|
HC HAND LIMITED 2 VIEWS
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
909001518
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$642.60 |
| Rate for Payer: Adventist Health Commercial |
$151.20
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.40
|
| Rate for Payer: EPIC Health Plan Senior |
$302.40
|
| Rate for Payer: Galaxy Health WC |
$642.60
|
| Rate for Payer: Global Benefits Group Commercial |
$453.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$504.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$467.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.44
|
| Rate for Payer: Multiplan Commercial |
$604.80
|
| Rate for Payer: Networks By Design Commercial |
$491.40
|
| Rate for Payer: Prime Health Services Commercial |
$642.60
|
|
|
HC HAND LIMITED 2 VIEWS
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
909001518
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$642.60 |
| Rate for Payer: Adventist Health Commercial |
$151.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$495.86
|
| 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 |
$139.38
|
| Rate for Payer: Blue Shield of California Commercial |
$462.67
|
| Rate for Payer: Blue Shield of California EPN |
$305.42
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cigna of CA HMO |
$483.84
|
| Rate for Payer: Cigna of CA PPO |
$559.44
|
| 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 |
$642.60
|
| Rate for Payer: Global Benefits Group Commercial |
$453.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$504.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.44
|
| 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 |
$604.80
|
| Rate for Payer: Networks By Design Commercial |
$491.40
|
| Rate for Payer: Prime Health Services Commercial |
$642.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$453.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$453.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| 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 HAND MUSCLE TESTING MANUAL MCAL
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
901300025
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$55.92 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$95.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$198.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$128.15
|
| Rate for Payer: Cash Price |
$128.15
|
| Rate for Payer: Cash Price |
$128.15
|
| Rate for Payer: Cigna of CA HMO |
$149.12
|
| Rate for Payer: Cigna of CA PPO |
$172.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$198.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.20
|
| Rate for Payer: EPIC Health Plan Senior |
$93.20
|
| Rate for Payer: Galaxy Health WC |
$198.05
|
| Rate for Payer: Global Benefits Group Commercial |
$139.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$144.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$163.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$163.10
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: Networks By Design Commercial |
$151.45
|
| Rate for Payer: Prime Health Services Commercial |
$198.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$198.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.05
|
| Rate for Payer: Vantage Medical Group Senior |
$198.05
|
|
|
HC HAND MUSCLE TESTING MANUAL MCAL
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
901300025
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$46.60 |
| Max. Negotiated Rate |
$198.05 |
| Rate for Payer: Adventist Health Commercial |
$46.60
|
| Rate for Payer: Cash Price |
$128.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.20
|
| Rate for Payer: EPIC Health Plan Senior |
$93.20
|
| Rate for Payer: Galaxy Health WC |
$198.05
|
| Rate for Payer: Global Benefits Group Commercial |
$139.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$144.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.92
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: Networks By Design Commercial |
$151.45
|
| Rate for Payer: Prime Health Services Commercial |
$198.05
|
|
|
HC HAND MUSCLE TESTING MANUAL MCAL
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
900400010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.60 |
| Max. Negotiated Rate |
$198.05 |
| Rate for Payer: Adventist Health Commercial |
$46.60
|
| Rate for Payer: Cash Price |
$128.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.20
|
| Rate for Payer: EPIC Health Plan Senior |
$93.20
|
| Rate for Payer: Galaxy Health WC |
$198.05
|
| Rate for Payer: Global Benefits Group Commercial |
$139.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$144.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.92
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: Networks By Design Commercial |
$151.45
|
| Rate for Payer: Prime Health Services Commercial |
$198.05
|
|
|
HC HAND MUSCLE TESTING MANUAL MCAL
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
900400010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.92 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$95.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$198.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$128.15
|
| Rate for Payer: Cash Price |
$128.15
|
| Rate for Payer: Cash Price |
$128.15
|
| Rate for Payer: Cigna of CA HMO |
$149.12
|
| Rate for Payer: Cigna of CA PPO |
$172.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$198.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.20
|
| Rate for Payer: EPIC Health Plan Senior |
$93.20
|
| Rate for Payer: Galaxy Health WC |
$198.05
|
| Rate for Payer: Global Benefits Group Commercial |
$139.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$144.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$163.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$163.10
