|
HC NUTRITION/METABOLIC FOLLOWUP
|
Facility
|
OP
|
$260.00
|
|
| Hospital Charge Code |
902000203
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$170.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$221.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.91
|
| Rate for Payer: Blue Distinction Transplant |
$156.00
|
| Rate for Payer: Blue Shield of California Commercial |
$191.62
|
| Rate for Payer: Blue Shield of California EPN |
$151.84
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna of CA HMO |
$166.40
|
| Rate for Payer: Cigna of CA PPO |
$192.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.00
|
| Rate for Payer: Dignity Health Media |
$221.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$221.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$104.00
|
| Rate for Payer: Galaxy Health WC |
$221.00
|
| Rate for Payer: Global Benefits Group Commercial |
$156.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$195.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$173.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: Networks By Design Commercial |
$169.00
|
| Rate for Payer: Prime Health Services Commercial |
$221.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$156.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$156.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$221.00
|
| Rate for Payer: Vantage Medical Group Senior |
$221.00
|
|
|
HC NUTRITION/METABOLIC FOLLOWUP
|
Facility
|
IP
|
$260.00
|
|
| Hospital Charge Code |
902000203
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.00
|
| Rate for Payer: Galaxy Health WC |
$221.00
|
| Rate for Payer: Global Benefits Group Commercial |
$156.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$173.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: Networks By Design Commercial |
$169.00
|
| Rate for Payer: Prime Health Services Commercial |
$221.00
|
|
|
HC NUTRITION THER GRP 30 MIN
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
902000205
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.43 |
| Max. Negotiated Rate |
$181.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$122.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$181.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$117.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.91
|
| Rate for Payer: Blue Distinction Transplant |
$127.80
|
| Rate for Payer: Blue Shield of California Commercial |
$156.98
|
| Rate for Payer: Blue Shield of California EPN |
$124.39
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cigna of CA HMO |
$136.32
|
| Rate for Payer: Cigna of CA PPO |
$157.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$181.05
|
| Rate for Payer: Dignity Health Media |
$181.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$181.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$85.20
|
| Rate for Payer: Galaxy Health WC |
$181.05
|
| Rate for Payer: Global Benefits Group Commercial |
$127.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$159.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.12
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: Networks By Design Commercial |
$138.45
|
| Rate for Payer: Prime Health Services Commercial |
$181.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.50
|
| Rate for Payer: United Healthcare All Other HMO |
$106.50
|
| Rate for Payer: United Healthcare HMO Rider |
$106.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$181.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.05
|
| Rate for Payer: Vantage Medical Group Senior |
$181.05
|
|
|
HC NUTRITION THER GRP 30 MIN
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
902000205
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$26.43 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$122.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$181.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$117.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.91
|
| Rate for Payer: Blue Distinction Transplant |
$127.80
|
| Rate for Payer: Blue Shield of California Commercial |
$156.98
|
| Rate for Payer: Blue Shield of California EPN |
$124.39
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cigna of CA HMO |
$136.32
|
| Rate for Payer: Cigna of CA PPO |
$157.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$181.05
|
| Rate for Payer: Dignity Health Media |
$181.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$181.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$85.20
|
| Rate for Payer: Galaxy Health WC |
$181.05
|
| Rate for Payer: Global Benefits Group Commercial |
$127.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$159.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.12
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: Networks By Design Commercial |
$138.45
|
| Rate for Payer: Prime Health Services Commercial |
$181.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$181.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.05
|
| Rate for Payer: Vantage Medical Group Senior |
$181.05
|
|
|
HC NUTRITION THER GRP 30 MIN
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
902000205
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$181.05 |
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.20
|
| Rate for Payer: Galaxy Health WC |
$181.05
|
| Rate for Payer: Global Benefits Group Commercial |
$127.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.12
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: Networks By Design Commercial |
$138.45
|
| Rate for Payer: Prime Health Services Commercial |
$181.05
|
|
|
HC NUTRITION THER GRP 30 MIN
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
902000205
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$181.05 |
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.20
|
| Rate for Payer: Galaxy Health WC |
$181.05
|
| Rate for Payer: Global Benefits Group Commercial |
