|
HC NUTR THER INIT EVAL 30 MN MCAL
|
Facility
|
OP
|
$135.00
|
|
| Hospital Charge Code |
902000206
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.90
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna of CA HMO |
$86.40
|
| Rate for Payer: Cigna of CA PPO |
$99.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$94.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.50
|
| Rate for Payer: United Healthcare All Other HMO |
$67.50
|
| Rate for Payer: United Healthcare HMO Rider |
$67.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$67.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.75
|
| Rate for Payer: Vantage Medical Group Senior |
$114.75
|
|
|
HC NUTR THER INIT EVAL 30 MN MCAL
|
Facility
|
IP
|
$135.00
|
|
| Hospital Charge Code |
902000206
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
|
|
HC NUTR THER-RE EVAL 15 MIN
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
902000201
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$43.86 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$84.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$175.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$113.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$155.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.12
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cigna of CA HMO |
$132.48
|
| Rate for Payer: Cigna of CA PPO |
$153.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$175.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$175.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.80
|
| Rate for Payer: EPIC Health Plan Senior |
$82.80
|
| Rate for Payer: Galaxy Health WC |
$175.95
|
| Rate for Payer: Global Benefits Group Commercial |
$124.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$144.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$144.90
|
| Rate for Payer: Multiplan Commercial |
$165.60
|
| Rate for Payer: Networks By Design Commercial |
$134.55
|
| Rate for Payer: Prime Health Services Commercial |
$175.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$124.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$124.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$175.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.95
|
| Rate for Payer: Vantage Medical Group Senior |
$175.95
|
|
|
HC NUTR THER-RE EVAL 15 MIN
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
902000201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$175.95 |
| Rate for Payer: Adventist Health Commercial |
$41.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$175.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$113.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$155.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.12
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cigna of CA HMO |
$132.48
|
| Rate for Payer: Cigna of CA PPO |
$153.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$175.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$175.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.80
|
| Rate for Payer: EPIC Health Plan Senior |
$82.80
|
| Rate for Payer: Galaxy Health WC |
$175.95
|
| Rate for Payer: Global Benefits Group Commercial |
$124.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$144.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$144.90
|
| Rate for Payer: Multiplan Commercial |
$165.60
|
| Rate for Payer: Networks By Design Commercial |
$134.55
|
| Rate for Payer: Prime Health Services Commercial |
$175.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$124.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$124.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.50
|
| Rate for Payer: United Healthcare All Other HMO |
$103.50
|
| Rate for Payer: United Healthcare HMO Rider |
$103.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$103.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$175.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.95
|
| Rate for Payer: Vantage Medical Group Senior |
$175.95
|
|
|
HC NUTR THER-RE EVAL 15 MIN
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
902000201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$175.95 |
| Rate for Payer: Adventist Health Commercial |
$41.40
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.80
|
| Rate for Payer: EPIC Health Plan Senior |
$82.80
|
| Rate for Payer: Galaxy Health WC |
$175.95
|
| Rate for Payer: Global Benefits Group Commercial |
$124.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.68
|
| Rate for Payer: Multiplan Commercial |
$165.60
|
| Rate for Payer: Networks By Design Commercial |
$134.55
|
| Rate for Payer: Prime Health Services Commercial |
$175.95
|
|
|
HC NUTR THER-RE EVAL 15 MIN
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
902000201
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$175.95 |
| Rate for Payer: Adventist Health Commercial |
$41.40
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.80
|
| Rate for Payer: EPIC Health Plan Senior |
$82.80
|
| Rate for Payer: Galaxy Health WC |
