|
HC THERAPEUTIC INJECTION IA
|
Facility
|
OP
|
$544.00
|
|
|
Service Code
|
CPT 96373
|
| Hospital Charge Code |
909020041
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$30.21 |
| Max. Negotiated Rate |
$914.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$127.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.00
|
| Rate for Payer: Blue Distinction Transplant |
$326.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna of CA HMO |
$348.16
|
| Rate for Payer: Cigna of CA PPO |
$402.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Media |
$267.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$462.40
|
| Rate for Payer: Global Benefits Group Commercial |
$326.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$408.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$439.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$433.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$433.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$362.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| Rate for Payer: Multiplan Commercial |
$435.20
|
| Rate for Payer: Networks By Design Commercial |
$353.60
|
| Rate for Payer: Prime Health Services Commercial |
$462.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$326.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC THERAPEUTIC PROCEDURE 15 MIN MCAL
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
907000036
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.00
|
| Rate for Payer: Galaxy Health WC |
$267.75
|
| Rate for Payer: Global Benefits Group Commercial |
$189.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$204.75
|
| Rate for Payer: Prime Health Services Commercial |
$267.75
|
|
|
HC THERAPEUTIC PROCEDURE 15 MIN MCAL
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
907000036
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$20.82 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$138.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$267.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$173.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$189.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cigna of CA HMO |
$201.60
|
| Rate for Payer: Cigna of CA PPO |
$233.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.75
|
| Rate for Payer: Dignity Health Media |
$267.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$126.00
|
| Rate for Payer: Galaxy Health WC |
$267.75
|
| Rate for Payer: Global Benefits Group Commercial |
$189.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$236.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$204.75
|
| Rate for Payer: Prime Health Services Commercial |
$267.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$189.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$189.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$267.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.75
|
| Rate for Payer: Vantage Medical Group Senior |
$267.75
|
|
|
HC THERAPEUTIC PROCEDURE 15 MIN MCARE COMM
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
900407110
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.00
|
| Rate for Payer: Galaxy Health WC |
$267.75
|
| Rate for Payer: Global Benefits Group Commercial |
$189.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$204.75
|
| Rate for Payer: Prime Health Services Commercial |
$267.75
|
|
|
HC THERAPEUTIC PROCEDURE 15 MIN MCARE COMM
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
900407110
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.82 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$138.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$267.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$173.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$189.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cigna of CA HMO |
$201.60
|
| Rate for Payer: Cigna of CA PPO |
$233.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.75
|
| Rate for Payer: Dignity Health Media |
$267.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$126.00
|
| Rate for Payer: Galaxy Health WC |
$267.75
|
| Rate for Payer: Global Benefits Group Commercial |
$189.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$236.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$204.75
|
| Rate for Payer: Prime Health Services Commercial |
$267.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$189.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$189.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$267.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.75
|
| Rate for Payer: Vantage Medical Group Senior |
$267.75
|
|
|
HC THERAPEUTIC PROCEDURE 15MIN OT
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
905104225
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.00
|
| Rate for Payer: Galaxy Health WC |
$267.75
|
| Rate for Payer: Global Benefits Group Commercial |
$189.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$204.75
|
| Rate for Payer: Prime Health Services Commercial |
$267.75
|
|
|
HC THERAPEUTIC PROCEDURE 15MIN OT
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
905104225
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$20.82 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$138.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$267.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$173.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$189.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cigna of CA HMO |
$201.60
|
| Rate for Payer: Cigna of CA PPO |
$233.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.75
|
| Rate for Payer: Dignity Health Media |
$267.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$126.00
|
| Rate for Payer: Galaxy Health WC |
$267.75
|
| Rate for Payer: Global Benefits Group Commercial |
$189.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$236.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$204.75
|
| Rate for Payer: Prime Health Services Commercial |
$267.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$189.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$189.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$267.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.75
|
| Rate for Payer: Vantage Medical Group Senior |
$267.75
|
|
|
HC THERAPEUTIC PROCEDURE 30MIN MCAL
|
Facility
