|
HC FETAL CORD OCCLUS ADDL FETUS
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 59072
|
| Hospital Charge Code |
910400091
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$399.50 |
| Rate for Payer: EPIC Health Plan Commercial |
$188.00
|
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: EPIC Health Plan Senior |
$188.00
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$313.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.80
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
|
|
HC FETAL CORD OCCLUS ADDL FETUS
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 59072
|
| Hospital Charge Code |
910400091
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$7,885.00 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Cigna of CA HMO |
$300.80
|
| Rate for Payer: Cigna of CA PPO |
$347.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$742.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$313.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$839.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$282.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$282.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$235.00
|
| Rate for Payer: United Healthcare All Other HMO |
$235.00
|
| Rate for Payer: United Healthcare HMO Rider |
$235.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC FETAL CORD OCCLUSION
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 59072
|
| Hospital Charge Code |
910400090
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$399.50 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$188.00
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$313.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.80
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
|
|
HC FETAL CORD OCCLUSION
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 59072
|
| Hospital Charge Code |
910400090
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$7,885.00 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Cigna of CA HMO |
$300.80
|
| Rate for Payer: Cigna of CA PPO |
$347.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$742.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$313.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$839.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$282.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$282.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$235.00
|
| Rate for Payer: United Healthcare All Other HMO |
$235.00
|
| Rate for Payer: United Healthcare HMO Rider |
$235.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC FETAL DOPPLER MID CEREBRAL ART
|
Facility
|
OP
|
$1,418.00
|
|
|
Service Code
|
CPT 76821
|
| Hospital Charge Code |
906601316
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$1,205.30 |
| Rate for Payer: Adventist Health Commercial |
$283.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$930.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$870.79
|
| Rate for Payer: Blue Shield of California Commercial |
$867.82
|
| Rate for Payer: Blue Shield of California EPN |
$572.87
|
| Rate for Payer: Cash Price |
$779.90
|
| Rate for Payer: Cash Price |
$779.90
|
| Rate for Payer: Cigna of CA HMO |
$907.52
|
| Rate for Payer: Cigna of CA PPO |
$1,049.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,205.30
|
| Rate for Payer: Global Benefits Group Commercial |
$850.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$140.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$945.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,134.40
|
| Rate for Payer: Networks By Design Commercial |
$921.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,205.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$850.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$850.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC FETAL DOPPLER MID CEREBRAL ART
|
Facility
|
IP
|
$1,418.00
|
|
|
Service Code
|
CPT 76821
|
| Hospital Charge Code |
906601316
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$283.60 |
| Max. Negotiated Rate |
$1,205.30 |
| Rate for Payer: Adventist Health Commercial |
$283.60
|
| Rate for Payer: Cash Price |
$779.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$567.20
|
| Rate for Payer: EPIC Health Plan Senior |
$567.20
|
| Rate for Payer: Galaxy Health WC |
$1,205.30
|
| Rate for Payer: Global Benefits Group Commercial |
$850.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$945.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$540.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$877.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.32
|
| Rate for Payer: Multiplan Commercial |
$1,134.40
|
| Rate for Payer: Networks By Design Commercial |
$921.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,205.30
|
|
|
HC FETAL DOPPLER UMBILICAL ARTERY
|
Facility
|
IP
|
$1,493.00
|
|
|
Service Code
|
CPT 76820
|
| Hospital Charge Code |
906601315
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$298.60 |
| Max. Negotiated Rate |
$1,269.05 |
| Rate for Payer: Adventist Health Commercial |
$298.60
|
| Rate for Payer: Cash Price |
$821.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$597.20
|
| Rate for Payer: EPIC Health Plan Senior |
$597.20
|
| Rate for Payer: Galaxy Health WC |
$1,269.05
|
| Rate for Payer: Global Benefits Group Commercial |
$895.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$995.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$568.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$924.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.32
|
| Rate for Payer: Multiplan Commercial |
$1,194.40
|
| Rate for Payer: Networks By Design Commercial |
$970.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,269.05
|
|
|
HC FETAL DOPPLER UMBILICAL ARTERY
|
Facility
|
OP
|
$1,493.00
|
|
|
Service Code
|
CPT 76820
|
| Hospital Charge Code |
906601315
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$65.07 |
