|
HC COLPOSCOPY W/BIOPSY CERVIX
|
Facility
|
OP
|
$1,607.00
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
902890150
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$163.67 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$658.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$948.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$723.15
|
| Rate for Payer: Cash Price |
$723.15
|
| Rate for Payer: Cash Price |
$723.15
|
| Rate for Payer: Cigna of CA HMO |
$1,028.48
|
| Rate for Payer: Cigna of CA PPO |
$1,189.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,124.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.68
|
| Rate for Payer: EPIC Health Plan Senior |
$431.12
|
| Rate for Payer: Galaxy Health WC |
$1,365.95
|
| Rate for Payer: Global Benefits Group Commercial |
$964.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$642.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,020.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$163.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$421.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$493.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.19
|
| Rate for Payer: Multiplan Commercial |
$1,285.60
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: Networks By Design Commercial |
$1,044.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.95
|
| Rate for Payer: Prime Health Services WC |
$609.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$964.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$964.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$391.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
HC COMMON CAROTID HEAD UNI
|
Facility
|
OP
|
$8,829.00
|
|
|
Service Code
|
CPT 36223
|
| Hospital Charge Code |
909020146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$431.58 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,765.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$3,973.05
|
| Rate for Payer: Cash Price |
$3,973.05
|
| Rate for Payer: Cash Price |
$3,973.05
|
| Rate for Payer: Cigna of CA HMO |
$5,650.56
|
| Rate for Payer: Cigna of CA PPO |
$6,533.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,180.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,808.82
|
| Rate for Payer: EPIC Health Plan Senior |
$7,872.55
|
| Rate for Payer: Galaxy Health WC |
$7,504.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,297.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,737.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$431.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,606.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$488.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,019.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,118.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,017.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,590.19
|
| Rate for Payer: Multiplan Commercial |
$7,063.20
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: Networks By Design Commercial |
$5,738.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,504.65
|
| Rate for Payer: Prime Health Services WC |
$10,832.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,297.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,414.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,156.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
HC COMMON CAROTID HEAD UNI
|
Facility
|
IP
|
$8,829.00
|
|
|
Service Code
|
CPT 36223
|
| Hospital Charge Code |
909020146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,765.80 |
| Max. Negotiated Rate |
$7,504.65 |
| Rate for Payer: Adventist Health Commercial |
$1,765.80
|
| Rate for Payer: Cash Price |
$3,973.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,180.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,531.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,531.60
|
| Rate for Payer: Galaxy Health WC |
$7,504.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,297.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,606.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,209.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,118.96
|
| Rate for Payer: Multiplan Commercial |
$7,063.20
|
| Rate for Payer: Networks By Design Commercial |
$5,738.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,504.65
|
|
|
HC COMMON CAROTID NECK UNI
|
Facility
|
IP
|
$8,388.00
|
|
|
Service Code
|
CPT 36222
|
| Hospital Charge Code |
909020145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,677.60 |
| Max. Negotiated Rate |
$7,129.80 |
| Rate for Payer: Adventist Health Commercial |
$1,677.60
|
| Rate for Payer: Cash Price |
$3,774.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,871.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,355.20
|
| Rate for Payer: Galaxy Health WC |
$7,129.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,032.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,326.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,948.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,013.12
|
| Rate for Payer: Multiplan Commercial |
$6,710.40
|
| Rate for Payer: Networks By Design Commercial |
$5,452.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,129.80
|
|
|
HC COMMON CAROTID NECK UNI
|
Facility
|
OP
|
$8,388.00
|
|
|
Service Code
|
CPT 36222
|
| Hospital Charge Code |
909020145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$399.67 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,677.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$3,774.60
|
| Rate for Payer: Cash Price |
$3,774.60
|
| Rate for Payer: Cash Price |
$3,774.60
|
| Rate for Payer: Cigna of CA HMO |
$5,368.32
|
| Rate for Payer: Cigna of CA PPO |
$6,207.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,871.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$7,129.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,032.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$399.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,326.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$452.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,013.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$6,710.40
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$5,452.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,129.80
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,032.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,194.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC COMM/WORK REINTEGRATION 15 MIN MCAL
