|
HC THERAPEUTIC PROCEDURE 15 MIN MCAL
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
907000036
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$18.41 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$135.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$281.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$248.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cigna of CA HMO |
$211.84
|
| Rate for Payer: Cigna of CA PPO |
$244.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$281.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$281.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$231.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.40
|
| Rate for Payer: EPIC Health Plan Senior |
$132.40
|
| Rate for Payer: Galaxy Health WC |
$281.35
|
| Rate for Payer: Global Benefits Group Commercial |
$198.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$210.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$195.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$231.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$231.70
|
| Rate for Payer: Multiplan Commercial |
$264.80
|
| Rate for Payer: Networks By Design Commercial |
$215.15
|
| Rate for Payer: Prime Health Services Commercial |
$281.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$198.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$281.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.35
|
| Rate for Payer: Vantage Medical Group Senior |
$281.35
|
|
|
HC THERAPEUTIC PROCEDURE 15 MIN MCARE COMM
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
900407110
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.41 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$135.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$281.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$248.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cigna of CA HMO |
$211.84
|
| Rate for Payer: Cigna of CA PPO |
$244.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$281.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$281.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$231.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.40
|
| Rate for Payer: EPIC Health Plan Senior |
$132.40
|
| Rate for Payer: Galaxy Health WC |
$281.35
|
| Rate for Payer: Global Benefits Group Commercial |
$198.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$210.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$195.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$231.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$231.70
|
| Rate for Payer: Multiplan Commercial |
$264.80
|
| Rate for Payer: Networks By Design Commercial |
$215.15
|
| Rate for Payer: Prime Health Services Commercial |
$281.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$198.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$281.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.35
|
| Rate for Payer: Vantage Medical Group Senior |
$281.35
|
|
|
HC THERAPEUTIC PROCEDURE 15 MIN MCARE COMM
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
900407110
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$66.20 |
| Max. Negotiated Rate |
$281.35 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$231.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.40
|
| Rate for Payer: EPIC Health Plan Senior |
$132.40
|
| Rate for Payer: Galaxy Health WC |
$281.35
|
| Rate for Payer: Global Benefits Group Commercial |
$198.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$210.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$195.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.44
|
| Rate for Payer: Multiplan Commercial |
$264.80
|
| Rate for Payer: Networks By Design Commercial |
$215.15
|
| Rate for Payer: Prime Health Services Commercial |
$281.35
|
|
|
HC THERAPEUTIC PROCEDURE 15MIN OT
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
905104225
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$18.41 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$135.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$281.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$248.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cigna of CA HMO |
$211.84
|
| Rate for Payer: Cigna of CA PPO |
$244.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$281.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$281.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$231.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.40
|
| Rate for Payer: EPIC Health Plan Senior |
$132.40
|
| Rate for Payer: Galaxy Health WC |
$281.35
|
| Rate for Payer: Global Benefits Group Commercial |
$198.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$210.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$195.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$231.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$231.70
|
| Rate for Payer: Multiplan Commercial |
$264.80
|
| Rate for Payer: Networks By Design Commercial |
$215.15
|
| Rate for Payer: Prime Health Services Commercial |
$281.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$198.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$281.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.35
|
| Rate for Payer: Vantage Medical Group Senior |
$281.35
|
|
|
HC THERAPEUTIC PROCEDURE 15MIN OT
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
905104225
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$66.20 |
| Max. Negotiated Rate |
$281.35 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$231.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.40
|
| Rate for Payer: EPIC Health Plan Senior |
$132.40
|
| Rate for Payer: Galaxy Health WC |
$281.35
|
| Rate for Payer: Global Benefits Group Commercial |
$198.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$210.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$195.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.44
|
| Rate for Payer: Multiplan Commercial |
$264.80
|
| Rate for Payer: Networks By Design Commercial |
$215.15
|
| Rate for Payer: Prime Health Services Commercial |
$281.35
|
|
|
HC THERAPEUTIC PROCEDURE 30MIN MCAL
|
Facility
|
OP
|
$169.00
|
|
| Hospital Charge Code |