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: Networks By Design Commercial |
$151.45
|
| Rate for Payer: Prime Health Services Commercial |
$198.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$198.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.05
|
| Rate for Payer: Vantage Medical Group Senior |
$198.05
|
|
|
HC HAND WRIST BOTH 1 VIEW
|
Facility
|
IP
|
$1,095.00
|
|
|
Service Code
|
CPT 73120 50
|
| Hospital Charge Code |
909073120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$930.75 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Cash Price |
$602.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$730.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.80
|
| Rate for Payer: Multiplan Commercial |
$876.00
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
|
|
HC HAND WRIST BOTH 1 VIEW
|
Facility
|
OP
|
$1,095.00
|
|
|
Service Code
|
CPT 73120 50
|
| Hospital Charge Code |
909073120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$930.75 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$718.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$602.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$821.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.38
|
| Rate for Payer: Blue Shield of California Commercial |
$670.14
|
| Rate for Payer: Blue Shield of California EPN |
$442.38
|
| Rate for Payer: Cash Price |
$602.25
|
| Rate for Payer: Cash Price |
$602.25
|
| Rate for Payer: Cigna of CA HMO |
$700.80
|
| Rate for Payer: Cigna of CA PPO |
$810.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$930.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$930.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$930.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$730.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$766.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$766.50
|
| Rate for Payer: Multiplan Commercial |
$876.00
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$657.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$930.75
|
| Rate for Payer: Vantage Medical Group Senior |
$930.75
|
|
|
HC HAPTOGLOBIN
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
900910844
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$137.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.22
|
| Rate for Payer: Blue Shield of California Commercial |
$140.49
|
| Rate for Payer: Blue Shield of California EPN |
$92.82
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.98
|
| Rate for Payer: EPIC Health Plan Senior |
$12.58
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.86
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.19
|
| Rate for Payer: United Healthcare All Other HMO |
$10.19
|
| Rate for Payer: United Healthcare HMO Rider |
$10.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.84
|
| Rate for Payer: Vantage Medical Group Senior |
$12.58
|
|
|
HC HAPTOGLOBIN
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
900910844
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
|
|
HC HARD PROTECT HELMET CUSTOM
|
Facility
|
IP
|
$4,460.00
|
|
|
Service Code
|
CPT A8003
|
| Hospital Charge Code |
915350101
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$892.00 |
| Max. Negotiated Rate |
$3,791.00 |
| Rate for Payer: Adventist Health Commercial |
$892.00
|
| Rate for Payer: Cash Price |
$2,453.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,784.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,784.00
|
| Rate for Payer: Galaxy Health WC |
$3,791.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,676.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,974.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,699.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,760.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,070.40
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: Networks By Design Commercial |
$2,899.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,791.00
|
|
|
HC HARD PROTECT HELMET CUSTOM
|
Facility
|
IP
|
$4,460.00
|
|
|
Service Code
|
CPT A8003
|
| Hospital Charge Code |
905350101
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$892.00 |
| Max. Negotiated Rate |
$3,791.00 |
| Rate for Payer: Adventist Health Commercial |
$892.00
|
| Rate for Payer: Cash Price |
$2,453.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,784.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,784.00
|
| Rate for Payer: Galaxy Health WC |
$3,791.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,676.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,974.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,699.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,760.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,070.40
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: Networks By Design Commercial |
$2,899.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,791.00
|
|
|
HC HARD PROTECT HELMET CUSTOM
|
Facility
|
OP
|
$4,460.00
|
|
|
Service Code
|
CPT A8003
|
| Hospital Charge Code |
915350101
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$892.00 |
| Max. Negotiated Rate |
$3,791.00 |
| Rate for Payer: Adventist Health Commercial |
$892.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,925.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,791.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,453.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,345.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,738.89
|
| Rate for Payer: Cash Price |
$2,453.00
|
| Rate for Payer: Cigna of CA HMO |
$2,854.40
|
| Rate for Payer: Cigna of CA PPO |