$127.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.12
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: Networks By Design Commercial |
$138.45
|
| Rate for Payer: Prime Health Services Commercial |
$181.05
|
|
|
HC NUTR THER INIT EVAL 15 MIN
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
902000200
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$60.96 |
| Max. Negotiated Rate |
$215.90 |
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.60
|
| Rate for Payer: Galaxy Health WC |
$215.90
|
| Rate for Payer: Global Benefits Group Commercial |
$152.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.96
|
| Rate for Payer: Multiplan Commercial |
$203.20
|
| Rate for Payer: Networks By Design Commercial |
$165.10
|
| Rate for Payer: Prime Health Services Commercial |
$215.90
|
|
|
HC NUTR THER INIT EVAL 15 MIN
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
902000200
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$57.66 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$260.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$139.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$139.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.33
|
| Rate for Payer: Blue Distinction Transplant |
$152.40
|
| Rate for Payer: Blue Shield of California Commercial |
$187.20
|
| Rate for Payer: Blue Shield of California EPN |
$148.34
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna of CA HMO |
$162.56
|
| Rate for Payer: Cigna of CA PPO |
$187.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.90
|
| Rate for Payer: Dignity Health Media |
$215.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$101.60
|
| Rate for Payer: Galaxy Health WC |
$215.90
|
| Rate for Payer: Global Benefits Group Commercial |
$152.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$190.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.96
|
| Rate for Payer: Multiplan Commercial |
$203.20
|
| Rate for Payer: Networks By Design Commercial |
$165.10
|
| Rate for Payer: Prime Health Services Commercial |
$215.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$152.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$152.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$215.90
|
| Rate for Payer: Vantage Medical Group Senior |
$215.90
|
|
|
HC NUTR THER INIT EVAL 30 MN MCAL
|
Facility
|
IP
|
$132.00
|
|
| Hospital Charge Code |
902000206
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
|
|
HC NUTR THER INIT EVAL 30 MN MCAL
|
Facility
|
OP
|
$132.00
|
|
| Hospital Charge Code |
902000206
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$86.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.65
|
| Rate for Payer: Blue Distinction Transplant |
$79.20
|
| Rate for Payer: Blue Shield of California Commercial |
$97.28
|
| Rate for Payer: Blue Shield of California EPN |
$77.09
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna of CA HMO |
$84.48
|
| Rate for Payer: Cigna of CA PPO |
$97.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Media |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.00
|
| Rate for Payer: United Healthcare All Other HMO |
$66.00
|
| Rate for Payer: United Healthcare HMO Rider |
$66.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC NUTR THER-RE EVAL 15 MIN
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
902000201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$181.05 |
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.20
|
| Rate for Payer: Galaxy Health WC |
$181.05
|
| Rate for Payer: Global Benefits Group Commercial |
$127.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.12
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: Networks By Design Commercial |
$138.45
|
| Rate for Payer: Prime Health Services Commercial |
$181.05
|
|
|
HC NUTR THER-RE EVAL 15 MIN
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
902000201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$224.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$224.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$181.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$117.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.91
|
| Rate for Payer: Blue Distinction Transplant |
$127.80
|
| Rate for Payer: Blue Shield of California Commercial |
$156.98
|
| Rate for Payer: Blue Shield of California EPN |
$124.39
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cigna of CA HMO |
$136.32
|
| Rate for Payer: Cigna of CA PPO |
$157.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$181.05
|
| Rate for Payer: Dignity Health Media |
$181.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$181.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$85.20
|
| Rate for Payer: Galaxy Health WC |
$181.05
|
| Rate for Payer: Global Benefits Group Commercial |
$127.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$159.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.12
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: Networks By Design Commercial |
$138.45
|
| Rate for Payer: Prime Health Services Commercial |
$181.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.50
|
| Rate for Payer: United Healthcare All Other HMO |
$106.50
|
| Rate for Payer: United Healthcare HMO Rider |
$106.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$181.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.05
|
| Rate for Payer: Vantage Medical Group Senior |
$181.05
|
|
|
HC NUTR THER-RE EVAL 15 MIN
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
902000201
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$224.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$181.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$117.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.91
|
| Rate for Payer: Blue Distinction Transplant |
$127.80
|
| Rate for Payer: Blue Shield of California Commercial |
$156.98
|
| Rate for Payer: Blue Shield of California EPN |
$124.39