900409030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.56 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$69.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$143.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$92.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$126.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cigna of CA HMO |
$108.16
|
| Rate for Payer: Cigna of CA PPO |
$125.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$143.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$143.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$118.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.60
|
| Rate for Payer: EPIC Health Plan Senior |
$67.60
|
| Rate for Payer: Galaxy Health WC |
$143.65
|
| Rate for Payer: Global Benefits Group Commercial |
$101.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$118.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$118.30
|
| Rate for Payer: Multiplan Commercial |
$135.20
|
| Rate for Payer: Networks By Design Commercial |
$109.85
|
| Rate for Payer: Prime Health Services Commercial |
$143.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$143.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.65
|
| Rate for Payer: Vantage Medical Group Senior |
$143.65
|
|
|
HC THERAPEUTIC PROCEDURE 30MIN MCAL
|
Facility
|
IP
|
$169.00
|
|
| Hospital Charge Code |
900409030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$143.65 |
| Rate for Payer: Adventist Health Commercial |
$33.80
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$118.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.60
|
| Rate for Payer: EPIC Health Plan Senior |
$67.60
|
| Rate for Payer: Galaxy Health WC |
$143.65
|
| Rate for Payer: Global Benefits Group Commercial |
$101.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.56
|
| Rate for Payer: Multiplan Commercial |
$135.20
|
| Rate for Payer: Networks By Design Commercial |
$109.85
|
| Rate for Payer: Prime Health Services Commercial |
$143.65
|
|
|
HC THERAPEUTIC PROCEDURE ADDL 15MIN PT
|
Facility
|
OP
|
$101.00
|
|
| Hospital Charge Code |
900409031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.24 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$41.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cash Price |
$45.45
|
| 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 |
$85.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.40
|
| Rate for Payer: EPIC Health Plan Senior |
$40.40
|
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$64.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.70
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
| 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 |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.85
|
| Rate for Payer: Vantage Medical Group Senior |
$85.85
|
|
|
HC THERAPEUTIC PROCEDURE ADDL 15MIN PT
|
Facility
|
IP
|
$101.00
|
|
| Hospital Charge Code |
900409031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$85.85 |
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.40
|
| Rate for Payer: EPIC Health Plan Senior |
$40.40
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$64.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.24
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
|
|
HC THERAPEUTIC PROCEDURE GRP MCAL
|
Facility
|
OP
|
$647.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
900400055
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$549.95 |
| Rate for Payer: Adventist Health Commercial |
$265.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$549.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$355.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$485.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Cigna of CA HMO |
$414.08
|
| Rate for Payer: Cigna of CA PPO |
$478.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$549.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$549.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$549.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$452.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.80
|
| Rate for Payer: EPIC Health Plan Senior |
$258.80
|
| Rate for Payer: Galaxy Health WC |
$549.95
|
| Rate for Payer: Global Benefits Group Commercial |
$388.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$410.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$381.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$452.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$452.90
|
| Rate for Payer: Multiplan Commercial |
$517.60
|
| Rate for Payer: Networks By Design Commercial |
$420.55
|
| Rate for Payer: Prime Health Services Commercial |
$549.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$388.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$388.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$549.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$549.95
|
| Rate for Payer: Vantage Medical Group Senior |
$549.95
|
|
|
HC THERAPEUTIC PROCEDURE GRP MCAL
|
Facility
|
OP
|
$647.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
901300059
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$549.95 |
| Rate for Payer: Adventist Health Commercial |
$265.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$549.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$355.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$485.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Cigna of CA HMO |
$414.08
|
| Rate for Payer: Cigna of CA PPO |
$478.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$549.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$549.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$549.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$452.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.80
|
| Rate for Payer: EPIC Health Plan Senior |
$258.80
|
| Rate for Payer: Galaxy Health WC |
$549.95
|
| Rate for Payer: Global Benefits Group Commercial |
$388.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$410.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$381.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$452.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$452.90
|
| Rate for Payer: Multiplan Commercial |
$517.60
|
| Rate for Payer: Networks By Design Commercial |
$420.55
|
| Rate for Payer: Prime Health Services Commercial |