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
901300068
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$248.20 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$204.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$116.80
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$185.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$172.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.08
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: Networks By Design Commercial |
$189.80
|
| Rate for Payer: Prime Health Services Commercial |
$248.20
|
|
|
HC COMM/WORK REINTEGRATION 15 MIN MCAL
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
901300068
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$70.08 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$119.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$160.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.00
|
| 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 |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna of CA HMO |
$186.88
|
| Rate for Payer: Cigna of CA PPO |
$216.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$248.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$204.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$116.80
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$185.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$172.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$204.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$204.40
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: Networks By Design Commercial |
$189.80
|
| Rate for Payer: Prime Health Services Commercial |
$248.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$175.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$175.20
|
| 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 |
$248.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.20
|
| Rate for Payer: Vantage Medical Group Senior |
$248.20
|
|
|
HC COMPASS IAP KIT
|
Facility
|
IP
|
$453.91
|
|
| Hospital Charge Code |
901698466
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.78 |
| Max. Negotiated Rate |
$385.82 |
| Rate for Payer: Adventist Health Commercial |
$90.78
|
| Rate for Payer: Cash Price |
$204.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$317.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$181.56
|
| Rate for Payer: EPIC Health Plan Senior |
$181.56
|
| Rate for Payer: Galaxy Health WC |
$385.82
|
| Rate for Payer: Global Benefits Group Commercial |
$272.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$288.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$267.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.94
|
| Rate for Payer: Multiplan Commercial |
$363.13
|
| Rate for Payer: Networks By Design Commercial |
$295.04
|
| Rate for Payer: Prime Health Services Commercial |
$385.82
|
|
|
HC COMPASS IAP KIT
|
Facility
|
OP
|
$453.91
|
|
| Hospital Charge Code |
901698466
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.78 |
| Max. Negotiated Rate |
$385.82 |
| Rate for Payer: Adventist Health Commercial |
$90.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$297.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$385.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$249.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$340.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$291.27
|
| Rate for Payer: Cash Price |
$204.26
|
| Rate for Payer: Cigna of CA HMO |
$290.50
|
| Rate for Payer: Cigna of CA PPO |
$335.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$385.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$385.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$385.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$317.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$181.56
|
| Rate for Payer: EPIC Health Plan Senior |
$181.56
|
| Rate for Payer: Galaxy Health WC |
$385.82
|
| Rate for Payer: Global Benefits Group Commercial |
$272.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$288.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$267.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$317.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$317.74
|
| Rate for Payer: Multiplan Commercial |
$363.13
|
| Rate for Payer: Networks By Design Commercial |
$295.04
|
| Rate for Payer: Prime Health Services Commercial |
$385.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$272.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$272.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$226.96
|
| Rate for Payer: United Healthcare All Other HMO |
$226.96
|
| Rate for Payer: United Healthcare HMO Rider |
$226.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$226.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$385.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$385.82
|
| Rate for Payer: Vantage Medical Group Senior |
$385.82
|
|
|
HC COMPASS IAP MINAL PRESSURE KIT
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901698469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC COMPASS IAP MINAL PRESSURE KIT
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901698469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$380.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$372.19
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC COMP CHART REVIEW NURSE SPE
|
Facility
|
IP
|
$278.00
|
|
| Hospital Charge Code |
908600146
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$236.30 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$194.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$111.20
|
| Rate for Payer: Galaxy Health WC |
$236.30
|
| Rate for Payer: Global Benefits Group Commercial |
$166.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$176.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$164.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.72
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: Networks By Design Commercial |
$180.70
|
| Rate for Payer: Prime Health Services Commercial |
$236.30
|
|
|
HC COMP CHART REVIEW NURSE SPE
|
Facility
|
OP
|
$278.00
|
|
| Hospital Charge Code |
908600146
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$236.30 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$182.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$236.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$152.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$208.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$178.39