| Max. Negotiated Rate |
$1,269.05 |
| Rate for Payer: Adventist Health Commercial |
$298.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$979.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$916.85
|
| Rate for Payer: Blue Shield of California Commercial |
$913.72
|
| Rate for Payer: Blue Shield of California EPN |
$603.17
|
| Rate for Payer: Cash Price |
$821.15
|
| Rate for Payer: Cash Price |
$821.15
|
| Rate for Payer: Cigna of CA HMO |
$955.52
|
| Rate for Payer: Cigna of CA PPO |
$1,104.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,269.05
|
| Rate for Payer: Global Benefits Group Commercial |
$895.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$995.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,194.40
|
| Rate for Payer: Networks By Design Commercial |
$970.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,269.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$895.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$895.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC FETAL FIBRONECTIN
|
Facility
|
OP
|
$1,778.00
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
900912319
|
|
Hospital Revenue Code
|
304
|
| Min. Negotiated Rate |
$52.17 |
| Max. Negotiated Rate |
$1,511.30 |
| Rate for Payer: Adventist Health Commercial |
$355.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,166.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,329.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1,189.48
|
| Rate for Payer: Blue Shield of California EPN |
$785.88
|
| Rate for Payer: Cash Price |
$977.90
|
| Rate for Payer: Cash Price |
$977.90
|
| Rate for Payer: Cigna of CA HMO |
$1,137.92
|
| Rate for Payer: Cigna of CA PPO |
$1,315.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.95
|
| Rate for Payer: EPIC Health Plan Senior |
$64.41
|
| Rate for Payer: Galaxy Health WC |
$1,511.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,066.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,185.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$426.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$81.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86.31
|
| Rate for Payer: Multiplan Commercial |
$1,422.40
|
| Rate for Payer: Networks By Design Commercial |
$1,155.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,511.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,066.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,066.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.17
|
| Rate for Payer: United Healthcare All Other HMO |
$52.17
|
| Rate for Payer: United Healthcare HMO Rider |
$52.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.17
|
| Rate for Payer: Upland Medical Group Pediatric |
$64.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.85
|
| Rate for Payer: Vantage Medical Group Senior |
$64.41
|
|
|
HC FETAL FIBRONECTIN
|
Facility
|
IP
|
$1,778.00
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
900912319
|
|
Hospital Revenue Code
|
304
|
| Min. Negotiated Rate |
$355.60 |
| Max. Negotiated Rate |
$1,511.30 |
| Rate for Payer: Adventist Health Commercial |
$355.60
|
| Rate for Payer: Cash Price |
$977.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.20
|
| Rate for Payer: EPIC Health Plan Senior |
$711.20
|
| Rate for Payer: Galaxy Health WC |
$1,511.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,066.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,185.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$677.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,100.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$426.72
|
| Rate for Payer: Multiplan Commercial |
$1,422.40
|
| Rate for Payer: Networks By Design Commercial |
$1,155.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,511.30
|
|
|
HC FETAL FLUID DRAIN INCLUD US GU
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT 59074
|
| Hospital Charge Code |
910400098
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$476.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.40
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Networks By Design Commercial |
$364.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
|
|
HC FETAL FLUID DRAIN INCLUD US GU
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT 59074
|
| Hospital Charge Code |
910400098
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cigna of CA HMO |
$358.40
|
| Rate for Payer: Cigna of CA PPO |
$414.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$527.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$596.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Networks By Design Commercial |
$364.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$336.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$280.00
|
| Rate for Payer: United Healthcare All Other HMO |
$280.00
|
| Rate for Payer: United Healthcare HMO Rider |
$280.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$280.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC FETAL FLUID DRAIN INCLUD US GU
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT 59074
|
| Hospital Charge Code |
910400098
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cigna of CA HMO |
$358.40
|
| Rate for Payer: Cigna of CA PPO |
$414.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$527.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$596.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Networks By Design Commercial |
$364.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$336.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC FETAL FLUID DRAIN INCLUD US GU
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT 59074
|
| Hospital Charge Code |
910400098
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$476.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.40
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Networks By Design Commercial |