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cigna of CA HMO |
$136.32
|
| Rate for Payer: Cigna of CA PPO |
$157.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$181.05
|
| Rate for Payer: Dignity Health Media |
$181.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$181.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$85.20
|
| Rate for Payer: Galaxy Health WC |
$181.05
|
| Rate for Payer: Global Benefits Group Commercial |
$127.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$159.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.12
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: Networks By Design Commercial |
$138.45
|
| Rate for Payer: Prime Health Services Commercial |
$181.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$181.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.05
|
| Rate for Payer: Vantage Medical Group Senior |
$181.05
|
|
|
HC NUTR THER-RE EVAL 15 MIN
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
902000201
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$181.05 |
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.20
|
| Rate for Payer: Galaxy Health WC |
$181.05
|
| Rate for Payer: Global Benefits Group Commercial |
$127.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.12
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: Networks By Design Commercial |
$138.45
|
| Rate for Payer: Prime Health Services Commercial |
$181.05
|
|
|
HC NUTR THER-RE EVAL 30 MN MCAL
|
Facility
|
OP
|
$132.00
|
|
| Hospital Charge Code |
902000207
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$86.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.65
|
| Rate for Payer: Blue Distinction Transplant |
$79.20
|
| Rate for Payer: Blue Shield of California Commercial |
$97.28
|
| Rate for Payer: Blue Shield of California EPN |
$77.09
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna of CA HMO |
$84.48
|
| Rate for Payer: Cigna of CA PPO |
$97.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Media |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC NUTR THER-RE EVAL 30 MN MCAL
|
Facility
|
IP
|
$132.00
|
|
| Hospital Charge Code |
902000207
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
|
|
HC O2 UPTAKE REST EXERCISE
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT 94680
|
| Hospital Charge Code |
900801032
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$130.08 |
| Max. Negotiated Rate |
$460.70 |
| Rate for Payer: Cash Price |
$243.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.80
|
| Rate for Payer: Galaxy Health WC |
$460.70
|
| Rate for Payer: Global Benefits Group Commercial |
$325.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$361.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.08
|
| Rate for Payer: Multiplan Commercial |
$433.60
|
| Rate for Payer: Networks By Design Commercial |
$352.30
|
| Rate for Payer: Prime Health Services Commercial |
$460.70
|
|
|
HC O2 UPTAKE REST EXERCISE
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT 94680
|
| Hospital Charge Code |
900801032
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$77.90 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$317.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.92
|
| Rate for Payer: Blue Distinction Transplant |
$325.20
|
| Rate for Payer: Blue Shield of California Commercial |
$320.32
|
| Rate for Payer: Blue Shield of California EPN |
$254.20
|
| Rate for Payer: Cash Price |
$243.90
|
| Rate for Payer: Cash Price |
$243.90
|
| Rate for Payer: Cash Price |
$243.90
|
| Rate for Payer: Cigna of CA HMO |
$346.88
|
| Rate for Payer: Cigna of CA PPO |
$401.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$460.70
|
| Rate for Payer: Global Benefits Group Commercial |
$325.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$406.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.08
|
| Rate for Payer: Heritage Provider Network Transplant |
$320.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$316.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$316.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$361.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$433.60
|
| Rate for Payer: Networks By Design Commercial |
$352.30
|
| Rate for Payer: Prime Health Services Commercial |
$460.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$325.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$325.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC OB ULTRASOUND RPT/FOLLOW-UP ADDL FETUS
|
Facility
|
OP
|
$1,832.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
906601320
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,557.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$395.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,091.51
|
| Rate for Payer: Blue Distinction Transplant |
$1,099.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,082.71
|
| Rate for Payer: Blue Shield of California EPN |
$859.21
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cigna of CA HMO |
$1,172.48
|
| Rate for Payer: Cigna of CA PPO |
$1,355.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,557.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,099.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,374.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,221.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,465.60
|
| Rate for Payer: Networks By Design Commercial |
$1,190.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,557.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,099.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,099.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC OB ULTRASOUND RPT/FOLLOW-UP ADDL FETUS
|
Facility
|
IP
|
$1,832.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
906601320
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$439.68 |
| Max. Negotiated Rate |
$1,557.20 |
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.80
|