$549.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$388.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$388.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$549.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$549.95
|
| Rate for Payer: Vantage Medical Group Senior |
$549.95
|
|
|
HC THERAPEUTIC PROCEDURE GRP MCAL
|
Facility
|
IP
|
$647.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
901300059
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$129.40 |
| Max. Negotiated Rate |
$549.95 |
| Rate for Payer: Adventist Health Commercial |
$129.40
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$452.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.80
|
| Rate for Payer: EPIC Health Plan Senior |
$258.80
|
| Rate for Payer: Galaxy Health WC |
$549.95
|
| Rate for Payer: Global Benefits Group Commercial |
$388.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$410.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$381.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.28
|
| Rate for Payer: Multiplan Commercial |
$517.60
|
| Rate for Payer: Networks By Design Commercial |
$420.55
|
| Rate for Payer: Prime Health Services Commercial |
$549.95
|
|
|
HC THERAPEUTIC PROCEDURE GRP MCAL
|
Facility
|
IP
|
$647.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
900400055
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$129.40 |
| Max. Negotiated Rate |
$549.95 |
| Rate for Payer: EPIC Health Plan Senior |
$258.80
|
| Rate for Payer: Galaxy Health WC |
$549.95
|
| Rate for Payer: Adventist Health Commercial |
$129.40
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$452.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.80
|
| Rate for Payer: Global Benefits Group Commercial |
$388.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$410.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$381.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.28
|
| Rate for Payer: Multiplan Commercial |
$517.60
|
| Rate for Payer: Networks By Design Commercial |
$420.55
|
| Rate for Payer: Prime Health Services Commercial |
$549.95
|
|
|
HC THERAPEUTIC RAD PORT IMAGE
|
Facility
|
OP
|
$703.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
909100309
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$1,759.00 |
| Rate for Payer: Adventist Health Commercial |
$140.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$597.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$527.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.94
|
| Rate for Payer: Blue Shield of California Commercial |
$448.51
|
| Rate for Payer: Blue Shield of California Commercial |
$295.96
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Cigna of CA HMO |
$449.92
|
| Rate for Payer: Cigna of CA PPO |
$520.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$597.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$597.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$597.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$492.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.20
|
| Rate for Payer: EPIC Health Plan Senior |
$281.20
|
| Rate for Payer: Galaxy Health WC |
$597.55
|
| Rate for Payer: Global Benefits Group Commercial |
$421.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$446.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$492.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$492.10
|
| Rate for Payer: Multiplan Commercial |
$562.40
|
| Rate for Payer: Networks By Design Commercial |
$456.95
|
| Rate for Payer: Prime Health Services Commercial |
$597.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$421.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$597.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$597.55
|
| Rate for Payer: Vantage Medical Group Senior |
$597.55
|
|
|
HC THERAPEUTIC RAD PORT IMAGE
|
Facility
|
IP
|
$703.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
909100309
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$140.60 |
| Max. Negotiated Rate |
$597.55 |
| Rate for Payer: Adventist Health Commercial |
$140.60
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$492.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.20
|
| Rate for Payer: EPIC Health Plan Senior |
$281.20
|
| Rate for Payer: Galaxy Health WC |
$597.55
|
| Rate for Payer: Global Benefits Group Commercial |
$421.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$446.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.72
|
| Rate for Payer: Multiplan Commercial |
$562.40
|
| Rate for Payer: Networks By Design Commercial |
$456.95
|
| Rate for Payer: Prime Health Services Commercial |
$597.55
|
|
|
HC THERAPUTIC BRONCH SUB
|
Facility
|
IP
|
$3,516.00
|
|
|
Service Code
|
CPT 31646
|
| Hospital Charge Code |
900803511
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$703.20 |
| Max. Negotiated Rate |
$2,988.60 |
| Rate for Payer: Adventist Health Commercial |
$703.20
|
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,461.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,406.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,406.40
|
| Rate for Payer: Galaxy Health WC |
$2,988.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,109.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,232.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,074.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.84
|
| Rate for Payer: Multiplan Commercial |
$2,812.80
|
| Rate for Payer: Networks By Design Commercial |
$2,285.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,988.60
|
|
|
HC THERAPUTIC BRONCH SUB
|
Facility
|
OP
|
$3,516.00
|
|
|
Service Code
|
CPT 31646
|
| Hospital Charge Code |
900803511
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.89 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$703.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$865.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$754.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$553.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$503.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: Cigna of CA HMO |
$2,250.24
|
| Rate for Payer: Cigna of CA PPO |
$2,601.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$754.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$553.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$503.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,461.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$830.02