$364.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
|
|
HC FETAL INTRACARDIAC INJ
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 59897
|
| Hospital Charge Code |
910159897
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$101.80 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$312.58
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Cigna of CA HMO |
$325.76
|
| Rate for Payer: Cigna of CA PPO |
$376.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$383.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.07
|
| Rate for Payer: EPIC Health Plan Senior |
$255.61
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$419.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$255.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$322.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$342.52
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: Multiplan WC |
$407.27
|
| Rate for Payer: Networks By Design Commercial |
$330.85
|
| Rate for Payer: Prime Health Services Commercial |
$432.65
|
| Rate for Payer: Prime Health Services WC |
$403.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$305.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$255.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Vantage Medical Group Senior |
$255.61
|
|
|
HC FETAL INTRACARDIAC INJ
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 59897
|
| Hospital Charge Code |
910159897
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$101.80 |
| Max. Negotiated Rate |
$432.65 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.60
|
| Rate for Payer: EPIC Health Plan Senior |
$203.60
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.16
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: Networks By Design Commercial |
$330.85
|
| Rate for Payer: Prime Health Services Commercial |
$432.65
|
|
|
HC FETAL LUNG MATURITY (FLM)
|
Facility
|
IP
|
$538.00
|
|
|
Service Code
|
CPT 83663
|
| Hospital Charge Code |
900910962
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$107.60 |
| Max. Negotiated Rate |
$457.30 |
| Rate for Payer: Adventist Health Commercial |
$107.60
|
| Rate for Payer: Cash Price |
$295.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.20
|
| Rate for Payer: EPIC Health Plan Senior |
$215.20
|
| Rate for Payer: Galaxy Health WC |
$457.30
|
| Rate for Payer: Global Benefits Group Commercial |
$322.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$358.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$333.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.12
|
| Rate for Payer: Multiplan Commercial |
$430.40
|
| Rate for Payer: Networks By Design Commercial |
$349.70
|
| Rate for Payer: Prime Health Services Commercial |
$457.30
|
|
|
HC FETAL LUNG MATURITY (FLM)
|
Facility
|
OP
|
$538.00
|
|
|
Service Code
|
CPT 83663
|
| Hospital Charge Code |
900910962
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$457.30 |
| Rate for Payer: Adventist Health Commercial |
$107.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.36
|
| Rate for Payer: Blue Shield of California Commercial |
$359.92
|
| Rate for Payer: Blue Shield of California EPN |
$237.80
|
| Rate for Payer: Cash Price |
$295.90
|
| Rate for Payer: Cash Price |
$295.90
|
| Rate for Payer: Cigna of CA HMO |
$344.32
|
| Rate for Payer: Cigna of CA PPO |
$398.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.53
|
| Rate for Payer: EPIC Health Plan Senior |
$18.91
|
| Rate for Payer: Galaxy Health WC |
$457.30
|
| Rate for Payer: Global Benefits Group Commercial |
$322.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$358.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.34
|
| Rate for Payer: Multiplan Commercial |
$430.40
|
| Rate for Payer: Networks By Design Commercial |
$349.70
|
| Rate for Payer: Prime Health Services Commercial |
$457.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$322.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$322.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.32
|
| Rate for Payer: United Healthcare All Other HMO |
$15.32
|
| Rate for Payer: United Healthcare HMO Rider |
$15.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.32
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.80
|
| Rate for Payer: Vantage Medical Group Senior |
$18.91
|
|
|
HC FETAL MONITOR CONT HRLY
|
Facility
|
IP
|
$41.00
|
|
| Hospital Charge Code |
902400355
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$34.85 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
|
|
HC FETAL MONITOR CONT HRLY
|
Facility
|
OP
|
$41.00
|
|
| Hospital Charge Code |
902400355
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$1,091.00 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.18
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cigna of CA HMO |
$26.24
|
| Rate for Payer: Cigna of CA PPO |
$30.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.85
|
| Rate for Payer: Vantage Medical Group Senior |
$34.85
|
|
|
HC FETAL NON-STRESS TEST
|
Facility
|
OP
|
$1,360.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
902400362
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$38.30 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$272.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$892.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cigna of CA HMO |
$870.40
|
| Rate for Payer: Cigna of CA PPO |
$1,006.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$383.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.07
|
| Rate for Payer: EPIC Health Plan Senior |
$255.61
|
| Rate for Payer: Galaxy Health WC |
$1,156.00
|
| Rate for Payer: Global Benefits Group Commercial |
$816.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$419.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$255.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$907.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$322.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$342.52