$175.95
|
| Rate for Payer: Global Benefits Group Commercial |
$124.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.68
|
| Rate for Payer: Multiplan Commercial |
$165.60
|
| Rate for Payer: Networks By Design Commercial |
$134.55
|
| Rate for Payer: Prime Health Services Commercial |
$175.95
|
|
|
HC NUTR THER-RE EVAL 30 MN MCAL
|
Facility
|
OP
|
$135.00
|
|
| Hospital Charge Code |
902000207
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$55.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.90
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna of CA HMO |
$86.40
|
| Rate for Payer: Cigna of CA PPO |
$99.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$94.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.75
|
| Rate for Payer: Vantage Medical Group Senior |
$114.75
|
|
|
HC NUTR THER-RE EVAL 30 MN MCAL
|
Facility
|
IP
|
$135.00
|
|
| Hospital Charge Code |
902000207
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
|
|
HC O2 UPTAKE REST EXERCISE
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
CPT 94680
|
| Hospital Charge Code |
900801032
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$68.88 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$95.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$312.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$292.31
|
| Rate for Payer: Blue Shield of California Commercial |
$291.31
|
| Rate for Payer: Blue Shield of California EPN |
$192.30
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna of CA HMO |
$304.64
|
| Rate for Payer: Cigna of CA PPO |
$352.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$404.60
|
| Rate for Payer: Global Benefits Group Commercial |
$285.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$317.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$380.80
|
| Rate for Payer: Networks By Design Commercial |
$309.40
|
| Rate for Payer: Prime Health Services Commercial |
$404.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$285.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$285.60
|
| 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 |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC O2 UPTAKE REST EXERCISE
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
CPT 94680
|
| Hospital Charge Code |
900801032
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$95.20 |
| Max. Negotiated Rate |
$404.60 |
| Rate for Payer: Adventist Health Commercial |
$95.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.40
|
| Rate for Payer: EPIC Health Plan Senior |
$190.40
|
| Rate for Payer: Galaxy Health WC |
$404.60
|
| Rate for Payer: Global Benefits Group Commercial |
$285.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$317.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.24
|
| Rate for Payer: Multiplan Commercial |
$380.80
|
| Rate for Payer: Networks By Design Commercial |
$309.40
|
| Rate for Payer: Prime Health Services Commercial |
$404.60
|
|
|
HC O2 UPTAKE REST INDIRECT
|
Facility
|
IP
|
$443.00
|
|
|
Service Code
|
CPT 94690
|
| Hospital Charge Code |
900801015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$88.60 |
| Max. Negotiated Rate |
$376.55 |
| Rate for Payer: Adventist Health Commercial |
$88.60
|
| Rate for Payer: Cash Price |
$199.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.20
|
| Rate for Payer: EPIC Health Plan Senior |
$177.20
|
| Rate for Payer: Galaxy Health WC |
$376.55
|
| Rate for Payer: Global Benefits Group Commercial |
$265.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$295.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$274.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.32
|
| Rate for Payer: Multiplan Commercial |
$354.40
|
| Rate for Payer: Networks By Design Commercial |
$287.95
|
| Rate for Payer: Prime Health Services Commercial |
$376.55
|
|
|
HC O2 UPTAKE REST INDIRECT
|
Facility
|
OP
|
$443.00
|
|
|
Service Code
|
CPT 94690
|
| Hospital Charge Code |
900801015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$88.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$290.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$272.05
|
| Rate for Payer: Blue Shield of California Commercial |
$271.12
|
| Rate for Payer: Blue Shield of California EPN |
$178.97
|
| Rate for Payer: Cash Price |
$199.35
|
| Rate for Payer: Cash Price |
$199.35
|
| Rate for Payer: Cash Price |
$199.35
|
| Rate for Payer: Cigna of CA HMO |
$283.52
|
| Rate for Payer: Cigna of CA PPO |
$327.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$376.55
|
| Rate for Payer: Global Benefits Group Commercial |
$265.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$295.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$354.40
|
| Rate for Payer: Networks By Design Commercial |
$287.95
|
| Rate for Payer: Prime Health Services Commercial |
$376.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$265.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$265.80
|
| 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 |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC OB AIRWAY PRIMARY KIT
