|
HC NM MYCRD IMG PET RST & STRS CT
|
Facility
|
IP
|
$5,883.00
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
909308431
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,176.60 |
| Max. Negotiated Rate |
$5,294.70 |
| Rate for Payer: Cash Price |
$2,647.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,706.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,353.20
|
| Rate for Payer: Galaxy Health WC |
$5,000.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,529.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,294.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,923.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,241.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,176.60
|
| Rate for Payer: Multiplan Commercial |
$4,412.25
|
| Rate for Payer: Networks By Design Commercial |
$3,823.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,000.55
|
|
|
HC NM MYCRD IMG PET RST & STRS CT
|
Facility
|
OP
|
$5,883.00
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
909308431
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$152.19 |
| Max. Negotiated Rate |
$9,203.55 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,951.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,203.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,426.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,246.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,951.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$475.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,475.68
|
| Rate for Payer: Blue Distinction Transplant |
$3,529.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,635.69
|
| Rate for Payer: Blue Shield of California EPN |
$2,859.14
|
| Rate for Payer: Caremore Medicare Advantage |
$2,951.17
|
| Rate for Payer: Cash Price |
$2,647.35
|
| Rate for Payer: Cash Price |
$2,647.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,706.40
|
| Rate for Payer: Cigna of CA HMO |
$3,765.12
|
| Rate for Payer: Cigna of CA PPO |
$4,353.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,426.76
|
| Rate for Payer: Dignity Health Media |
$2,951.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,246.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,984.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,951.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,951.17
|
| Rate for Payer: Galaxy Health WC |
$5,000.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,529.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,294.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,412.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,839.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,869.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,951.17
|
| Rate for Payer: InnovAge PACE Commercial |
$4,426.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,923.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,951.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,176.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,954.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,954.57
|
| Rate for Payer: Multiplan Commercial |
$4,412.25
|
| Rate for Payer: Networks By Design Commercial |
$3,823.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,000.55
|
| Rate for Payer: Prime Health Services Medicare |
$3,128.24
|
| Rate for Payer: Riverside University Health System MISP |
$3,246.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,529.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,529.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$4,426.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,246.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2,951.17
|
|
|
HC NM MYCRD IMG PET RST/STRS W/CT
|
Facility
|
IP
|
$3,772.00
|
|
|
Service Code
|
CPT 78430
|
| Hospital Charge Code |
909308430
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$754.40 |
| Max. Negotiated Rate |
$3,394.80 |
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,017.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,508.80
|
| Rate for Payer: Galaxy Health WC |
$3,206.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,263.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,394.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,515.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,437.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$754.40
|
| Rate for Payer: Multiplan Commercial |
$2,829.00
|
| Rate for Payer: Networks By Design Commercial |
$2,451.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,206.20
|
|
|
HC NM MYCRD IMG PET RST/STRS W/CT
|
Facility
|
OP
|
$3,772.00
|
|
|
Service Code
|
CPT 78430
|
| Hospital Charge Code |
909308430
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$130.68 |
| Max. Negotiated Rate |
$9,203.55 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,954.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,203.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,954.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$408.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,228.50
|
| Rate for Payer: Blue Distinction Transplant |
$2,263.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,331.10
|
| Rate for Payer: Blue Shield of California EPN |
$1,833.19
|
| Rate for Payer: Caremore Medicare Advantage |
$1,954.68
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,017.60
|
| Rate for Payer: Cigna of CA HMO |
$2,414.08
|
| Rate for Payer: Cigna of CA PPO |
$2,791.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Dignity Health Media |
$1,954.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,638.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,954.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,954.68
|
| Rate for Payer: Galaxy Health WC |
$3,206.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,263.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,394.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,829.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,205.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,225.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,954.68
|
| Rate for Payer: InnovAge PACE Commercial |
$2,932.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,515.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,954.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$754.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,619.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,619.27
|
| Rate for Payer: Multiplan Commercial |
$2,829.00
|
| Rate for Payer: Networks By Design Commercial |
$2,451.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,206.20
|
| Rate for Payer: Prime Health Services Medicare |
$2,071.96
|
| Rate for Payer: Riverside University Health System MISP |
$2,150.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,263.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,263.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,954.68
|
|
|
HC NM MYOCRD IMG PET 1 STUDY W/CT
|
Facility
|
OP
|
$3,772.00
|
|
|
Service Code
|
CPT 78429
|
| Hospital Charge Code |
909308429
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$137.75 |
| Max. Negotiated Rate |
$9,203.55 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,954.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,203.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,954.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$431.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,228.50
|
| Rate for Payer: Blue Distinction Transplant |
$2,263.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,331.10
|
| Rate for Payer: Blue Shield of California EPN |
$1,833.19
|
| Rate for Payer: Caremore Medicare Advantage |
$1,954.68
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,017.60
|
| Rate for Payer: Cigna of CA HMO |
$2,414.08
|
| Rate for Payer: Cigna of CA PPO |
$2,791.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Dignity Health Media |
