|
HC PHOTOPHERESIS
|
Facility
|
OP
|
$6,508.00
|
|
|
Service Code
|
CPT 36522
|
| Hospital Charge Code |
946100104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,301.60 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$1,301.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,929.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,548.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,952.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$3,579.40
|
| Rate for Payer: Cash Price |
$3,579.40
|
| Rate for Payer: Cash Price |
$3,579.40
|
| Rate for Payer: Cigna of CA HMO |
$4,165.12
|
| Rate for Payer: Cigna of CA PPO |
$4,815.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,929.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,548.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,952.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,036.52
|
| Rate for Payer: EPIC Health Plan Senior |
$5,952.98
|
| Rate for Payer: Galaxy Health WC |
$5,531.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,904.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,762.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,972.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,952.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,340.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,623.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,952.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,561.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,500.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,976.99
|
| Rate for Payer: Multiplan Commercial |
$5,206.40
|
| Rate for Payer: Multiplan WC |
$9,485.01
|
| Rate for Payer: Networks By Design Commercial |
$4,230.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,531.80
|
| Rate for Payer: Prime Health Services WC |
$9,388.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,904.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$5,952.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,929.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,548.28
|
| Rate for Payer: Vantage Medical Group Senior |
$5,952.98
|
|
|
HC PHOTOPHERESIS
|
Facility
|
OP
|
$6,508.00
|
|
|
Service Code
|
CPT 36522
|
| Hospital Charge Code |
945000104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,301.60 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$1,301.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,929.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,548.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,952.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$3,579.40
|
| Rate for Payer: Cash Price |
$3,579.40
|
| Rate for Payer: Cash Price |
$3,579.40
|
| Rate for Payer: Cigna of CA HMO |
$4,165.12
|
| Rate for Payer: Cigna of CA PPO |
$4,815.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,929.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,548.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,952.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,036.52
|
| Rate for Payer: EPIC Health Plan Senior |
$5,952.98
|
| Rate for Payer: Galaxy Health WC |
$5,531.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,904.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,762.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,972.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,952.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,340.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,623.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,952.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,561.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,500.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,976.99
|
| Rate for Payer: Multiplan Commercial |
$5,206.40
|
| Rate for Payer: Multiplan WC |
$9,485.01
|
| Rate for Payer: Networks By Design Commercial |
$4,230.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,531.80
|
| Rate for Payer: Prime Health Services WC |
$9,388.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,904.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$5,952.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,929.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,548.28
|
| Rate for Payer: Vantage Medical Group Senior |
$5,952.98
|
|
|
HC PHRNC NRV STIM INSRT GEN, LEAD
|
Facility
|
OP
|
$72,520.00
|
|
|
Service Code
|
CPT 0424T
|
| Hospital Charge Code |
906810424
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,560.14 |
| Max. Negotiated Rate |
$109,559.00 |
| Rate for Payer: Adventist Health Commercial |
$14,504.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61,642.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39,886.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54,390.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,618.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$39,886.00
|
| Rate for Payer: Cash Price |
$39,886.00
|
| Rate for Payer: Cigna of CA HMO |
$46,412.80
|
| Rate for Payer: Cigna of CA PPO |
$53,664.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61,642.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$61,642.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61,642.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,008.00
|
| Rate for Payer: EPIC Health Plan Senior |
$29,008.00
|
| Rate for Payer: Galaxy Health WC |
$61,642.00
|
| Rate for Payer: Global Benefits Group Commercial |
$43,512.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48,370.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27,630.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44,889.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,404.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50,764.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50,764.00
|
| Rate for Payer: Multiplan Commercial |
$58,016.00
|
| Rate for Payer: Networks By Design Commercial |
$47,138.00
|
| Rate for Payer: Prime Health Services Commercial |
$61,642.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43,512.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$109,559.00
|
| Rate for Payer: United Healthcare All Other HMO |
$97,437.00
|
| Rate for Payer: United Healthcare HMO Rider |
$84,191.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77,134.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61,642.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61,642.00