$3,300.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,791.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,791.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,791.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,784.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,784.00
|
| Rate for Payer: Galaxy Health WC |
$3,791.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,676.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,974.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,760.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,070.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,122.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,122.00
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: Networks By Design Commercial |
$2,899.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,791.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,676.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,676.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,230.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,230.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,230.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,230.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,791.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,791.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,791.00
|
|
|
HC HARD PROTECT HELMET CUSTOM
|
Facility
|
OP
|
$4,460.00
|
|
|
Service Code
|
CPT A8003
|
| Hospital Charge Code |
905350101
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$892.00 |
| Max. Negotiated Rate |
$3,791.00 |
| Rate for Payer: Adventist Health Commercial |
$892.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,925.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,791.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,453.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,345.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,738.89
|
| Rate for Payer: Cash Price |
$2,453.00
|
| Rate for Payer: Cigna of CA HMO |
$2,854.40
|
| Rate for Payer: Cigna of CA PPO |
$3,300.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,791.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,791.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,791.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,784.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,784.00
|
| Rate for Payer: Galaxy Health WC |
$3,791.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,676.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,974.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,760.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,070.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,122.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,122.00
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: Networks By Design Commercial |
$2,899.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,791.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,676.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,676.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,230.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,230.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,230.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,230.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,791.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,791.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,791.00
|
|
|
HC HARVEST THAW WO WASHING
|
Facility
|
IP
|
$666.00
|
|
|
Service Code
|
CPT 38208
|
| Hospital Charge Code |
900904699
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$566.10 |
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.40
|
| Rate for Payer: EPIC Health Plan Senior |
$266.40
|
| Rate for Payer: Galaxy Health WC |
$566.10
|
| Rate for Payer: Global Benefits Group Commercial |
$399.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$444.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$412.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.84
|
| Rate for Payer: Multiplan Commercial |
$532.80
|
| Rate for Payer: Networks By Design Commercial |
$432.90
|
| Rate for Payer: Prime Health Services Commercial |
$566.10
|
|
|
HC HARVEST THAW WO WASHING
|
Facility
|
OP
|
$666.00
|
|
|
Service Code
|
CPT 38208
|
| Hospital Charge Code |
900904699
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$436.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$445.55
|
| Rate for Payer: Blue Shield of California EPN |
$294.37
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cigna of CA HMO |
$426.24
|
| Rate for Payer: Cigna of CA PPO |
$492.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| Rate for Payer: Galaxy Health WC |
$566.10
|
| Rate for Payer: Global Benefits Group Commercial |
$399.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$444.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$699.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| Rate for Payer: Multiplan Commercial |
$532.80
|
| Rate for Payer: Networks By Design Commercial |
$432.90
|
| Rate for Payer: Prime Health Services Commercial |
$566.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$399.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$399.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$333.00
|
| Rate for Payer: United Healthcare All Other HMO |
$333.00
|
| Rate for Payer: United Healthcare HMO Rider |
$333.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$333.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC HAST
|
Facility
|
IP
|
$1,003.00
|
|
|
Service Code
|
CPT 94452
|
| Hospital Charge Code |
900801034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$200.60 |
| Max. Negotiated Rate |
$852.55 |
| Rate for Payer: Adventist Health Commercial |
$200.60
|
| Rate for Payer: Cash Price |