$1,954.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,638.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,954.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,954.68
|
| Rate for Payer: Galaxy Health WC |
$3,206.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,263.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,394.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,829.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,205.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,225.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,954.68
|
| Rate for Payer: InnovAge PACE Commercial |
$2,932.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,515.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,954.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$754.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,619.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,619.27
|
| Rate for Payer: Multiplan Commercial |
$2,829.00
|
| Rate for Payer: Networks By Design Commercial |
$2,451.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,206.20
|
| Rate for Payer: Prime Health Services Medicare |
$2,071.96
|
| Rate for Payer: Riverside University Health System MISP |
$2,150.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,263.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,263.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,954.68
|
|
|
HC NM MYOCRD IMG PET 1 STUDY W/CT
|
Facility
|
IP
|
$3,772.00
|
|
|
Service Code
|
CPT 78429
|
| Hospital Charge Code |
909308429
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$754.40 |
| Max. Negotiated Rate |
$3,394.80 |
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,017.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,508.80
|
| Rate for Payer: Galaxy Health WC |
$3,206.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,263.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,394.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,515.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,437.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$754.40
|
| Rate for Payer: Multiplan Commercial |
$2,829.00
|
| Rate for Payer: Networks By Design Commercial |
$2,451.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,206.20
|
|
|
HC NM MYOCRD IMG PET DUAL TRCR CT
|
Facility
|
IP
|
$7,192.00
|
|
|
Service Code
|
CPT 78433
|
| Hospital Charge Code |
909308433
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,438.40 |
| Max. Negotiated Rate |
$6,472.80 |
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,753.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,876.80
|
| Rate for Payer: Galaxy Health WC |
$6,113.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,472.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,797.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,740.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,438.40
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
| Rate for Payer: Networks By Design Commercial |
$4,674.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,113.20
|
|
|
HC NM MYOCRD IMG PET DUAL TRCR CT
|
Facility
|
OP
|
$7,192.00
|
|
|
Service Code
|
CPT 78433
|
| Hospital Charge Code |
909308433
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$176.95 |
| Max. Negotiated Rate |
$9,203.55 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,557.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,203.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,836.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,813.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,557.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$553.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,249.03
|
| Rate for Payer: Blue Distinction Transplant |
$4,315.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,444.66
|
| Rate for Payer: Blue Shield of California EPN |
$3,495.31
|
| Rate for Payer: Caremore Medicare Advantage |
$2,557.77
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,753.60
|
| Rate for Payer: Cigna of CA HMO |
$4,602.88
|
| Rate for Payer: Cigna of CA PPO |
$5,322.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,836.66
|
| Rate for Payer: Dignity Health Media |
$2,557.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,813.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,452.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,557.77
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,557.77
|
| Rate for Payer: Galaxy Health WC |
$6,113.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,472.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,394.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,194.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,220.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,557.77
|
| Rate for Payer: InnovAge PACE Commercial |
$3,836.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,797.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,557.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,438.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,427.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,427.41
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
| Rate for Payer: Networks By Design Commercial |
$4,674.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,113.20
|
| Rate for Payer: Prime Health Services Medicare |
$2,711.24
|
| Rate for Payer: Riverside University Health System MISP |
$2,813.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,315.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,315.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$3,836.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,813.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,557.77
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 1
|
Facility
|
IP
|
$3,326.00
|
|
|
Service Code
|
CPT 78830
|
| Hospital Charge Code |
909308830
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$665.20 |
| Max. Negotiated Rate |
$2,993.40 |
| Rate for Payer: Cash Price |
$1,496.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,660.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,330.40
|
| Rate for Payer: Galaxy Health WC |
$2,827.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,995.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,993.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,218.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,267.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.20
|
| Rate for Payer: Multiplan Commercial |
$2,494.50
|
| Rate for Payer: Networks By Design Commercial |
$2,161.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,827.10
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 1
|
Facility
|
OP
|
$3,326.00
|
|
|
Service Code
|
CPT 78830
|
| Hospital Charge Code |
909308830
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$665.20 |
| Max. Negotiated Rate |
$3,256.45 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,774.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,975.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,965.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,995.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,055.47
|
| Rate for Payer: Blue Shield of California EPN |
$1,616.44
|
| Rate for Payer: Caremore Medicare Advantage |
$1,774.15
|
| Rate for Payer: Cash Price |
$1,496.70
|
| Rate for Payer: Cash Price |
$1,496.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,660.80
|
| Rate for Payer: Cigna of CA HMO |
$2,128.64
|
| Rate for Payer: Cigna of CA PPO |
$2,461.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Dignity Health Media |
$1,774.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,395.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,774.15
|
| Rate for Payer: Galaxy Health WC |
$2,827.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,995.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,993.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,494.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,909.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,927.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,774.15
