Blue Shield of California Commercial |
$3,524.85
|
| Rate for Payer: Blue Shield of California EPN |
$2,305.38
|
| Rate for Payer: Cash Price |
$2,613.15
|
| Rate for Payer: Cash Price |
$2,613.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,645.60
|
| Rate for Payer: Cigna of CA HMO |
$3,716.48
|
| Rate for Payer: Cigna of CA PPO |
$4,297.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,717.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,726.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,478.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,345.72
|
| Rate for Payer: EPIC Health Plan Senior |
$2,478.31
|
| Rate for Payer: Galaxy Health WC |
$4,935.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,484.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,226.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,064.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$160.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,478.31
|
| Rate for Payer: InnovAge PACE Commercial |
$3,717.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,873.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,478.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,320.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,320.94
|
| Rate for Payer: Multiplan Commercial |
$4,355.25
|
| Rate for Payer: Networks By Design Commercial |
$3,774.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,478.31
|
| Rate for Payer: Prime Health Services Commercial |
$4,935.95
|
| Rate for Payer: Prime Health Services Medicare |
$2,627.01
|
| Rate for Payer: Riverside University Health System MISP |
$2,726.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,484.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,484.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,041.28
|
| Rate for Payer: United Healthcare All Other HMO |
$7,041.28
|
| Rate for Payer: United Healthcare HMO Rider |
$7,041.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,041.28
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,478.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,717.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,726.14
|
| Rate for Payer: Vantage Medical Group Senior |
$2,478.31
|
|
|
HC NM MYOCRD IMG PET DUAL TRCR CT
|
Facility
|
IP
|
$5,807.00
|
|
|
Service Code
|
CPT 78433
|
| Hospital Charge Code |
909308433
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,161.40 |
| Max. Negotiated Rate |
$5,226.30 |
| Rate for Payer: Adventist Health Commercial |
$1,161.40
|
| Rate for Payer: Cash Price |
$2,613.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,645.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,322.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,322.80
|
| Rate for Payer: Galaxy Health WC |
$4,935.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,484.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,226.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,873.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,212.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,594.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.40
|
| Rate for Payer: Multiplan Commercial |
$4,355.25
|
| Rate for Payer: Networks By Design Commercial |
$3,774.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,935.95
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 1
|
Facility
|
IP
|
$2,686.00
|
|
|
Service Code
|
CPT 78830
|
| Hospital Charge Code |
909308830
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$537.20 |
| Max. Negotiated Rate |
$2,417.40 |
| Rate for Payer: Adventist Health Commercial |
$537.20
|
| Rate for Payer: Cash Price |
$1,208.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,148.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,074.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,074.40
|
| Rate for Payer: Galaxy Health WC |
$2,283.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,611.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,417.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,791.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,023.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,662.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.20
|
| Rate for Payer: Multiplan Commercial |
$2,014.50
|
| Rate for Payer: Networks By Design Commercial |
$1,745.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,283.10
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 1
|
Facility
|
OP
|
$2,686.00
|
|
|
Service Code
|
CPT 78830
|
| Hospital Charge Code |
909308830
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$537.20 |
| Max. Negotiated Rate |
$3,256.45 |
| Rate for Payer: Adventist Health Commercial |
$537.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,658.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,658.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,975.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,577.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1,630.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,066.34
|
| Rate for Payer: Cash Price |
$1,208.70
|
| Rate for Payer: Cash Price |
$1,208.70
|
| Rate for Payer: Cash Price |
$1,208.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,148.80
|
| Rate for Payer: Cigna of CA HMO |
$1,719.04
|
| Rate for Payer: Cigna of CA PPO |
$1,987.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,824.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,658.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,239.30
|
| Rate for Payer: EPIC Health Plan Senior |
$1,658.74
|
| Rate for Payer: Galaxy Health WC |
$2,283.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,611.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,417.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,720.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$743.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,658.74
|
| Rate for Payer: InnovAge PACE Commercial |
$2,488.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,791.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$821.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,658.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,222.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,222.71
|
| Rate for Payer: Multiplan Commercial |
$2,014.50
|
| Rate for Payer: Networks By Design Commercial |
$1,745.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,658.74
|
| Rate for Payer: Prime Health Services Commercial |
$2,283.10
|
| Rate for Payer: Prime Health Services Medicare |
$1,758.26
|
| Rate for Payer: Riverside University Health System MISP |
$1,824.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,611.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,611.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,256.45
|
| Rate for Payer: United Healthcare All Other HMO |
$3,256.45
|
| Rate for Payer: United Healthcare HMO Rider |
$3,256.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,256.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,658.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,658.74
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 2
|
Facility
|
IP
|
$3,046.00
|
|
|
Service Code
|
CPT 78832
|
| Hospital Charge Code |
909308832
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$609.20 |
| Max. Negotiated Rate |
$2,741.40 |
| Rate for Payer: Adventist Health Commercial |
$609.20
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,436.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,218.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,218.40
|
| Rate for Payer: Galaxy Health WC |
$2,589.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,827.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,741.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,031.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,160.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,885.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$609.20
|
| Rate for Payer: Multiplan Commercial |
$2,284.50
|
| Rate for Payer: Networks By Design Commercial |
$1,979.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,589.10
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 2
|