|
OP
|
$165.00
|
|
| Hospital Charge Code |
900409030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$108.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$140.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$90.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$99.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cigna of CA HMO |
$105.60
|
| Rate for Payer: Cigna of CA PPO |
$122.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$140.25
|
| Rate for Payer: Dignity Health Media |
$140.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$140.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$123.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$140.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: Vantage Medical Group Senior |
$140.25
|
|
|
HC THERAPEUTIC PROCEDURE 30MIN MCAL
|
Facility
|
IP
|
$165.00
|
|
| Hospital Charge Code |
900409030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$140.25 |
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
|
|
HC THERAPEUTIC PROCEDURE ADDL 15MIN PT
|
Facility
|
OP
|
$99.00
|
|
| Hospital Charge Code |
900409031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.76 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$64.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$84.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$59.40
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cigna of CA HMO |
$63.36
|
| Rate for Payer: Cigna of CA PPO |
$73.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.15
|
| Rate for Payer: Dignity Health Media |
$84.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$39.60
|
| Rate for Payer: Galaxy Health WC |
$84.15
|
| Rate for Payer: Global Benefits Group Commercial |
$59.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$74.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.76
|
| Rate for Payer: Multiplan Commercial |
$79.20
|
| Rate for Payer: Networks By Design Commercial |
$64.35
|
| Rate for Payer: Prime Health Services Commercial |
$84.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.15
|
| Rate for Payer: Vantage Medical Group Senior |
$84.15
|
|
|
HC THERAPEUTIC PROCEDURE ADDL 15MIN PT
|
Facility
|
IP
|
$99.00
|
|
| Hospital Charge Code |
900409031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.76 |
| Max. Negotiated Rate |
$84.15 |
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.60
|
| Rate for Payer: Galaxy Health WC |
$84.15
|
| Rate for Payer: Global Benefits Group Commercial |
$59.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.76
|
| Rate for Payer: Multiplan Commercial |
$79.20
|
| Rate for Payer: Networks By Design Commercial |
$64.35
|
| Rate for Payer: Prime Health Services Commercial |
$84.15
|
|
|
HC THERAPEUTIC PROCEDURE GRP MCAL
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
901300059
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$147.84 |
| Max. Negotiated Rate |
$523.60 |
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$246.40
|
| Rate for Payer: Galaxy Health WC |
$523.60
|
| Rate for Payer: Global Benefits Group Commercial |
$369.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$410.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.84
|
| Rate for Payer: Multiplan Commercial |
$492.80
|
| Rate for Payer: Networks By Design Commercial |
$400.40
|
| Rate for Payer: Prime Health Services Commercial |
$523.60
|
|
|
HC THERAPEUTIC PROCEDURE GRP MCAL
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
900400055
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.73 |
| Max. Negotiated Rate |
$523.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$89.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$523.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$338.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$338.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$369.60
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cigna of CA HMO |
$394.24
|
| Rate for Payer: Cigna of CA PPO |
$455.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$523.60
|
| Rate for Payer: Dignity Health Media |
$523.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$523.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$246.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$246.40
|
| Rate for Payer: Galaxy Health WC |
$523.60
|
| Rate for Payer: Global Benefits Group Commercial |
$369.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$462.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$410.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.84
|
| Rate for Payer: Multiplan Commercial |
$492.80
|
| Rate for Payer: Networks By Design Commercial |
$400.40
|
| Rate for Payer: Prime Health Services Commercial |
$523.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$369.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$369.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$523.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$523.60
|
| Rate for Payer: Vantage Medical Group Senior |
$523.60
|
|
|
HC THERAPEUTIC PROCEDURE GRP MCAL
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
900400055
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$147.84 |
| Max. Negotiated Rate |
$523.60 |
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$246.40
|
| Rate for Payer: Galaxy Health WC |
$523.60
|
| Rate for Payer: Global Benefits Group Commercial |
$369.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$410.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.84
|
| Rate for Payer: Multiplan Commercial |
$492.80
|
| Rate for Payer: Networks By Design Commercial |
$400.40
|
| Rate for Payer: Prime Health Services Commercial |
$523.60
|
|
|
HC THERAPEUTIC PROCEDURE GRP MCAL
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
901300059
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$25.73 |
| Max. Negotiated Rate |
$523.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$89.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$523.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$338.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$338.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$369.60
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cigna of CA HMO |
$394.24
|
| Rate for Payer: Cigna of CA PPO |
$455.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$523.60