|
| Rate for Payer: Vantage Medical Group Senior |
$61,642.00
|
|
|
HC PHRNC NRV STIM INSRT GEN, LEAD
|
Facility
|
IP
|
$72,520.00
|
|
|
Service Code
|
CPT 0424T
|
| Hospital Charge Code |
906810424
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,504.00 |
| Max. Negotiated Rate |
$61,642.00 |
| Rate for Payer: Adventist Health Commercial |
$14,504.00
|
| Rate for Payer: Cash Price |
$39,886.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,008.00
|
| Rate for Payer: EPIC Health Plan Senior |
$29,008.00
|
| Rate for Payer: Galaxy Health WC |
$61,642.00
|
| Rate for Payer: Global Benefits Group Commercial |
$43,512.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48,370.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27,630.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44,889.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,404.80
|
| Rate for Payer: Multiplan Commercial |
$58,016.00
|
| Rate for Payer: Networks By Design Commercial |
$47,138.00
|
| Rate for Payer: Prime Health Services Commercial |
$61,642.00
|
|
|
HC PHRNC NRV STIM INSRT TRNSVNS LEAD
|
Facility
|
OP
|
$15,409.00
|
|
|
Service Code
|
CPT 0425T
|
| Hospital Charge Code |
906810425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,081.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,081.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,097.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,474.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,556.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$8,474.95
|
| Rate for Payer: Cash Price |
$8,474.95
|
| Rate for Payer: Cigna of CA HMO |
$9,861.76
|
| Rate for Payer: Cigna of CA PPO |
$11,402.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,097.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,097.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,097.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,163.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,163.60
|
| Rate for Payer: Galaxy Health WC |
$13,097.65
|
| Rate for Payer: Global Benefits Group Commercial |
$9,245.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,277.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,870.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,538.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,698.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,786.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,786.30
|
| Rate for Payer: Multiplan Commercial |
$12,327.20
|
| Rate for Payer: Networks By Design Commercial |
$10,015.85
|
| Rate for Payer: Prime Health Services Commercial |
$13,097.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,245.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,097.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,097.65
|
| Rate for Payer: Vantage Medical Group Senior |
$13,097.65
|
|
|
HC PHRNC NRV STIM INSRT TRNSVNS LEAD
|
Facility
|
IP
|
$15,409.00
|
|
|
Service Code
|
CPT 0425T
|
| Hospital Charge Code |
906810425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,081.80 |
| Max. Negotiated Rate |
$13,097.65 |
| Rate for Payer: Adventist Health Commercial |
$3,081.80
|
| Rate for Payer: Cash Price |
$8,474.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,163.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,163.60
|
| Rate for Payer: Galaxy Health WC |
$13,097.65
|
| Rate for Payer: Global Benefits Group Commercial |
$9,245.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,277.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,870.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,538.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,698.16
|
| Rate for Payer: Multiplan Commercial |
$12,327.20
|
| Rate for Payer: Networks By Design Commercial |
$10,015.85
|
| Rate for Payer: Prime Health Services Commercial |
$13,097.65
|
|
|
HC PHRNC NRV STIM REMOVAL, REPL GEN
|
Facility
|
OP
|
$72,520.00
|
|
|
Service Code
|
CPT 0431T
|
| Hospital Charge Code |
906810431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,560.14 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$14,504.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61,642.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39,886.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54,390.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,618.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$39,886.00
|
| Rate for Payer: Cash Price |
$39,886.00
|
| Rate for Payer: Cigna of CA HMO |
$46,412.80
|
| Rate for Payer: Cigna of CA PPO |
$53,664.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61,642.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$61,642.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61,642.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,008.00
|
| Rate for Payer: EPIC Health Plan Senior |
$29,008.00
|
| Rate for Payer: Galaxy Health WC |
$61,642.00
|
| Rate for Payer: Global Benefits Group Commercial |
$43,512.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48,370.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27,630.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44,889.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,404.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50,764.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50,764.00
|
| Rate for Payer: Multiplan Commercial |
$58,016.00
|
| Rate for Payer: Networks By Design Commercial |
$47,138.00
|
| Rate for Payer: Prime Health Services Commercial |
$61,642.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43,512.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60,866.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61,642.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61,642.00
|
| Rate for Payer: Vantage Medical Group Senior |
$61,642.00
|
|
|
HC PHRNC NRV STIM REMOVAL, REPL GEN
|
Facility
|
IP
|
$72,520.00
|
|
|
Service Code
|
CPT 0431T
|
| Hospital Charge Code |
906810431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,504.00 |
| Max. Negotiated Rate |
$61,642.00 |
| Rate for Payer: Adventist Health Commercial |
$14,504.00
|
| Rate for Payer: Cash Price |
$39,886.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,008.00
|
| Rate for Payer: EPIC Health Plan Senior |
$29,008.00
|
| Rate for Payer: Galaxy Health WC |