|
| Rate for Payer: Multiplan Commercial |
$1,088.00
|
| Rate for Payer: Networks By Design Commercial |
$884.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,156.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$816.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$816.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$255.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Vantage Medical Group Senior |
$255.61
|
|
|
HC FETAL NON-STRESS TEST
|
Facility
|
IP
|
$1,360.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
902400362
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$272.00 |
| Max. Negotiated Rate |
$1,156.00 |
| Rate for Payer: Adventist Health Commercial |
$272.00
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$544.00
|
| Rate for Payer: EPIC Health Plan Senior |
$544.00
|
| Rate for Payer: Galaxy Health WC |
$1,156.00
|
| Rate for Payer: Global Benefits Group Commercial |
$816.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$907.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$518.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$841.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.40
|
| Rate for Payer: Multiplan Commercial |
$1,088.00
|
| Rate for Payer: Networks By Design Commercial |
$884.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,156.00
|
|
|
HC FETAL NON-STRESS TEST ADDL FETUS
|
Facility
|
OP
|
$1,360.00
|
|
|
Service Code
|
CPT 59025 59
|
| Hospital Charge Code |
910400087
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.70 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$272.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$892.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,156.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$748.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,020.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cigna of CA HMO |
$870.40
|
| Rate for Payer: Cigna of CA PPO |
$1,006.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,156.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,156.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,156.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$544.00
|
| Rate for Payer: EPIC Health Plan Senior |
$544.00
|
| Rate for Payer: Galaxy Health WC |
$1,156.00
|
| Rate for Payer: Global Benefits Group Commercial |
$816.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$907.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$841.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$952.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$952.00
|
| Rate for Payer: Multiplan Commercial |
$1,088.00
|
| Rate for Payer: Networks By Design Commercial |
$884.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,156.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$816.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$816.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$680.00
|
| Rate for Payer: United Healthcare All Other HMO |
$680.00
|
| Rate for Payer: United Healthcare HMO Rider |
$680.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$680.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,156.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,156.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,156.00
|
|
|
HC FETAL NON-STRESS TEST ADDL FETUS
|
Facility
|
IP
|
$1,360.00
|
|
|
Service Code
|
CPT 59025 59
|
| Hospital Charge Code |
910400087
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$272.00 |
| Max. Negotiated Rate |
$1,156.00 |
| Rate for Payer: Adventist Health Commercial |
$272.00
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$544.00
|
| Rate for Payer: EPIC Health Plan Senior |
$544.00
|
| Rate for Payer: Galaxy Health WC |
$1,156.00
|
| Rate for Payer: Global Benefits Group Commercial |
$816.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$907.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$518.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$841.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.40
|
| Rate for Payer: Multiplan Commercial |
$1,088.00
|
| Rate for Payer: Networks By Design Commercial |
$884.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,156.00
|
|
|
HC FETAL NON-STRESS TEST SINGLE FETUS
|
Facility
|
OP
|
$1,360.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
910400086
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.30 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$272.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$892.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cigna of CA HMO |
$870.40
|
| Rate for Payer: Cigna of CA PPO |
$1,006.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$383.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.07
|
| Rate for Payer: EPIC Health Plan Senior |
$255.61
|
| Rate for Payer: Galaxy Health WC |
$1,156.00
|
| Rate for Payer: Global Benefits Group Commercial |
$816.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$419.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$255.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$907.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$322.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$342.52
|
| Rate for Payer: Multiplan Commercial |
$1,088.00
|
| Rate for Payer: Networks By Design Commercial |
$884.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,156.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$816.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$816.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$680.00
|
| Rate for Payer: United Healthcare All Other HMO |
$680.00
|
| Rate for Payer: United Healthcare HMO Rider |
$680.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$680.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$255.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Vantage Medical Group Senior |
$255.61
|
|