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna of CA HMO |
$177.92
|
| Rate for Payer: Cigna of CA PPO |
$205.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$236.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$236.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$236.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$194.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$111.20
|
| Rate for Payer: Galaxy Health WC |
$236.30
|
| Rate for Payer: Global Benefits Group Commercial |
$166.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$176.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$100.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$164.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$194.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$194.60
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: Networks By Design Commercial |
$180.70
|
| Rate for Payer: Prime Health Services Commercial |
$236.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$166.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$166.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$139.00
|
| Rate for Payer: United Healthcare All Other HMO |
$139.00
|
| Rate for Payer: United Healthcare HMO Rider |
$139.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$139.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$236.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$236.30
|
| Rate for Payer: Vantage Medical Group Senior |
$236.30
|
|
|
HC COMP CHART REVIEW PHYSICIAN
|
Facility
|
IP
|
$136.00
|
|
| Hospital Charge Code |
908600149
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$115.60 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Senior |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.64
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
|
|
HC COMP CHART REVIEW PHYSICIAN
|
Facility
|
OP
|
$136.00
|
|
| Hospital Charge Code |
908600149
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$115.60 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$115.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$102.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.27
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$115.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$115.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$115.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Senior |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.20
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.00
|
| Rate for Payer: United Healthcare All Other HMO |
$68.00
|
| Rate for Payer: United Healthcare HMO Rider |
$68.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$115.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$115.60
|
| Rate for Payer: Vantage Medical Group Senior |
$115.60
|
|
|
HC COMPLEMENT C-3
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900910841
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$185.30 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.90
|
| Rate for Payer: Blue Shield of California Commercial |
$42.41
|
| Rate for Payer: Blue Shield of California Commercial |
$100.50
|
| Rate for Payer: Blue Shield of California Commercial |
$64.12
|
| Rate for Payer: Blue Shield of California Commercial |
$151.95
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna of CA HMO |
$58.88
|
| Rate for Payer: Cigna of CA HMO |
$139.52
|
| Rate for Payer: Cigna of CA PPO |
$161.32
|
| Rate for Payer: Cigna of CA PPO |
$68.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$64.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.80
|
| Rate for Payer: EPIC Health Plan Senior |
$13.20
|
| Rate for Payer: EPIC Health Plan Senior |
$13.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Galaxy Health WC |
$78.20
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Global Benefits Group Commercial |
$55.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.68
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$58.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Networks By Design Commercial |
$59.80
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
| Rate for Payer: Prime Health Services Commercial |
$78.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.72
|
| Rate for Payer: United Healthcare All Other HMO |
$9.72
|
| Rate for Payer: United Healthcare All Other HMO |
$9.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
|
|
HC COMPLEMENT C-3
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900910841
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$185.30 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.32
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
|
|
HC COMPLEMENT C-4
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900910979
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$185.30 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.90
|
| Rate for Payer: Blue Shield of California Commercial |
$42.41
|
| Rate for Payer: Blue Shield of California Commercial |
$100.50
|
| Rate for Payer: Blue Shield of California Commercial |
$64.12
|
| Rate for Payer: Blue Shield of California Commercial |
$151.95
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna of CA HMO |
$58.88
|
| Rate for Payer: Cigna of CA HMO |
$139.52
|
| Rate for Payer: Cigna of CA PPO |
$161.32
|
| Rate for Payer: Cigna of CA PPO |
$68.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$64.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.80
|
| Rate for Payer: EPIC Health Plan Senior |
$13.20
|
| Rate for Payer: EPIC Health Plan Senior |
$13.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Galaxy Health WC |
$78.20
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Global Benefits Group Commercial |
$55.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.68
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$58.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Networks By Design Commercial |
$59.80
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
| Rate for Payer: Prime Health Services Commercial |
$78.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.72
|
| Rate for Payer: United Healthcare All Other HMO |
$9.72
|
| Rate for Payer: United Healthcare All Other HMO |
$9.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
|
|
HC COMPLEMENT C-4
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900910979
