|
HC THERAPEUTIC PROCEDURE 30 MIN OT
|
Facility
OP
|
$202.00
|
|
| Hospital Charge Code |
901300603
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$70.70 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$122.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$171.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$111.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$111.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$121.20
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Central Health Plan Commercial |
$161.60
|
| Rate for Payer: Cigna of CA HMO |
$129.28
|
| Rate for Payer: Cigna of CA PPO |
$149.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$171.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.80
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$181.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$151.50
|
| Rate for Payer: IEHP medi-cal |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.82
|
| Rate for Payer: Multiplan Commercial |
$151.50
|
| Rate for Payer: Networks By Design Commercial |
$131.30
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$121.20
|
| Rate for Payer: Riverside University Health MISP |
$80.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$121.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$121.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$171.70
|
| Rate for Payer: Vantage Medical Group Senior |
$171.70
|
|
|
HC THERAPEUTIC PROCEDURE 30 MIN OT
|
Facility
IP
|
$431.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
905104139
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$86.20 |
| Max. Negotiated Rate |
$387.90 |
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: Central Health Plan Commercial |
$344.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.40
|
| Rate for Payer: Galaxy Health WC |
$366.35
|
| Rate for Payer: Global Benefits Group Commercial |
$258.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$287.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.20
|
| Rate for Payer: Multiplan Commercial |
$323.25
|
| Rate for Payer: Networks By Design Commercial |
$280.15
|
| Rate for Payer: Prime Health Services Commercial |
$366.35
|
|
|
HC THERAPEUTIC PROCEDURE ADDL 15MIN PT
|
Facility
IP
|
$299.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
900410402
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$269.10 |
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Central Health Plan Commercial |
$239.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.60
|
| Rate for Payer: Galaxy Health WC |
$254.15
|
| Rate for Payer: Global Benefits Group Commercial |
$179.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$269.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$199.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.80
|
| Rate for Payer: Multiplan Commercial |
$224.25
|
| Rate for Payer: Networks By Design Commercial |
$194.35
|
| Rate for Payer: Prime Health Services Commercial |
$254.15
|
|
|
HC THERAPEUTIC PROCEDURE ADDL 15MIN PT
|
Facility
OP
|
$299.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
900410402
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$104.65 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$122.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$254.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$164.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$164.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$179.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Central Health Plan Commercial |
$239.20
|
| Rate for Payer: Cigna of CA HMO |
$191.36
|
| Rate for Payer: Cigna of CA PPO |
$221.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$254.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$119.60
|
| Rate for Payer: Galaxy Health WC |
$254.15
|
| Rate for Payer: Global Benefits Group Commercial |
$179.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$269.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$224.25
|
| Rate for Payer: IEHP medi-cal |
$104.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$199.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.59
|
| Rate for Payer: Multiplan Commercial |
$224.25
|
| Rate for Payer: Networks By Design Commercial |
$194.35
|
| Rate for Payer: Prime Health Services Commercial |
$254.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$179.40
|
| Rate for Payer: Riverside University Health MISP |
$119.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$179.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$179.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$254.15
|
| Rate for Payer: Vantage Medical Group Senior |
$254.15
|
|
|
HC THERAPEUTIC PROCEDURE ADDL 15MIN PT
|
Facility
IP
|
$102.00
|
|
| Hospital Charge Code |
900409031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Central Health Plan Commercial |
$81.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.80
|
| Rate for Payer: Galaxy Health WC |
$86.70
|
| Rate for Payer: Global Benefits Group Commercial |
$61.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$91.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: Multiplan Commercial |
$76.50
|
| Rate for Payer: Networks By Design Commercial |
$66.30
|
| Rate for Payer: Prime Health Services Commercial |
$86.70
|
|
|
HC THERAPEUTIC PROCEDURE ADDL 15MIN PT
|
Facility
OP
|
$102.00
|
|
| Hospital Charge Code |
900409031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$61.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$86.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$56.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$56.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$61.20
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Central Health Plan Commercial |
$81.60
|
| Rate for Payer: Cigna of CA HMO |
$65.28
|
| Rate for Payer: Cigna of CA PPO |
$75.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$86.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.80
|
| Rate for Payer: Galaxy Health WC |
$86.70
|
| Rate for Payer: Global Benefits Group Commercial |
$61.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$91.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$76.50
|
| Rate for Payer: IEHP medi-cal |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.82
|
| Rate for Payer: Multiplan Commercial |
$76.50
|
| Rate for Payer: Networks By Design Commercial |
$66.30
|
| Rate for Payer: Prime Health Services Commercial |
$86.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$61.20
|
| Rate for Payer: Riverside University Health MISP |
$40.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.70
|
| Rate for Payer: Vantage Medical Group Senior |
$86.70
|
|
|
HC THERAPEUTIC PROCEDURE GRP MCAL
|
Facility
IP
|
$585.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
900400055
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$526.50 |
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Central Health Plan Commercial |
$468.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.00
|
| Rate for Payer: Galaxy Health WC |
$497.25
|
| Rate for Payer: Global Benefits Group Commercial |
$351.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$526.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$390.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$438.75
|
| Rate for Payer: Networks By Design Commercial |
$380.25
|
| Rate for Payer: Prime Health Services Commercial |
$497.25
|
|
|
HC THERAPEUTIC PROCEDURE GRP MCAL
|
Facility
IP
|
$585.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
901300059
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$526.50 |
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Central Health Plan Commercial |
$468.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.00
|
| Rate for Payer: Galaxy Health WC |
$497.25
|
| Rate for Payer: Global Benefits Group Commercial |
$351.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$526.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$390.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$438.75
|
| Rate for Payer: Networks By Design Commercial |