|
Facility
|
OP
|
$5.33
|
|
| Hospital Charge Code |
901698560
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$4.53 |
| Rate for Payer: Adventist Health Commercial |
$1.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.27
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna of CA HMO |
$3.41
|
| Rate for Payer: Cigna of CA PPO |
$3.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.13
|
| Rate for Payer: EPIC Health Plan Senior |
$2.13
|
| Rate for Payer: Galaxy Health WC |
$4.53
|
| Rate for Payer: Global Benefits Group Commercial |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.73
|
| Rate for Payer: Multiplan Commercial |
$4.26
|
| Rate for Payer: Networks By Design Commercial |
$3.46
|
| Rate for Payer: Prime Health Services Commercial |
$4.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.67
|
| Rate for Payer: United Healthcare All Other HMO |
$2.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.53
|
| Rate for Payer: Vantage Medical Group Senior |
$4.53
|
|
|
HC OB AIRWAY PRIMARY KIT
|
Facility
|
IP
|
$5.33
|
|
| Hospital Charge Code |
901698560
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$4.53 |
| Rate for Payer: Adventist Health Commercial |
$1.07
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.13
|
| Rate for Payer: EPIC Health Plan Senior |
$2.13
|
| Rate for Payer: Galaxy Health WC |
$4.53
|
| Rate for Payer: Global Benefits Group Commercial |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$4.26
|
| Rate for Payer: Networks By Design Commercial |
$3.46
|
| Rate for Payer: Prime Health Services Commercial |
$4.53
|
|
|
HC OB AIRWAY SECONDARY KIT
|
Facility
|
OP
|
$247.24
|
|
| Hospital Charge Code |
901698561
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.45 |
| Max. Negotiated Rate |
$210.15 |
| Rate for Payer: Adventist Health Commercial |
$49.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$162.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$210.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.83
|
| Rate for Payer: Cash Price |
$111.26
|
| Rate for Payer: Cigna of CA HMO |
$158.23
|
| Rate for Payer: Cigna of CA PPO |
$182.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$210.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$210.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$210.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.90
|
| Rate for Payer: EPIC Health Plan Senior |
$98.90
|
| Rate for Payer: Galaxy Health WC |
$210.15
|
| Rate for Payer: Global Benefits Group Commercial |
$148.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$153.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$197.79
|
| Rate for Payer: Networks By Design Commercial |
$160.71
|
| Rate for Payer: Prime Health Services Commercial |
$210.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$148.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$148.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.62
|
| Rate for Payer: United Healthcare All Other HMO |
$123.62
|
| Rate for Payer: United Healthcare HMO Rider |
$123.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$210.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$210.15
|
| Rate for Payer: Vantage Medical Group Senior |
$210.15
|
|
|
HC OB AIRWAY SECONDARY KIT
|
Facility
|
IP
|
$247.24
|
|
| Hospital Charge Code |
901698561
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.45 |
| Max. Negotiated Rate |
$210.15 |
| Rate for Payer: Adventist Health Commercial |
$49.45
|
| Rate for Payer: Cash Price |
$111.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.90
|
| Rate for Payer: EPIC Health Plan Senior |
$98.90
|
| Rate for Payer: Galaxy Health WC |
$210.15
|
| Rate for Payer: Global Benefits Group Commercial |
$148.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$153.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.34
|
| Rate for Payer: Multiplan Commercial |
$197.79
|
| Rate for Payer: Networks By Design Commercial |
$160.71
|
| Rate for Payer: Prime Health Services Commercial |
$210.15
|
|
|
HC OBTURATOR CAP, HEMOSTSIS 8FR
|
Facility
|
IP
|
$20.83
|
|
| Hospital Charge Code |
901698235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$17.71 |
| Rate for Payer: Adventist Health Commercial |
$4.17
|
| Rate for Payer: Cash Price |
$9.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.33
|
| Rate for Payer: EPIC Health Plan Senior |
$8.33
|
| Rate for Payer: Galaxy Health WC |
$17.71
|
| Rate for Payer: Global Benefits Group Commercial |
$12.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$16.66
|
| Rate for Payer: Networks By Design Commercial |
$13.54
|
| Rate for Payer: Prime Health Services Commercial |
$17.71
|
|
|
HC OBTURATOR CAP, HEMOSTSIS 8FR
|
Facility
|
OP
|
$20.83
|
|
| Hospital Charge Code |
901698235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$17.71 |
| Rate for Payer: Adventist Health Commercial |
$4.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.79
|
| Rate for Payer: Cash Price |