Facility
|
OP
|
$3,046.00
|
|
|
Service Code
|
CPT 78832
|
| Hospital Charge Code |
909308832
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$609.20 |
| Max. Negotiated Rate |
$5,833.65 |
| Rate for Payer: Adventist Health Commercial |
$609.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,853.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,853.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,833.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,788.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1,848.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,209.26
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,436.80
|
| Rate for Payer: Cigna of CA HMO |
$1,949.44
|
| Rate for Payer: Cigna of CA PPO |
$2,254.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,038.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,853.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,501.93
|
| Rate for Payer: EPIC Health Plan Senior |
$1,853.28
|
| Rate for Payer: Galaxy Health WC |
$2,589.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,827.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,741.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,039.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,415.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: InnovAge PACE Commercial |
$2,779.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,031.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,563.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,853.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$609.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,483.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,483.40
|
| Rate for Payer: Multiplan Commercial |
$2,284.50
|
| Rate for Payer: Networks By Design Commercial |
$1,979.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,853.28
|
| Rate for Payer: Prime Health Services Commercial |
$2,589.10
|
| Rate for Payer: Prime Health Services Medicare |
$1,964.48
|
| Rate for Payer: Riverside University Health System MISP |
$2,038.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,827.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,827.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,694.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3,694.08
|
| Rate for Payer: United Healthcare HMO Rider |
$3,694.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,694.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,853.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,853.28
|
|
|
HC NON-CORROSIVE FINISH PER BAR
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT L2780
|
| Hospital Charge Code |
905352780
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.14 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Adventist Health Commercial |
$60.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.33
|
| Rate for Payer: Blue Shield of California Commercial |
$113.63
|
| Rate for Payer: Blue Shield of California EPN |
$74.09
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Central Health Plan Commercial |
$117.60
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$124.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$132.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$68.92
|
| Rate for Payer: InnovAge PACE Commercial |
$73.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.90
|
| Rate for Payer: Multiplan Commercial |
$110.25
|
| Rate for Payer: Networks By Design Commercial |
$73.50
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: Riverside University Health System MISP |
$58.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other HMO |
$53.70
|
| Rate for Payer: United Healthcare HMO Rider |
$52.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.95
|
| Rate for Payer: Vantage Medical Group Senior |
$124.95
|
|
|
HC NON-CORROSIVE FINISH PER BAR
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT L2780
|
| Hospital Charge Code |
905352780
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Adventist Health Commercial |
$29.40
|
| Rate for Payer: Blue Shield of California Commercial |
$113.63
|
| Rate for Payer: Blue Shield of California EPN |
$74.09
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Central Health Plan Commercial |
$117.60
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$132.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.40
|
| Rate for Payer: Multiplan Commercial |
$110.25
|
| Rate for Payer: Networks By Design Commercial |
$95.55
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other HMO |
$53.70
|
| Rate for Payer: United Healthcare HMO Rider |
$52.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.14
|
|
|
HC NON-CORROSIVE FINISH PER BAR
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT L2780
|
| Hospital Charge Code |
915352780
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Adventist Health Commercial |
$29.40
|
| Rate for Payer: Blue Shield of California Commercial |
$113.63
|
| Rate for Payer: Blue Shield of California EPN |
$74.09
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Central Health Plan Commercial |
$117.60
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$132.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.40
|
| Rate for Payer: Multiplan Commercial |
$110.25
|
| Rate for Payer: Networks By Design Commercial |
$95.55
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other HMO |
$53.70
|
| Rate for Payer: United Healthcare HMO Rider |
$52.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.14
|
|
|
HC NON-CORROSIVE FINISH PER BAR
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT L2780
|
| Hospital Charge Code |
915352780
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.14 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Adventist Health Commercial |
$60.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.33
|
| Rate for Payer: Blue Shield of California Commercial |
$113.63
|
| Rate for Payer: Blue Shield of California EPN |
$74.09
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Central Health Plan Commercial |
$117.60
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$124.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$132.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$68.92
|
| Rate for Payer: InnovAge PACE Commercial |
$73.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.90
|
| Rate for Payer: Multiplan Commercial |
$110.25
|
| Rate for Payer: Networks By Design Commercial |
$73.50
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: Riverside University Health System MISP |
$58.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other HMO |
$53.70
|
| Rate for Payer: United Healthcare HMO Rider |
$52.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.95
|
| Rate for Payer: Vantage Medical Group Senior |
$124.95
|
|
|
HC NON-GYN FLUID WASH BRUSH PG
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
903800214
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
|
|
HC NON-GYN FLUID WASH BRUSH PG
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
903800214
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$81.79 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$49.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.36
|
| Rate for Payer: Blue Shield of California Commercial |
$53.42
|
| Rate for Payer: Blue Shield of California EPN |
$34.94
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: Cigna of CA HMO |
$56.32
|
| Rate for Payer: Cigna of CA PPO |
$65.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.32
|
| Rate for Payer: EPIC Health Plan Senior |
$49.87
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$81.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.87
|
| Rate for Payer: InnovAge PACE Commercial |
$74.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.83
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$49.87
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Prime Health Services Medicare |
$52.86
|
| Rate for Payer: Riverside University Health System MISP |
$54.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$49.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Vantage Medical Group Senior |
$49.87
|
|