|
| Rate for Payer: InnovAge PACE Commercial |
$2,661.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,218.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$821.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,774.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,377.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,377.36
|
| Rate for Payer: Multiplan Commercial |
$2,494.50
|
| Rate for Payer: Networks By Design Commercial |
$2,161.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,827.10
|
| Rate for Payer: Prime Health Services Medicare |
$1,880.60
|
| Rate for Payer: Riverside University Health System MISP |
$1,951.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,995.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,995.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 2
|
Facility
|
IP
|
$3,772.00
|
|
|
Service Code
|
CPT 78832
|
| Hospital Charge Code |
909308832
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$754.40 |
| Max. Negotiated Rate |
$3,394.80 |
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,017.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,508.80
|
| Rate for Payer: Galaxy Health WC |
$3,206.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,263.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,394.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,515.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,437.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$754.40
|
| Rate for Payer: Multiplan Commercial |
$2,829.00
|
| Rate for Payer: Networks By Design Commercial |
$2,451.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,206.20
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 2
|
Facility
|
OP
|
$3,772.00
|
|
|
Service Code
|
CPT 78832
|
| Hospital Charge Code |
909308832
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$754.40 |
| Max. Negotiated Rate |
$5,833.65 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,954.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,954.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,833.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,228.50
|
| Rate for Payer: Blue Distinction Transplant |
$2,263.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,331.10
|
| Rate for Payer: Blue Shield of California EPN |
$1,833.19
|
| Rate for Payer: Caremore Medicare Advantage |
$1,954.68
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,017.60
|
| Rate for Payer: Cigna of CA HMO |
$2,414.08
|
| Rate for Payer: Cigna of CA PPO |
$2,791.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Dignity Health Media |
$1,954.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,638.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,954.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,954.68
|
| Rate for Payer: Galaxy Health WC |
$3,206.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,263.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,394.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,829.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,205.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,225.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,954.68
|
| Rate for Payer: InnovAge PACE Commercial |
$2,932.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,515.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,563.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,954.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$754.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,619.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,619.27
|
| Rate for Payer: Multiplan Commercial |
$2,829.00
|
| Rate for Payer: Networks By Design Commercial |
$2,451.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,206.20
|
| Rate for Payer: Prime Health Services Medicare |
$2,071.96
|
| Rate for Payer: Riverside University Health System MISP |
$2,150.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,263.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,263.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,954.68
|
|
|
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: Blue Shield of California EPN |
$78.50
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$29.40
|
| 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: United Healthcare All Other Commercial |
$55.51
|
| Rate for Payer: United Healthcare All Other HMO |
$54.21
|
| Rate for Payer: United Healthcare HMO Rider |
$53.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.51
|
|
|
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 |
$51.45 |
| Max. Negotiated Rate |
$132.30 |
| 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 |
$80.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.85
|
| Rate for Payer: Blue Distinction Transplant |
$88.20
|
| Rate for Payer: Blue Shield of California Commercial |
$110.25
|
| Rate for Payer: Blue Shield of California EPN |
$79.97
|
| 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 Media |
$124.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$110.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.45
|
| 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: LLUH Dept of Risk Management WC |
$60.27
|
| 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 |
$73.50
|
| Rate for Payer: United Healthcare All Other HMO |
$73.50
|
| Rate for Payer: United Healthcare HMO Rider |
$73.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.50
|
| 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
|
$90.00
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
903800214
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
|
|
HC NON-GYN FLUID WASH BRUSH PG
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
903800214
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$211.07 |
| Rate for Payer: Adventist Health Medi-Cal |
$50.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.28
|
| Rate for Payer: Blue Distinction Transplant |
$54.00
|
| Rate for Payer: Blue Shield of California Commercial |
$55.62
|
| Rate for Payer: Blue Shield of California EPN |
$43.74
|
| Rate for Payer: Caremore Medicare Advantage |
$50.11
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$57.60
|
| Rate for Payer: Cigna of CA PPO |
$66.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: Dignity Health Media |
$50.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$50.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.11
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$67.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$82.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$82.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$50.11
|
| Rate for Payer: InnovAge PACE Commercial |
$75.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.15
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Prime Health Services Medicare |
$53.12
|
| Rate for Payer: Riverside University Health System MISP |
$55.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.11
|
|
|
HC NON-GYN THIN-PREP, PG
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
903800213
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Central Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.40
|
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.20
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
|
|
HC NON-GYN THIN-PREP, PG
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
903800213
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$392.31 |
| Rate for Payer: Adventist Health Medi-Cal |
$67.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$258.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$321.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$392.31
|
| Rate for Payer: Blue Distinction Transplant |
$60.60
|
| Rate for Payer: Blue Shield of California Commercial |
$62.42
|
| Rate for Payer: Blue Shield of California EPN |
$49.09
|