$9.37
|
| Rate for Payer: Cigna of CA HMO |
$13.33
|
| Rate for Payer: Cigna of CA PPO |
$15.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.33
|
| Rate for Payer: EPIC Health Plan Senior |
$8.33
|
| Rate for Payer: Galaxy Health WC |
$17.71
|
| Rate for Payer: Global Benefits Group Commercial |
$12.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.58
|
| Rate for Payer: Multiplan Commercial |
$16.66
|
| Rate for Payer: Networks By Design Commercial |
$13.54
|
| Rate for Payer: Prime Health Services Commercial |
$17.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.41
|
| Rate for Payer: United Healthcare All Other HMO |
$10.41
|
| Rate for Payer: United Healthcare HMO Rider |
$10.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.71
|
| Rate for Payer: Vantage Medical Group Senior |
$17.71
|
|
|
HC OB ULTRASOUND RPT/FOLLOW-UP ADDL FETUS
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
CPT 76816 59
|
| Hospital Charge Code |
906601320
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$87.09 |
| Max. Negotiated Rate |
$1,330.25 |
| Rate for Payer: Adventist Health Commercial |
$313.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,026.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,330.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$860.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,173.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$961.07
|
| Rate for Payer: Blue Shield of California Commercial |
$957.78
|
| Rate for Payer: Blue Shield of California EPN |
$632.26
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: Cigna of CA HMO |
$1,001.60
|
| Rate for Payer: Cigna of CA PPO |
$1,158.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,330.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,330.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,330.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$626.00
|
| Rate for Payer: EPIC Health Plan Senior |
$626.00
|
| Rate for Payer: Galaxy Health WC |
$1,330.25
|
| Rate for Payer: Global Benefits Group Commercial |
$939.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$87.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,043.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$968.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,095.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,095.50
|
| Rate for Payer: Multiplan Commercial |
$1,252.00
|
| Rate for Payer: Networks By Design Commercial |
$1,017.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,330.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$939.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$939.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,330.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,330.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,330.25
|
|
|
HC OB ULTRASOUND RPT/FOLLOW-UP ADDL FETUS
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
CPT 76816 59
|
| Hospital Charge Code |
906601320
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$313.00 |
| Max. Negotiated Rate |
$1,330.25 |
| Rate for Payer: Adventist Health Commercial |
$313.00
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$626.00
|
| Rate for Payer: EPIC Health Plan Senior |
$626.00
|
| Rate for Payer: Galaxy Health WC |
$1,330.25
|
| Rate for Payer: Global Benefits Group Commercial |
$939.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,043.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$596.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$968.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.60
|
| Rate for Payer: Multiplan Commercial |
$1,252.00
|
| Rate for Payer: Networks By Design Commercial |
$1,017.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,330.25
|
|
|
HC OB ULTRASOUND RPT/FOLLOW-UP SINGLE FETUS
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
906601311
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$1,330.25 |
| Rate for Payer: Adventist Health Commercial |
$313.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,026.48
|
| 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 |
$961.07
|
| Rate for Payer: Blue Shield of California Commercial |
$957.78
|
| Rate for Payer: Blue Shield of California EPN |
$632.26
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: Cigna of CA HMO |
$1,001.60
|
| Rate for Payer: Cigna of CA PPO |
$1,158.10
|
| 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 |
$1,330.25
|
| Rate for Payer: Global Benefits Group Commercial |
$939.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$173.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,043.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.60
|
| 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 |
$1,252.00
|
| Rate for Payer: Networks By Design Commercial |
$1,017.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,330.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$939.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$939.00
|