$551.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.20
|
| Rate for Payer: EPIC Health Plan Senior |
$401.20
|
| Rate for Payer: Galaxy Health WC |
$852.55
|
| Rate for Payer: Global Benefits Group Commercial |
$601.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$620.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.72
|
| Rate for Payer: Multiplan Commercial |
$802.40
|
| Rate for Payer: Networks By Design Commercial |
$651.95
|
| Rate for Payer: Prime Health Services Commercial |
$852.55
|
|
|
HC HAST
|
Facility
|
OP
|
$1,003.00
|
|
|
Service Code
|
CPT 94452
|
| Hospital Charge Code |
900801034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$163.78 |
| Max. Negotiated Rate |
$852.55 |
| Rate for Payer: Adventist Health Commercial |
$200.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$657.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$615.94
|
| Rate for Payer: Blue Shield of California Commercial |
$613.84
|
| Rate for Payer: Blue Shield of California EPN |
$405.21
|
| Rate for Payer: Cash Price |
$551.65
|
| Rate for Payer: Cash Price |
$551.65
|
| Rate for Payer: Cash Price |
$551.65
|
| Rate for Payer: Cigna of CA HMO |
$641.92
|
| Rate for Payer: Cigna of CA PPO |
$742.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$852.55
|
| Rate for Payer: Global Benefits Group Commercial |
$601.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$802.40
|
| Rate for Payer: Networks By Design Commercial |
$651.95
|
| Rate for Payer: Prime Health Services Commercial |
$852.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$601.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$601.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC HAST W/02 TITRATE
|
Facility
|
IP
|
$943.00
|
|
|
Service Code
|
CPT 94453
|
| Hospital Charge Code |
900801035
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$188.60 |
| Max. Negotiated Rate |
$801.55 |
| Rate for Payer: Adventist Health Commercial |
$188.60
|
| Rate for Payer: Cash Price |
$518.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.20
|
| Rate for Payer: EPIC Health Plan Senior |
$377.20
|
| Rate for Payer: Galaxy Health WC |
$801.55
|
| Rate for Payer: Global Benefits Group Commercial |
$565.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$628.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.32
|
| Rate for Payer: Multiplan Commercial |
$754.40
|
| Rate for Payer: Networks By Design Commercial |
$612.95
|
| Rate for Payer: Prime Health Services Commercial |
$801.55
|
|
|
HC HAST W/02 TITRATE
|
Facility
|
OP
|
$943.00
|
|
|
Service Code
|
CPT 94453
|
| Hospital Charge Code |
900801035
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$163.78 |
| Max. Negotiated Rate |
$801.55 |
| Rate for Payer: Adventist Health Commercial |
$188.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$618.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$579.10
|
| Rate for Payer: Blue Shield of California Commercial |
$577.12
|
| Rate for Payer: Blue Shield of California EPN |
$380.97
|
| Rate for Payer: Cash Price |
$518.65
|
| Rate for Payer: Cash Price |
$518.65
|
| Rate for Payer: Cash Price |
$518.65
|
| Rate for Payer: Cigna of CA HMO |
$603.52
|
| Rate for Payer: Cigna of CA PPO |
$697.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$801.55
|
| Rate for Payer: Global Benefits Group Commercial |
$565.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$628.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$754.40
|
| Rate for Payer: Networks By Design Commercial |
$612.95
|
| Rate for Payer: Prime Health Services Commercial |
$801.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$565.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$565.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC HBO THERAPY INTL 15 MIN INCREM
|
Facility
|
OP
|
$682.00
|
|
| Hospital Charge Code |
900803110
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$3,863.00 |
| Rate for Payer: Adventist Health Commercial |
$136.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$447.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$375.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$511.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Cash Price |
$375.10
|
| Rate for Payer: Cash Price |
$375.10
|
| Rate for Payer: Cash Price |
$375.10
|
| Rate for Payer: Cigna of CA HMO |
$436.48
|
| Rate for Payer: Cigna of CA PPO |
$504.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$579.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$579.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.80
|
| Rate for Payer: EPIC Health Plan Senior |
$272.80
|
| Rate for Payer: Galaxy Health WC |
$579.70
|
| Rate for Payer: Global Benefits Group Commercial |
$409.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$454.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$259.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$422.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$477.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$477.40
|
| Rate for Payer: Multiplan Commercial |
$545.60
|
| Rate for Payer: Networks By Design Commercial |
$443.30
|
| Rate for Payer: Prime Health Services Commercial |
$579.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$409.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$409.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,863.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,314.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,510.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$579.70
|
| Rate for Payer: Vantage Medical Group Senior |
$579.70
|
|
|
HC HBO THERAPY INTL 15 MIN INCREM
|
Facility
|
IP
|
$682.00
|
|
| Hospital Charge Code |
900803110
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$579.70 |