$61,642.00
|
| Rate for Payer: Global Benefits Group Commercial |
$43,512.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48,370.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27,630.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44,889.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,404.80
|
| Rate for Payer: Multiplan Commercial |
$58,016.00
|
| Rate for Payer: Networks By Design Commercial |
$47,138.00
|
| Rate for Payer: Prime Health Services Commercial |
$61,642.00
|
|
|
HC PHRNC NRV STIM REMOVAL , REPL TRNSVNS LEAD
|
Facility
|
IP
|
$48,014.00
|
|
|
Service Code
|
CPT 0426T
|
| Hospital Charge Code |
906810426
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,602.80 |
| Max. Negotiated Rate |
$40,811.90 |
| Rate for Payer: Adventist Health Commercial |
$9,602.80
|
| Rate for Payer: Cash Price |
$26,407.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19,205.60
|
| Rate for Payer: Galaxy Health WC |
$40,811.90
|
| Rate for Payer: Global Benefits Group Commercial |
$28,808.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,025.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,293.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,720.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,523.36
|
| Rate for Payer: Multiplan Commercial |
$38,411.20
|
| Rate for Payer: Networks By Design Commercial |
$31,209.10
|
| Rate for Payer: Prime Health Services Commercial |
$40,811.90
|
|
|
HC PHRNC NRV STIM REMOVAL , REPL TRNSVNS LEAD
|
Facility
|
OP
|
$48,014.00
|
|
|
Service Code
|
CPT 0426T
|
| Hospital Charge Code |
906810426
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,560.14 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$9,602.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40,811.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,407.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,010.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$26,407.70
|
| Rate for Payer: Cash Price |
$26,407.70
|
| Rate for Payer: Cigna of CA HMO |
$30,728.96
|
| Rate for Payer: Cigna of CA PPO |
$35,530.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40,811.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$40,811.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40,811.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19,205.60
|
| Rate for Payer: Galaxy Health WC |
$40,811.90
|
| Rate for Payer: Global Benefits Group Commercial |
$28,808.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,025.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,293.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,720.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,523.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33,609.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,609.80
|
| Rate for Payer: Multiplan Commercial |
$38,411.20
|
| Rate for Payer: Networks By Design Commercial |
$31,209.10
|
| Rate for Payer: Prime Health Services Commercial |
$40,811.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,808.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40,811.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40,811.90
|
| Rate for Payer: Vantage Medical Group Senior |
$40,811.90
|
|
|
HC PHRNC NRV STIM REMOVAL TRNSVNS
|
Facility
|
OP
|
$7,841.00
|
|
|
Service Code
|
CPT 0430T
|
| Hospital Charge Code |
906810430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,568.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,568.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,664.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,312.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,880.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$4,312.55
|
| Rate for Payer: Cash Price |
$4,312.55
|
| Rate for Payer: Cigna of CA HMO |
$5,018.24
|
| Rate for Payer: Cigna of CA PPO |
$5,802.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,664.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,664.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,664.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,136.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,136.40
|
| Rate for Payer: Galaxy Health WC |
$6,664.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,704.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,229.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,987.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,853.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,881.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,488.70
|
| Rate for Payer: Multiplan Commercial |
$6,272.80
|
| Rate for Payer: Networks By Design Commercial |
$5,096.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,664.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,704.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,664.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,664.85
|
| Rate for Payer: Vantage Medical Group Senior |
$6,664.85
|
|
|
HC PHRNC NRV STIM REMOVAL TRNSVNS
|
Facility
|
IP
|
$7,841.00
|
|
|
Service Code
|
CPT 0430T
|
| Hospital Charge Code |
906810430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,568.20 |
| Max. Negotiated Rate |
$6,664.85 |
| Rate for Payer: Adventist Health Commercial |
$1,568.20
|
| Rate for Payer: Cash Price |
$4,312.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,136.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,136.40
|
| Rate for Payer: Galaxy Health WC |
$6,664.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,704.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,229.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,987.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,853.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,881.84
|
| Rate for Payer: Multiplan Commercial |
$6,272.80
|
| Rate for Payer: Networks By Design Commercial |
$5,096.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,664.85
|
|
|
HC PHRNC NRV STIM RMVL GEN
|
Facility
|
IP
|
$7,841.00
|
|
|
Service Code
|
CPT 0428T
|
| Hospital Charge Code |
906810428
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,568.20 |
| Max. Negotiated Rate |
$6,664.85 |
| Rate for Payer: Adventist Health Commercial |
$1,568.20
|
| Rate for Payer: Cash Price |
$4,312.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,136.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,136.40