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$185.30 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.32
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
|
|
HC COMPLEMENT TOTAL
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
900910842
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$209.65 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.35
|
| Rate for Payer: Vantage Medical Group Senior |
$20.32
|
| Rate for Payer: Vantage Medical Group Senior |
$20.32
|
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Adventist Health Commercial |
$16.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$168.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$168.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$209.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$209.65
|
| Rate for Payer: Blue Shield of California Commercial |
$36.88
|
| Rate for Payer: Blue Shield of California Commercial |
$50.25
|
| Rate for Payer: Blue Shield of California Commercial |
$55.76
|
| Rate for Payer: Blue Shield of California Commercial |
$75.97
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Cigna of CA HMO |
$51.20
|
| Rate for Payer: Cigna of CA HMO |
$69.76
|
| Rate for Payer: Cigna of CA PPO |
$80.66
|
| Rate for Payer: Cigna of CA PPO |
$59.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.53
|
| Rate for Payer: EPIC Health Plan Senior |
$22.35
|
| Rate for Payer: EPIC Health Plan Senior |
$22.35
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Galaxy Health WC |
$68.00
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Global Benefits Group Commercial |
$48.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.23
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: Networks By Design Commercial |
$52.00
|
| Rate for Payer: Networks By Design Commercial |
$70.85
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
| Rate for Payer: Prime Health Services Commercial |
$68.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.46
|
| Rate for Payer: United Healthcare All Other HMO |
$16.46
|
| Rate for Payer: United Healthcare All Other HMO |
$16.46
|
| Rate for Payer: United Healthcare HMO Rider |
$16.46
|
| Rate for Payer: United Healthcare HMO Rider |
$16.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.32
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.48
|
|
|
HC COMPLEMENT TOTAL
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
900910842
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$92.65 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.60
|
| Rate for Payer: EPIC Health Plan Senior |
$43.60
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.16
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: Networks By Design Commercial |
$70.85
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
|
|
HC COMPLEX PUSHABLE COIL
|
Facility
|
OP
|
$370.00
|
|
| Hospital Charge Code |
909081803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$314.50 |
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$314.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$223.96
|
| Rate for Payer: Blue Shield of California Commercial |
$187.59
|
| Rate for Payer: Blue Shield of California Commercial |
$284.53
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna of CA HMO |
$259.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$314.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$314.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$314.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$259.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.00
|
| Rate for Payer: EPIC Health Plan Senior |
$148.00
|
| Rate for Payer: Galaxy Health WC |
$314.50
|
| Rate for Payer: Global Benefits Group Commercial |
$222.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$234.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$218.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$259.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$259.00
|
| Rate for Payer: Multiplan Commercial |
$296.00
|
| Rate for Payer: Networks By Design Commercial |
$185.00
|
| Rate for Payer: Prime Health Services Commercial |
$314.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$222.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$222.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.86
|
| Rate for Payer: United Healthcare All Other HMO |
$135.16
|
| Rate for Payer: United Healthcare HMO Rider |
$132.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$314.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$314.50
|
| Rate for Payer: Vantage Medical Group Senior |
$314.50
|
|
|
HC COMPLEX PUSHABLE COIL
|
Facility
|
IP
|
$370.00
|
|
| Hospital Charge Code |
909081803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna of CA HMO |
$259.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$259.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.00
|
| Rate for Payer: EPIC Health Plan Senior |
$148.00
|
| Rate for Payer: Galaxy Health WC |
$314.50
|
| Rate for Payer: Global Benefits Group Commercial |
$222.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$234.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$218.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.80
|
| Rate for Payer: Multiplan Commercial |
$296.00
|
| Rate for Payer: Networks By Design Commercial |
$185.00
|
| Rate for Payer: Prime Health Services Commercial |
$314.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.86
|
| Rate for Payer: United Healthcare All Other HMO |
$135.16
|
| Rate for Payer: United Healthcare HMO Rider |
$132.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.17
|
|
|
HC COMPREH CHART REVIEW PHYSICIAN
|
Facility
|
IP
|
$162.00
|
|
| Hospital Charge Code |
912174304
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.88
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
|
|
HC COMPREH CHART REVIEW PHYSICIAN
|
Facility
|
OP
|
$162.00
|
|
| Hospital Charge Code |
912174304
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.96
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna of CA HMO |
$103.68
|
| Rate for Payer: Cigna of CA PPO |
$119.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.40
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.00
|
| Rate for Payer: United Healthcare All Other HMO |
$81.00
|
| Rate for Payer: United Healthcare HMO Rider |
$81.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.70
|
|