|
| Rate for Payer: Dignity Health Media |
$523.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$523.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$246.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$246.40
|
| Rate for Payer: Galaxy Health WC |
$523.60
|
| Rate for Payer: Global Benefits Group Commercial |
$369.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$462.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$410.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.84
|
| Rate for Payer: Multiplan Commercial |
$492.80
|
| Rate for Payer: Networks By Design Commercial |
$400.40
|
| Rate for Payer: Prime Health Services Commercial |
$523.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$369.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$369.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$523.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$523.60
|
| Rate for Payer: Vantage Medical Group Senior |
$523.60
|
|
|
HC THERAPEUTIC RAD PORT IMAGE
|
Facility
|
IP
|
$871.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
909100309
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$209.04 |
| Max. Negotiated Rate |
$740.35 |
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$348.40
|
| Rate for Payer: Galaxy Health WC |
$740.35
|
| Rate for Payer: Global Benefits Group Commercial |
$522.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.04
|
| Rate for Payer: Multiplan Commercial |
$696.80
|
| Rate for Payer: Networks By Design Commercial |
$566.15
|
| Rate for Payer: Prime Health Services Commercial |
$740.35
|
|
|
HC THERAPEUTIC RAD PORT IMAGE
|
Facility
|
OP
|
$871.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
909100309
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$18.66 |
| Max. Negotiated Rate |
$1,675.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$94.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$740.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$479.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.10
|
| Rate for Payer: Blue Distinction Transplant |
$522.60
|
| Rate for Payer: Blue Shield of California Commercial |
$514.76
|
| Rate for Payer: Blue Shield of California EPN |
$408.50
|
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Cigna of CA HMO |
$557.44
|
| Rate for Payer: Cigna of CA PPO |
$644.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$740.35
|
| Rate for Payer: Dignity Health Media |
$740.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$740.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$348.40
|
| Rate for Payer: Galaxy Health WC |
$740.35
|
| Rate for Payer: Global Benefits Group Commercial |
$522.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$653.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.04
|
| Rate for Payer: Multiplan Commercial |
$696.80
|
| Rate for Payer: Networks By Design Commercial |
$566.15
|
| Rate for Payer: Prime Health Services Commercial |
$740.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$522.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$740.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$740.35
|
| Rate for Payer: Vantage Medical Group Senior |
$740.35
|
|
|
HC THERAPUTIC BRONCH SUB
|
Facility
|
IP
|
$4,354.00
|
|
|
Service Code
|
CPT 31646
|
| Hospital Charge Code |
900803511
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,044.96 |
| Max. Negotiated Rate |
$3,700.90 |
| Rate for Payer: Cash Price |
$1,959.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,741.60
|
| Rate for Payer: Galaxy Health WC |
$3,700.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,612.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,904.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,658.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,044.96
|
| Rate for Payer: Multiplan Commercial |
$3,483.20
|
| Rate for Payer: Networks By Design Commercial |
$2,830.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,700.90
|
|
|
HC THERAPUTIC BRONCH SUB
|
Facility
|
OP
|
$4,354.00
|
|
|
Service Code
|
CPT 31646
|
| Hospital Charge Code |
900803511
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.97 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,612.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,208.90
|
| Rate for Payer: Blue Shield of California EPN |
$2,542.74
|
| Rate for Payer: Cash Price |
$1,959.30
|
| Rate for Payer: Cash Price |
$1,959.30
|
| Rate for Payer: Cigna of CA HMO |
$2,786.56
|
| Rate for Payer: Cigna of CA PPO |
$3,221.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.27
|
| Rate for Payer: Dignity Health Media |
$510.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$510.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$510.18
|
| Rate for Payer: Galaxy Health WC |
$3,700.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,612.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,265.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$836.70
|
| Rate for Payer: Heritage Provider Network Transplant |
$836.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$826.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$826.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,904.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,044.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$642.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$683.64
|
| Rate for Payer: Multiplan Commercial |
$3,483.20
|
| Rate for Payer: Networks By Design Commercial |
$2,830.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,700.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,612.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,612.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,177.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,177.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,177.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,177.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.20
|
| Rate for Payer: Vantage Medical Group Senior |
$510.18
|
|
|
HC THERMODILUTION CONG EVAL DEFECTS
|
Facility
|
OP
|
$3,517.00
|
|
|
Service Code
|
CPT 93598
|
| Hospital Charge Code |
906811598