|
| Rate for Payer: Galaxy Health WC |
$6,664.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,704.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,229.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,987.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,853.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,881.84
|
| Rate for Payer: Multiplan Commercial |
$6,272.80
|
| Rate for Payer: Networks By Design Commercial |
$5,096.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,664.85
|
|
|
HC PHRNC NRV STIM RMVL GEN
|
Facility
|
OP
|
$7,841.00
|
|
|
Service Code
|
CPT 0428T
|
| Hospital Charge Code |
906810428
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,568.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,568.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,664.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,312.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,880.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,618.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$4,312.55
|
| Rate for Payer: Cash Price |
$4,312.55
|
| Rate for Payer: Cigna of CA HMO |
$5,018.24
|
| Rate for Payer: Cigna of CA PPO |
$5,802.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,664.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,664.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,664.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,136.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,136.40
|
| Rate for Payer: Galaxy Health WC |
$6,664.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,704.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,229.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,987.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,853.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,881.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,488.70
|
| Rate for Payer: Multiplan Commercial |
$6,272.80
|
| Rate for Payer: Networks By Design Commercial |
$5,096.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,664.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,704.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,664.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,664.85
|
| Rate for Payer: Vantage Medical Group Senior |
$6,664.85
|
|
|
HC PHRNC NRV STIM RMVL GEN AND LEAD
|
Facility
|
IP
|
$7,631.00
|
|
|
Service Code
|
CPT 33278
|
| Hospital Charge Code |
906819772
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,526.20 |
| Max. Negotiated Rate |
$6,486.35 |
| Rate for Payer: Adventist Health Commercial |
$1,526.20
|
| Rate for Payer: Cash Price |
$4,197.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,052.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,052.40
|
| Rate for Payer: Galaxy Health WC |
$6,486.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,578.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,089.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,907.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,723.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,831.44
|
| Rate for Payer: Multiplan Commercial |
$6,104.80
|
| Rate for Payer: Networks By Design Commercial |
$4,960.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,486.35
|
|
|
HC PHRNC NRV STIM RMVL GEN AND LEAD
|
Facility
|
OP
|
$7,631.00
|
|
|
Service Code
|
CPT 33278
|
| Hospital Charge Code |
906819772
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,526.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,554.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,806.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,369.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,686.20
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$4,197.05
|
| Rate for Payer: Cash Price |
$4,197.05
|
| Rate for Payer: Cash Price |
$4,197.05
|
| Rate for Payer: Cigna of CA HMO |
$4,883.84
|
| Rate for Payer: Cigna of CA PPO |
$5,646.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,554.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,806.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,369.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,898.97
|
| Rate for Payer: EPIC Health Plan Senior |
$4,369.61
|
| Rate for Payer: Galaxy Health WC |
$6,486.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,578.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,166.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,369.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,089.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,369.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,831.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,505.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,855.28
|
| Rate for Payer: Multiplan Commercial |
$6,104.80
|
| Rate for Payer: Multiplan WC |
$6,962.18
|
| Rate for Payer: Networks By Design Commercial |
$4,960.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,486.35
|
| Rate for Payer: Prime Health Services WC |
$6,891.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,578.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,815.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,815.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,815.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,815.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,369.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,554.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,806.57
|
| Rate for Payer: Vantage Medical Group Senior |
$4,369.61
|
|
|
HC PHRNC NRV STIM RPSTN TRNSVNS LEAD
|
Facility
|
IP
|
$7,841.00
|
|
|
Service Code
|
CPT 0432T
|
| Hospital Charge Code |
906810432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,568.20 |
| Max. Negotiated Rate |
$6,664.85 |
| Rate for Payer: Adventist Health Commercial |
$1,568.20
|
| Rate for Payer: Cash Price |
$4,312.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,136.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,136.40
|
| Rate for Payer: Galaxy Health WC |
$6,664.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,704.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,229.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,987.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,853.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,881.84
|