| Rate for Payer: Adventist Health Commercial |
$136.40
|
| Rate for Payer: Cash Price |
$375.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.80
|
| Rate for Payer: EPIC Health Plan Senior |
$272.80
|
| Rate for Payer: Galaxy Health WC |
$579.70
|
| Rate for Payer: Global Benefits Group Commercial |
$409.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$454.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$259.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$422.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.68
|
| Rate for Payer: Multiplan Commercial |
$545.60
|
| Rate for Payer: Networks By Design Commercial |
$443.30
|
| Rate for Payer: Prime Health Services Commercial |
$579.70
|
|
|
HC HBO THERAPY PER 30 MINUTES
|
Facility
|
IP
|
$1,448.00
|
|
|
Service Code
|
CPT G0277
|
| Hospital Charge Code |
900803100
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$289.60 |
| Max. Negotiated Rate |
$1,230.80 |
| Rate for Payer: Adventist Health Commercial |
$289.60
|
| Rate for Payer: Cash Price |
$796.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$579.20
|
| Rate for Payer: EPIC Health Plan Senior |
$579.20
|
| Rate for Payer: Galaxy Health WC |
$1,230.80
|
| Rate for Payer: Global Benefits Group Commercial |
$868.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$965.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$551.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$896.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.52
|
| Rate for Payer: Multiplan Commercial |
$1,158.40
|
| Rate for Payer: Networks By Design Commercial |
$941.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,230.80
|
|
|
HC HBO THERAPY PER 30 MINUTES
|
Facility
|
OP
|
$1,448.00
|
|
|
Service Code
|
CPT G0277
|
| Hospital Charge Code |
900803100
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$175.22 |
| Max. Negotiated Rate |
$3,863.00 |
| Rate for Payer: Adventist Health Commercial |
$289.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$949.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$262.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$175.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Cash Price |
$796.40
|
| Rate for Payer: Cash Price |
$796.40
|
| Rate for Payer: Cash Price |
$796.40
|
| Rate for Payer: Cash Price |
$796.40
|
| Rate for Payer: Cigna of CA HMO |
$926.72
|
| Rate for Payer: Cigna of CA PPO |
$1,071.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$262.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$175.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.55
|
| Rate for Payer: EPIC Health Plan Senior |
$175.22
|
| Rate for Payer: Galaxy Health WC |
$1,230.80
|
| Rate for Payer: Global Benefits Group Commercial |
$868.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$287.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$175.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$965.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$551.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$175.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$220.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$234.79
|
| Rate for Payer: Multiplan Commercial |
$1,158.40
|
| Rate for Payer: Networks By Design Commercial |
$941.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,230.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$868.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$868.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,863.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,314.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,510.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,298.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$175.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$262.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.74
|
| Rate for Payer: Vantage Medical Group Senior |
$175.22
|
|
|
HC HBO THERAPY SUB 15 MIN INCREM
|
Facility
|
OP
|
$682.00
|
|
| Hospital Charge Code |
900803111
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$3,863.00 |
| Rate for Payer: Adventist Health Commercial |
$136.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$447.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$375.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$511.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Cash Price |
$375.10
|
| Rate for Payer: Cash Price |
$375.10
|
| Rate for Payer: Cash Price |
$375.10
|
| Rate for Payer: Cigna of CA HMO |
$436.48
|
| Rate for Payer: Cigna of CA PPO |
$504.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$579.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$579.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.80
|
| Rate for Payer: EPIC Health Plan Senior |
$272.80
|
| Rate for Payer: Galaxy Health WC |
$579.70
|
| Rate for Payer: Global Benefits Group Commercial |
$409.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$454.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$259.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$422.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$477.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$477.40
|
| Rate for Payer: Multiplan Commercial |
$545.60
|
| Rate for Payer: Networks By Design Commercial |
$443.30
|
| Rate for Payer: Prime Health Services Commercial |
$579.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$409.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$409.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,863.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,314.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,510.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$579.70
|
| Rate for Payer: Vantage Medical Group Senior |
$579.70
|
|