| Rate for Payer: Caremore Medicare Advantage |
$67.70
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Central Health Plan Commercial |
$80.80
|
| Rate for Payer: Cigna of CA HMO |
$64.64
|
| Rate for Payer: Cigna of CA PPO |
$74.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.55
|
| Rate for Payer: Dignity Health Media |
$67.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$67.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$67.70
|
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$75.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$111.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$111.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.70
|
| Rate for Payer: InnovAge PACE Commercial |
$101.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.72
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
| Rate for Payer: Prime Health Services Medicare |
$71.76
|
| Rate for Payer: Riverside University Health System MISP |
$74.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Vantage Medical Group Senior |
$67.70
|
|
|
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: Blue Shield of California EPN |
$288.36
|
| Rate for Payer: Cash Price |
$243.00
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: Networks By Design Commercial |
$270.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.90
|
| Rate for Payer: United Healthcare All Other HMO |
$199.15
|
| Rate for Payer: United Healthcare HMO Rider |
$194.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$178.20
|
|
|
HC NON-MOLDED LACER KAFO ADDITION LE
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT L2320
|
| Hospital Charge Code |
905352320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$176.89 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$297.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$261.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$319.03
|
| Rate for Payer: Blue Distinction Transplant |
$324.00
|
| Rate for Payer: Blue Shield of California Commercial |
$405.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.76
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| 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: Dignity Health Commercial/Exchange |
$459.00
|
| Rate for Payer: Dignity Health Media |
$459.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$405.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$189.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.40
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: Networks By Design Commercial |
$270.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
| Rate for Payer: Riverside University Health System MISP |
$216.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.00
|
| Rate for Payer: United Healthcare All Other HMO |
$270.00
|
| Rate for Payer: United Healthcare HMO Rider |
$270.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$270.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.00
|
| Rate for Payer: Vantage Medical Group Senior |
$459.00
|
|
|
HC NON-PNEUMATIC WALKING SPLINT
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT L4386
|
| Hospital Charge Code |
905354386
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.15 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$136.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.11
|
| Rate for Payer: Blue Distinction Transplant |
$149.40
|
| Rate for Payer: Blue Shield of California Commercial |
$186.75
|
| Rate for Payer: Blue Shield of California EPN |
$135.46
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: Dignity Health Media |
$211.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$186.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$87.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.09
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: Riverside University Health System MISP |
$99.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$149.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$124.50
|
| Rate for Payer: United Healthcare All Other HMO |
$124.50
|
| Rate for Payer: United Healthcare HMO Rider |
$124.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$124.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
|
HC NON-PNEUMATIC WALKING SPLINT
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT L4386
|
| Hospital Charge Code |
905354386
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Blue Shield of California EPN |
$132.97
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.80
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.02
|
| Rate for Payer: United Healthcare All Other HMO |
$91.83
|
| Rate for Payer: United Healthcare HMO Rider |
$89.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.17
|
|
|
HC NON SELECT INJ IMAG VENOUS STC
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT 36299
|
| Hospital Charge Code |
909020165
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$483.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$676.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$437.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$437.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$385.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$470.28
|
| Rate for Payer: Blue Distinction Transplant |
$477.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Central Health Plan Commercial |
$636.80
|
| Rate for Payer: Cigna of CA PPO |
$589.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$676.60
|
| Rate for Payer: Dignity Health Media |
$676.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$676.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$318.40
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$716.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$597.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$278.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.20
|
| Rate for Payer: Multiplan Commercial |
$597.00
|
| Rate for Payer: Networks By Design Commercial |
$517.40
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: Riverside University Health System MISP |
$318.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$676.60
|
| Rate for Payer: Vantage Medical Group Senior |
$676.60
|
|
|
HC NON SELECT INJ IMAG VENOUS STC
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT 36299
|
| Hospital Charge Code |
909020165
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$716.40 |
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Central Health Plan Commercial |
$636.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.40
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$716.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.20
|
| Rate for Payer: Multiplan Commercial |
$597.00
|
| Rate for Payer: Networks By Design Commercial |
$517.40
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE
|
Facility
|
OP
|
$942.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
903200205
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$178.77 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$565.20
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Central Health Plan Commercial |
$753.60
|
| Rate for Payer: Cigna of CA HMO |
$602.88
|
| Rate for Payer: Cigna of CA PPO |
$697.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$800.70
|
| Rate for Payer: Global Benefits Group Commercial |
$565.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$847.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$706.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$412.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: InnovAge PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$628.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$706.50
|
| Rate for Payer: Networks By Design Commercial |
$612.30
|
| Rate for Payer: Prime Health Services Commercial |
$800.70
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Riverside University Health System MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$565.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