| Rate for Payer: Galaxy Health WC |
$1,557.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,099.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,221.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$697.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.68
|
| Rate for Payer: Multiplan Commercial |
$1,465.60
|
| Rate for Payer: Networks By Design Commercial |
$1,190.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,557.20
|
|
|
HC OB ULTRASOUND RPT/FOLLOW-UP SINGLE FETUS
|
Facility
|
IP
|
$1,832.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
906601311
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$439.68 |
| Max. Negotiated Rate |
$1,557.20 |
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.80
|
| Rate for Payer: Galaxy Health WC |
$1,557.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,099.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,221.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$697.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.68
|
| Rate for Payer: Multiplan Commercial |
$1,465.60
|
| Rate for Payer: Networks By Design Commercial |
$1,190.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,557.20
|
|
|
HC OB ULTRASOUND RPT/FOLLOW-UP SINGLE FETUS
|
Facility
|
OP
|
$1,832.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
906601311
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,557.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$395.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,091.51
|
| Rate for Payer: Blue Distinction Transplant |
$1,099.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,082.71
|
| Rate for Payer: Blue Shield of California EPN |
$859.21
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cigna of CA HMO |
$1,172.48
|
| Rate for Payer: Cigna of CA PPO |
$1,355.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,557.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,099.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,374.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,221.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,465.60
|
| Rate for Payer: Networks By Design Commercial |
$1,190.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,557.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,099.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,099.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC OB US AFI LMTD 1 OR MORE FETUS
|
Facility
|
OP
|
$1,502.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
910400110
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$1,276.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$382.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$894.89
|
| Rate for Payer: Blue Distinction Transplant |
$901.20
|
| Rate for Payer: Blue Shield of California Commercial |
$887.68
|
| Rate for Payer: Blue Shield of California EPN |
$704.44
|
| Rate for Payer: Cash Price |
$675.90
|
| Rate for Payer: Cash Price |
$675.90
|
| Rate for Payer: Cigna of CA HMO |
$961.28
|
| Rate for Payer: Cigna of CA PPO |
$1,111.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,276.70
|
| Rate for Payer: Global Benefits Group Commercial |
$901.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,126.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,001.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,201.60
|
| Rate for Payer: Networks By Design Commercial |
$976.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,276.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$901.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$901.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC OB US AFI LMTD 1 OR MORE FETUS
|
Facility
|
IP
|
$1,502.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
910400110
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$360.48 |
| Max. Negotiated Rate |
$1,276.70 |
| Rate for Payer: Cash Price |
$675.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$600.80
|
| Rate for Payer: Galaxy Health WC |
$1,276.70
|
| Rate for Payer: Global Benefits Group Commercial |
$901.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,001.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$572.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.48
|
| Rate for Payer: Multiplan Commercial |
$1,201.60
|
| Rate for Payer: Networks By Design Commercial |
$976.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,276.70
|
|
|
HC OCCLUSIVE DEVICE IN VEIN ART
|
Facility
|
OP
|
$1,074.00
|
|
|
Service Code
|
CPT G0269
|
| Hospital Charge Code |
906811384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$257.76 |
| Max. Negotiated Rate |
$18,738.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18,738.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$912.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$590.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$590.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$644.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cigna of CA PPO |
$794.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$912.90
|
| Rate for Payer: Dignity Health Media |
$912.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$912.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$429.60
|
| Rate for Payer: Galaxy Health WC |
$912.90
|
| Rate for Payer: Global Benefits Group Commercial |
$644.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$805.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$716.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.76
|
| Rate for Payer: Multiplan Commercial |
$859.20
|
| Rate for Payer: Networks By Design Commercial |
$698.10
|
| Rate for Payer: Prime Health Services Commercial |
$912.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$644.40
|
| 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 Commercial/Exchange |
$912.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$912.90
|
| Rate for Payer: Vantage Medical Group Senior |
$912.90
|
|
