|
HC NUTRITION THER GRP 30 MIN
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
902000205
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$144.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$131.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$122.13
|
| 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 NUTRITION THER GRP 30 MIN
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
902000205
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.37 |
| Max. Negotiated Rate |
$175.95 |
| Rate for Payer: Adventist Health Commercial |
$41.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.26
|
| 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 |
$132.83
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$144.90
|
| 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 |
$23.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$131.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$122.13
|
| 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 INIT EVAL 15 MIN
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
902000200
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$50.99 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$101.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$263.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$210.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.14
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cigna of CA HMO |
$158.72
|
| Rate for Payer: Cigna of CA PPO |
$183.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$210.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$210.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$210.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$173.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.20
|
| Rate for Payer: EPIC Health Plan Senior |
$99.20
|
| Rate for Payer: Galaxy Health WC |
$210.80
|
| Rate for Payer: Global Benefits Group Commercial |
$148.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$157.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.60
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: Networks By Design Commercial |
$161.20
|
| Rate for Payer: Prime Health Services Commercial |
$210.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$148.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$148.80
|
| 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 |
$210.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$210.80
|
| Rate for Payer: Vantage Medical Group Senior |
$210.80
|
|
|
HC NUTR THER INIT EVAL 15 MIN
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
902000200
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$49.60 |
| Max. Negotiated Rate |
$210.80 |
| Rate for Payer: Adventist Health Commercial |
$49.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$173.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.20
|
| Rate for Payer: EPIC Health Plan Senior |
$99.20
|
| Rate for Payer: Galaxy Health WC |
$210.80
|
| Rate for Payer: Global Benefits Group Commercial |
$148.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$157.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.52
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: Networks By Design Commercial |
$161.20
|
| Rate for Payer: Prime Health Services Commercial |
$210.80
|
|
|
HC NUTR THER INIT EVAL 30 MN MCAL
|
Facility
|
OP
|
$135.00
|
|
| Hospital Charge Code |
902000206
|
|
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 |
$86.63
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| 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 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 |
$86.63
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$144.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$131.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$122.13
|
| 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
|
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 |
$227.68
|
| 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 |
$132.83
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$144.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$131.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$122.13
|
| 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 |
$227.68 |
| Rate for Payer: Adventist Health Commercial |
$41.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$227.68
|
| 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 |
$132.83
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$144.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$131.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$122.13
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$144.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$131.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$122.13
|
| 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 |
$86.63
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| 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: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Adventist Health Commercial |
$95.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$339.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$305.45
|
| Rate for Payer: Blue Shield of California Commercial |
$200.40
|
| Rate for Payer: Blue Shield of California Commercial |
$303.69
|
| 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 |
$248.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$333.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$404.60
|
| Rate for Payer: Global Benefits Group Commercial |
$285.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$302.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.76
|
| 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 |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$333.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$302.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$280.84
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$310.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$281.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$261.37
|
| 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 |
$352.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.27
|
| Rate for Payer: Blue Shield of California Commercial |
$186.50
|
| Rate for Payer: Blue Shield of California Commercial |
$282.63
|
| 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 |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$310.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$376.55
|
| Rate for Payer: Global Benefits Group Commercial |
$265.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$281.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.67
|
| 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 |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
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 |
$3.42
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.73
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.14
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.73
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.14
|
| 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 |
$158.65
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$173.07
|
| 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 Foundation Hospitals Commercial/Self Funded |
$157.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$145.87
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$173.07
|
| 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 Foundation Hospitals Commercial/Self Funded |
$157.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$145.87
|
| 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
|
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 |
$13.37
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.58
|
| 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 Foundation Hospitals Commercial/Self Funded |
$13.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.29
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.58
|
| 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 Foundation Hospitals Commercial/Self Funded |
$13.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.29
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,095.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$993.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$923.35
|
| 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
|
|