|
| Rate for Payer: EPIC Health Plan Senior |
$553.34
|
| Rate for Payer: Galaxy Health WC |
$2,988.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,109.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$824.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$503.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,232.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$207.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$704.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$633.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$674.07
|
| Rate for Payer: Multiplan Commercial |
$2,812.80
|
| Rate for Payer: Networks By Design Commercial |
$2,285.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,988.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,109.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,109.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,758.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,758.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,758.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,758.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$503.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$754.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$553.34
|
| Rate for Payer: Vantage Medical Group Senior |
$503.04
|
|
|
HC THERMODILUTION CONGENITAL
|
Facility
|
OP
|
$4,018.00
|
|
|
Service Code
|
CPT 93561
|
| Hospital Charge Code |
906811494
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$803.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$803.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,415.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,209.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,013.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,578.35
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$1,808.10
|
| Rate for Payer: Cash Price |
$1,808.10
|
| Rate for Payer: Cigna of CA HMO |
$2,611.70
|
| Rate for Payer: Cigna of CA PPO |
$2,973.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,415.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,415.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,415.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,812.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,607.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,607.20
|
| Rate for Payer: Galaxy Health WC |
$3,415.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,410.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,551.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,458.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,370.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$964.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,812.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,812.60
|
| Rate for Payer: Multiplan Commercial |
$3,214.40
|
| Rate for Payer: Networks By Design Commercial |
$2,611.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,415.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,410.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,410.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,009.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,009.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,009.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,009.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,415.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,415.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,415.30
|
|
|
HC THERMODILUTION CONGENITAL
|
Facility
|
IP
|
$4,018.00
|
|
|
Service Code
|
CPT 93561
|
| Hospital Charge Code |
906811494
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$803.60 |
| Max. Negotiated Rate |
$3,415.30 |
| Rate for Payer: Adventist Health Commercial |
$803.60
|
| Rate for Payer: Cash Price |
$1,808.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,812.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,607.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,607.20
|
| Rate for Payer: Galaxy Health WC |
$3,415.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,410.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,551.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,370.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$964.32
|
| Rate for Payer: Multiplan Commercial |
$3,214.40
|
| Rate for Payer: Networks By Design Commercial |
$2,611.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,415.30
|
|
|
HC THERMODILUTION CONGENITAL ADDL
|
Facility
|
OP
|
$2,009.00
|
|
|
Service Code
|
CPT 93562
|
| Hospital Charge Code |
906811495
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$401.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$401.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,707.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,506.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,289.18
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: Cigna of CA HMO |
$1,305.85
|
| Rate for Payer: Cigna of CA PPO |
$1,486.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,707.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,707.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,707.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,406.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$803.60
|
| Rate for Payer: EPIC Health Plan Senior |
$803.60
|
| Rate for Payer: Galaxy Health WC |
$1,707.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,205.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,275.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$729.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,185.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,406.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,406.30
|
| Rate for Payer: Multiplan Commercial |
$1,607.20
|
| Rate for Payer: Networks By Design Commercial |
$1,305.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,707.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,205.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,205.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,004.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,004.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,004.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,004.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,707.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,707.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,707.65