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$844.08 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,306.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,989.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,934.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,934.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,095.43
|
| Rate for Payer: Blue Distinction Transplant |
$2,110.20
|
| 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 |
$1,582.65
|
| Rate for Payer: Cash Price |
$1,582.65
|
| Rate for Payer: Cash Price |
$1,582.65
|
| Rate for Payer: Cigna of CA PPO |
$2,602.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,989.45
|
| Rate for Payer: Dignity Health Media |
$2,989.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,989.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,406.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,406.80
|
| Rate for Payer: Galaxy Health WC |
$2,989.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,110.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,637.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,345.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$844.08
|
| Rate for Payer: Multiplan Commercial |
$2,813.60
|
| Rate for Payer: Networks By Design Commercial |
$2,286.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,989.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,110.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,110.20
|
| 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 |
$2,989.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,989.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,989.45
|
|
|
HC THERMODILUTION CONG EVAL DEFECTS
|
Facility
|
IP
|
$3,517.00
|
|
|
Service Code
|
CPT 93598
|
| Hospital Charge Code |
906811598
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$844.08 |
| Max. Negotiated Rate |
$2,989.45 |
| Rate for Payer: Cash Price |
$1,582.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,406.80
|
| Rate for Payer: Galaxy Health WC |
$2,989.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,110.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,345.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,339.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$844.08
|
| Rate for Payer: Multiplan Commercial |
$2,813.60
|
| Rate for Payer: Networks By Design Commercial |
$2,286.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,989.45
|
|
|
HC THIOCYANATE SERUM
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 84430
|
| Hospital Charge Code |
900910463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$106.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$96.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.14
|
| Rate for Payer: Blue Distinction Transplant |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$29.07
|
| Rate for Payer: Blue Shield of California EPN |
$23.04
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.44
|
| Rate for Payer: Dignity Health Media |
$11.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.63
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$33.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.07
|
| Rate for Payer: Heritage Provider Network Transplant |
$19.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$18.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.58
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.42
|
| Rate for Payer: United Healthcare All Other HMO |
$9.42
|
| Rate for Payer: United Healthcare HMO Rider |
$9.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.79
|
| Rate for Payer: Vantage Medical Group Senior |
$11.63
|
|
|
HC THORACENTESIS ASPIRATN W GUID
|
Facility
|
OP
|
$4,358.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
900200007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$175.43 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,614.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,961.10
|
| Rate for Payer: Cash Price |
$1,961.10
|
| Rate for Payer: Cigna of CA PPO |
$3,224.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$3,704.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,614.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,268.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,287.24
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,906.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,045.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$3,486.40
|
| Rate for Payer: Networks By Design Commercial |
$2,832.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,704.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,614.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC THORACENTESIS ASPIRATN W GUID
|
Facility
|
OP
|
$4,358.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
909020158
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$175.43 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,614.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,961.10
|
| Rate for Payer: Cash Price |
$1,961.10
|
| Rate for Payer: Cigna of CA PPO |
$3,224.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$3,704.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,614.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,268.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,287.24
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,906.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,045.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$3,486.40
|
| Rate for Payer: Networks By Design Commercial |
$2,832.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,704.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,614.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC THORACENTESIS ASPIRATN W GUID
|
Facility
|
IP
|
$4,358.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
909020158
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,045.92 |
| Max. Negotiated Rate |
$3,704.30 |
| Rate for Payer: Cash Price |
$1,961.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,743.20
|
| Rate for Payer: Galaxy Health WC |
$3,704.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,614.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,906.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,660.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,045.92
|
| Rate for Payer: Multiplan Commercial |
$3,486.40
|
| Rate for Payer: Networks By Design Commercial |
$2,832.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,704.30
|
|