| Rate for Payer: Multiplan Commercial |
$6,272.80
|
| Rate for Payer: Networks By Design Commercial |
$5,096.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,664.85
|
|
|
HC PHRNC NRV STIM RPSTN TRNSVNS LEAD
|
Facility
|
OP
|
$7,841.00
|
|
|
Service Code
|
CPT 0432T
|
| Hospital Charge Code |
906810432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,568.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,568.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,664.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,312.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,880.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$4,312.55
|
| Rate for Payer: Cash Price |
$4,312.55
|
| Rate for Payer: Cigna of CA HMO |
$5,018.24
|
| Rate for Payer: Cigna of CA PPO |
$5,802.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,664.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,664.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,664.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,136.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,136.40
|
| Rate for Payer: Galaxy Health WC |
$6,664.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,704.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,229.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,987.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,853.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,881.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,488.70
|
| Rate for Payer: Multiplan Commercial |
$6,272.80
|
| Rate for Payer: Networks By Design Commercial |
$5,096.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,664.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,704.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,664.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,664.85
|
| Rate for Payer: Vantage Medical Group Senior |
$6,664.85
|
|
|
HC PHYSCIAN-FAMILY CONF - 30 MIN
|
Facility
|
IP
|
$110.00
|
|
| Hospital Charge Code |
908603243
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
|
|
HC PHYSCIAN-FAMILY CONF - 30 MIN
|
Facility
|
OP
|
$110.00
|
|
| Hospital Charge Code |
908603243
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.55
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.00
|
| Rate for Payer: United Healthcare All Other HMO |
$55.00
|
| Rate for Payer: United Healthcare HMO Rider |
$55.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Vantage Medical Group Senior |
$93.50
|
|
|
HC PHYSICAL PERF TEST 15 MIN MC
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
900400023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.32 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$103.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$165.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$214.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$138.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$189.00
|
| 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 |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna of CA HMO |
$161.28
|
| Rate for Payer: Cigna of CA PPO |
$186.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$214.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$214.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Senior |
$100.80
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$176.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$176.40
|
| Rate for Payer: Multiplan Commercial |
$201.60
|
| Rate for Payer: Networks By Design Commercial |
$163.80
|
| Rate for Payer: Prime Health Services Commercial |
$214.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.20
|
| 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 |
$214.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.20
|
| Rate for Payer: Vantage Medical Group Senior |
$214.20
|
|
|
HC PHYSICAL PERF TEST 15 MIN MC
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
900400023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Adventist Health Commercial |
$50.40
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Senior |
$100.80
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.48
|
| Rate for Payer: Multiplan Commercial |
$201.60
|
| Rate for Payer: Networks By Design Commercial |
$163.80
|
| Rate for Payer: Prime Health Services Commercial |
$214.20
|
|
|
HC PHYSICAL PERF TEST 15 MIN MCAL
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
901300076
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.32 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$103.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$165.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$214.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$138.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$189.00
|
| 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 |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna of CA HMO |
$161.28
|
| Rate for Payer: Cigna of CA PPO |
$186.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$214.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$214.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Senior |
$100.80
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$176.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$176.40
|
| Rate for Payer: Multiplan Commercial |
$201.60
|
| Rate for Payer: Networks By Design Commercial |
$163.80
|
| Rate for Payer: Prime Health Services Commercial |
$214.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.20
|
| 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 |
$214.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.20
|
| Rate for Payer: Vantage Medical Group Senior |
$214.20
|
|
|
HC PHYSICAL PERF TEST 15 MIN MCAL
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
901300076
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Adventist Health Commercial |
$50.40
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Senior |
$100.80
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.48
|
| Rate for Payer: Multiplan Commercial |
$201.60
|
| Rate for Payer: Networks By Design Commercial |
$163.80
|
| Rate for Payer: Prime Health Services Commercial |
$214.20
|
|
|
HC PHYSICIAN CASE CONF COORD
|
Facility
|
IP
|
$233.00
|
|
| Hospital Charge Code |
908600147
|
|
Hospital Revenue Code
|
510
|
| 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
|
|