|
|
|
HC THERMODILUTION CONGENITAL ADDL
|
Facility
|
IP
|
$2,009.00
|
|
|
Service Code
|
CPT 93562
|
| Hospital Charge Code |
906811495
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$401.80 |
| Max. Negotiated Rate |
$1,707.65 |
| Rate for Payer: Adventist Health Commercial |
$401.80
|
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,406.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$803.60
|
| Rate for Payer: EPIC Health Plan Senior |
$803.60
|
| Rate for Payer: Galaxy Health WC |
$1,707.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,205.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,275.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,185.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.16
|
| Rate for Payer: Multiplan Commercial |
$1,607.20
|
| Rate for Payer: Networks By Design Commercial |
$1,305.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,707.65
|
|
|
HC THERMODILUTION CONG EVAL DEFECTS
|
Facility
|
OP
|
$3,437.00
|
|
|
Service Code
|
CPT 93598
|
| Hospital Charge Code |
906811598
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$687.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$687.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,921.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,890.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,577.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,205.52
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: Cigna of CA HMO |
$2,234.05
|
| Rate for Payer: Cigna of CA PPO |
$2,543.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,921.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,921.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,921.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,405.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,374.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,374.80
|
| Rate for Payer: Galaxy Health WC |
$2,921.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,062.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,182.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,027.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$824.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,405.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,405.90
|
| Rate for Payer: Multiplan Commercial |
$2,749.60
|
| Rate for Payer: Networks By Design Commercial |
$2,234.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,921.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,062.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,062.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,718.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,921.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,921.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,921.45
|
|
|
HC THERMODILUTION CONG EVAL DEFECTS
|
Facility
|
IP
|
$3,437.00
|
|
|
Service Code
|
CPT 93598
|
| Hospital Charge Code |
906811598
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$687.40 |
| Max. Negotiated Rate |
$2,921.45 |
| Rate for Payer: Adventist Health Commercial |
$687.40
|
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,405.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,374.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,374.80
|
| Rate for Payer: Galaxy Health WC |
$2,921.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,062.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,182.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,027.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$824.88
|
| Rate for Payer: Multiplan Commercial |
$2,749.60
|
| Rate for Payer: Networks By Design Commercial |
$2,234.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,921.45
|
|
|
HC THIOCYANATE SERUM
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 84430
|
| Hospital Charge Code |
900910463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$120.08 |
| Rate for Payer: Vantage Medical Group Senior |
$11.63
|
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.08
|
| Rate for Payer: Blue Shield of California Commercial |
$234.65
|
| Rate for Payer: Blue Shield of California Commercial |
$23.05
|
| Rate for Payer: Blue Shield of California Commercial |
$354.77
|
| Rate for Payer: Blue Shield of California Commercial |
$34.85
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$325.76
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Cigna of CA PPO |
$376.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$356.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.19
|
| Rate for Payer: EPIC Health Plan Senior |
$12.79
|
| Rate for Payer: EPIC Health Plan Senior |
$12.79
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$323.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.58
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$330.85
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Commercial |
$432.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$305.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$305.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.42
|
| Rate for Payer: United Healthcare All Other HMO |
$9.42
|
| Rate for Payer: United Healthcare All Other HMO |
$9.42
|
| Rate for Payer: United Healthcare HMO Rider |
$9.42
|
| Rate for Payer: United Healthcare HMO Rider |
$9.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.63
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.79
|
| Rate for Payer: Vantage Medical Group Senior |
$11.63
|
|
|
HC THIOCYANATE SERUM
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 84430
|
| Hospital Charge Code |
900910463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$101.80 |
| Max. Negotiated Rate |
$432.65 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$356.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.60
|
| Rate for Payer: EPIC Health Plan Senior |
$203.60
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$323.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$300.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.16
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: Networks By Design Commercial |
$330.85
|
| Rate for Payer: Prime Health Services Commercial |
$432.65
|
|