| 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 OB ULTRASOUND RPT/FOLLOW-UP SINGLE FETUS
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
906601311
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$313.00 |
| Max. Negotiated Rate |
$1,330.25 |
| Rate for Payer: Adventist Health Commercial |
$313.00
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$626.00
|
| Rate for Payer: EPIC Health Plan Senior |
$626.00
|
| Rate for Payer: Galaxy Health WC |
$1,330.25
|
| Rate for Payer: Global Benefits Group Commercial |
$939.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,043.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$596.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$968.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.60
|
| Rate for Payer: Multiplan Commercial |
$1,252.00
|
| Rate for Payer: Networks By Design Commercial |
$1,017.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,330.25
|
|
|
HC OB US AFI LMTD 1 OR MORE FETUS
|
Facility
|
IP
|
$1,640.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
910400110
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$328.00 |
| Max. Negotiated Rate |
$1,394.00 |
| Rate for Payer: Adventist Health Commercial |
$328.00
|
| Rate for Payer: Cash Price |
$738.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$656.00
|
| Rate for Payer: EPIC Health Plan Senior |
$656.00
|
| Rate for Payer: Galaxy Health WC |
$1,394.00
|
| Rate for Payer: Global Benefits Group Commercial |
$984.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,093.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$624.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,015.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.60
|
| Rate for Payer: Multiplan Commercial |
$1,312.00
|
| Rate for Payer: Networks By Design Commercial |
$1,066.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,394.00
|
|
|
HC OB US AFI LMTD 1 OR MORE FETUS
|
Facility
|
OP
|
$1,640.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
910400110
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$105.76 |
| Max. Negotiated Rate |
$1,394.00 |
| Rate for Payer: Adventist Health Commercial |
$328.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,075.68
|
| 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 |
$1,007.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1,003.68
|
| Rate for Payer: Blue Shield of California EPN |
$662.56
|
| Rate for Payer: Cash Price |
$738.00
|
| Rate for Payer: Cash Price |
$738.00
|
| Rate for Payer: Cigna of CA HMO |
$1,049.60
|
| Rate for Payer: Cigna of CA PPO |
$1,213.60
|
| 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 |
$1,394.00
|
| Rate for Payer: Global Benefits Group Commercial |
$984.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,093.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.60
|
| 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 |
$1,312.00
|
| Rate for Payer: Networks By Design Commercial |
$1,066.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,394.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$984.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$984.00
|
| 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 OCCLUSION CATHETER
|
Facility
|
OP
|
$595.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
909081214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$505.75 |
| Rate for Payer: Adventist Health Commercial |
$119.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$390.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$505.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$327.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$446.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$365.39
|
| Rate for Payer: Cash Price |
$267.75
|
| Rate for Payer: Cigna of CA HMO |
$380.80
|
| Rate for Payer: Cigna of CA PPO |
$440.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$505.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$505.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$505.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.00
|
| Rate for Payer: EPIC Health Plan Senior |
$238.00
|
| Rate for Payer: Galaxy Health WC |
$505.75
|
| Rate for Payer: Global Benefits Group Commercial |
$357.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$396.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$368.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$416.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$416.50
|
| Rate for Payer: Multiplan Commercial |
$476.00
|
| Rate for Payer: Networks By Design Commercial |
$386.75
|
| Rate for Payer: Prime Health Services Commercial |
$505.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$357.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$357.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other HMO |
$297.50
|
| Rate for Payer: United Healthcare HMO Rider |
$297.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$505.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$505.75
|
| Rate for Payer: Vantage Medical Group Senior |
$505.75
|
|
