|
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 |
$27.50
|
| 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 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 |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| 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 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 |
$2,613.05
|
| Rate for Payer: Cash Price |
$2,613.05
|
| 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 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 |
$2,613.05
|
| 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 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 |
$1,675.30
|
| Rate for Payer: Cash Price |
$1,675.30
|
| 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 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 |
$1,675.30
|
| 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 |
$1,675.30
|
| Rate for Payer: Cash Price |
$1,675.30
|
| 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 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 |
$1,675.30
|
| 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 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 |
$3,193.85
|
| 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 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 |
$3,193.85
|
| Rate for Payer: Cash Price |
$3,193.85
|
| 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 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 |
$1,477.30
|
| 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 |
$1,477.30
|
| Rate for Payer: Cash Price |
$1,477.30
|
| Rate for Payer: Cash Price |
$1,477.30
|
| 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
|
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 |
$1,675.30
|
| Rate for Payer: Cash Price |
$1,675.30
|
| Rate for Payer: Cash Price |
$1,675.30
|
| 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 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 |
$1,675.30
|
| 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 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 |
$80.85
|
| Rate for Payer: Cash Price |
$80.85
|
| 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 |
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 |
$80.85
|
| 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 |
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 |
$80.85
|
| 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 |
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 |
$80.85
|
| Rate for Payer: Cash Price |
$80.85
|
| 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
|
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 |
$48.40
|
| Rate for Payer: Cash Price |
$48.40
|
| 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
|
|
|
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 |
$48.40
|
| 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 THIN-PREP, PG
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
903800213
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$208.80 |
| Rate for Payer: Adventist Health Commercial |
$46.40
|
| Rate for Payer: Cash Price |
$127.60
|
| Rate for Payer: Central Health Plan Commercial |
$185.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.80
|
| Rate for Payer: EPIC Health Plan Senior |
$92.80
|
| Rate for Payer: Galaxy Health WC |
$197.20
|
| Rate for Payer: Global Benefits Group Commercial |
$139.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$208.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.40
|
| Rate for Payer: Multiplan Commercial |
$174.00
|
| Rate for Payer: Networks By Design Commercial |
$150.80
|
| Rate for Payer: Prime Health Services Commercial |
$197.20
|
|
|
HC NON-GYN THIN-PREP, PG
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
903800213
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$321.63 |
| Rate for Payer: Adventist Health Commercial |
$46.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$67.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$140.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$321.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.28
|
| Rate for Payer: Blue Shield of California Commercial |
$140.82
|
| Rate for Payer: Blue Shield of California EPN |
$92.10
|
| Rate for Payer: Cash Price |
$127.60
|
| Rate for Payer: Cash Price |
$127.60
|
| Rate for Payer: Central Health Plan Commercial |
$185.60
|
| Rate for Payer: Cigna of CA HMO |
$148.48
|
| Rate for Payer: Cigna of CA PPO |
$171.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.65
|
| Rate for Payer: EPIC Health Plan Senior |
$67.89
|
| Rate for Payer: Galaxy Health WC |
$197.20
|
| Rate for Payer: Global Benefits Group Commercial |
$139.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$208.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$111.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$104.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.89
|
| Rate for Payer: InnovAge PACE Commercial |
$101.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.97
|
| Rate for Payer: Multiplan Commercial |
$174.00
|
| Rate for Payer: Networks By Design Commercial |
$150.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$67.89
|
| Rate for Payer: Prime Health Services Commercial |
$197.20
|
| Rate for Payer: Prime Health Services Medicare |
$71.96
|
| Rate for Payer: Riverside University Health System MISP |
$74.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
|
HC NON INVS DET HRT FAIL AUG ECHO
|
Facility
|
IP
|
$1,109.00
|
|
|
Service Code
|
CPT 0932T
|
| Hospital Charge Code |
906811516
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$221.80 |
| Max. Negotiated Rate |
$998.10 |
| Rate for Payer: Adventist Health Commercial |
$221.80
|
| Rate for Payer: Cash Price |
$609.95
|
| Rate for Payer: Central Health Plan Commercial |
$887.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$443.60
|
| Rate for Payer: EPIC Health Plan Senior |
$443.60
|
| Rate for Payer: Galaxy Health WC |
$942.65
|
| Rate for Payer: Global Benefits Group Commercial |
$665.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$998.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$739.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$422.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$686.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.80
|
| Rate for Payer: Multiplan Commercial |
$831.75
|
| Rate for Payer: Networks By Design Commercial |
$720.85
|
| Rate for Payer: Prime Health Services Commercial |
$942.65
|
|
|
HC NON INVS DET HRT FAIL AUG ECHO
|
Facility
|
OP
|
$1,109.00
|
|
|
Service Code
|
CPT 0932T
|
| Hospital Charge Code |
906811516
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$221.80 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$221.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$381.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$673.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$571.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$419.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$381.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$536.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$651.32
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$609.95
|
| Rate for Payer: Cash Price |
$609.95
|
| Rate for Payer: Cash Price |
$609.95
|
| Rate for Payer: Central Health Plan Commercial |
$887.20
|
| Rate for Payer: Cigna of CA HMO |
$709.76
|
| Rate for Payer: Cigna of CA PPO |
$820.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$571.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$419.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$381.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$514.44
|
| Rate for Payer: EPIC Health Plan Senior |
$381.07
|
| Rate for Payer: Galaxy Health WC |
$942.65
|
| Rate for Payer: Global Benefits Group Commercial |
$665.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$998.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$624.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$381.07
|
| Rate for Payer: InnovAge PACE Commercial |
$571.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$739.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$422.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$381.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$510.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$510.63
|
| Rate for Payer: Multiplan Commercial |
$831.75
|
| Rate for Payer: Networks By Design Commercial |
$720.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$381.07
|
| Rate for Payer: Prime Health Services Commercial |
$942.65
|
| Rate for Payer: Prime Health Services Medicare |
$403.93
|
| Rate for Payer: Riverside University Health System MISP |
$419.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$665.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$665.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$381.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$571.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$419.18
|
| Rate for Payer: Vantage Medical Group Senior |
$381.07
|
|
|
HC NON-MOLDED LACER KAFO ADDITION LE
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT L2320
|
| Hospital Charge Code |
905352320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Blue Shield of California Commercial |
$417.42
|
| Rate for Payer: Blue Shield of California EPN |
$272.16
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Central Health Plan Commercial |
$432.00
|
| Rate for Payer: Cigna of CA HMO |
$378.00
|
| Rate for Payer: Cigna of CA PPO |
$378.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Senior |
$216.00
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$202.66
|
| Rate for Payer: United Healthcare All Other HMO |
$197.26
|
| Rate for Payer: United Healthcare HMO Rider |
$193.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.85
|
|