$380.25
|
| Rate for Payer: Prime Health Services Commercial |
$497.25
|
|
|
HC THERAPEUTIC PROCEDURE GRP MCAL
|
Facility
OP
|
$585.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
901300059
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$78.78 |
| Max. Negotiated Rate |
$526.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$78.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$497.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$321.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$321.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$351.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Central Health Plan Commercial |
$468.00
|
| Rate for Payer: Cigna of CA HMO |
$374.40
|
| Rate for Payer: Cigna of CA PPO |
$432.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$497.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$234.00
|
| Rate for Payer: Galaxy Health WC |
$497.25
|
| Rate for Payer: Global Benefits Group Commercial |
$351.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$526.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$438.75
|
| Rate for Payer: IEHP medi-cal |
$204.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$390.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.85
|
| Rate for Payer: Multiplan Commercial |
$438.75
|
| Rate for Payer: Networks By Design Commercial |
$380.25
|
| Rate for Payer: Prime Health Services Commercial |
$497.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$351.00
|
| Rate for Payer: Riverside University Health MISP |
$234.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$351.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$351.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$497.25
|
| Rate for Payer: Vantage Medical Group Senior |
$497.25
|
|
|
HC THERAPEUTIC PROCEDURE GRP MCAL
|
Facility
OP
|
$585.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
900400055
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$78.78 |
| Max. Negotiated Rate |
$526.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$78.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$497.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$321.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$321.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$351.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Central Health Plan Commercial |
$468.00
|
| Rate for Payer: Cigna of CA HMO |
$374.40
|
| Rate for Payer: Cigna of CA PPO |
$432.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$497.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$234.00
|
| Rate for Payer: Galaxy Health WC |
$497.25
|
| Rate for Payer: Global Benefits Group Commercial |
$351.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$526.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$438.75
|
| Rate for Payer: IEHP medi-cal |
$204.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$390.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.85
|
| Rate for Payer: Multiplan Commercial |
$438.75
|
| Rate for Payer: Networks By Design Commercial |
$380.25
|
| Rate for Payer: Prime Health Services Commercial |
$497.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$351.00
|
| Rate for Payer: Riverside University Health MISP |
$234.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$351.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$351.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$497.25
|
| Rate for Payer: Vantage Medical Group Senior |
$497.25
|
|
|
HC THERAPEUTIC PROCEDURE GRP OT
|
Facility
IP
|
$585.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
905104147
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$526.50 |
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Central Health Plan Commercial |
$468.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.00
|
| Rate for Payer: Galaxy Health WC |
$497.25
|
| Rate for Payer: Global Benefits Group Commercial |
$351.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$526.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$390.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$438.75
|
| Rate for Payer: Networks By Design Commercial |
$380.25
|
| Rate for Payer: Prime Health Services Commercial |
$497.25
|
|
|
HC THERAPEUTIC PROCEDURE GRP OT
|
Facility
OP
|
$585.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
905104147
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$78.78 |
| Max. Negotiated Rate |
$526.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$78.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$497.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$321.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$321.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$351.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Central Health Plan Commercial |
$468.00
|
| Rate for Payer: Cigna of CA HMO |
$374.40
|
| Rate for Payer: Cigna of CA PPO |
$432.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$497.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$234.00
|
| Rate for Payer: Galaxy Health WC |
$497.25
|
| Rate for Payer: Global Benefits Group Commercial |
$351.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$526.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$438.75
|
| Rate for Payer: IEHP medi-cal |
$204.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$390.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.85
|
| Rate for Payer: Multiplan Commercial |
$438.75
|
| Rate for Payer: Networks By Design Commercial |
$380.25
|
| Rate for Payer: Prime Health Services Commercial |
$497.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$351.00
|
| Rate for Payer: Riverside University Health MISP |
$234.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$351.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$351.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$497.25
|
| Rate for Payer: Vantage Medical Group Senior |
$497.25
|
|
|
HC THERAPEUTIC PROCEDURE GRP PT
|
Facility
OP
|
$585.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
905103147
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$78.78 |
| Max. Negotiated Rate |
$526.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$78.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$497.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$321.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$321.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$351.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Central Health Plan Commercial |
$468.00
|
| Rate for Payer: Cigna of CA HMO |
$374.40
|
| Rate for Payer: Cigna of CA PPO |
$432.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$497.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$234.00
|
| Rate for Payer: Galaxy Health WC |
$497.25
|
| Rate for Payer: Global Benefits Group Commercial |
$351.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$526.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$438.75
|
| Rate for Payer: IEHP medi-cal |
$204.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$390.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.85
|
| Rate for Payer: Multiplan Commercial |
$438.75
|
| Rate for Payer: Networks By Design Commercial |
$380.25
|
| Rate for Payer: Prime Health Services Commercial |
$497.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$351.00
|
| Rate for Payer: Riverside University Health MISP |
$234.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$351.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$351.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$497.25
|
| Rate for Payer: Vantage Medical Group Senior |
$497.25
|
|
|
HC THERAPEUTIC PROCEDURE GRP PT
|
Facility
IP
|
$585.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
905103147
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$526.50 |
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Central Health Plan Commercial |
$468.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.00
|
| Rate for Payer: Galaxy Health WC |
$497.25
|
| Rate for Payer: Global Benefits Group Commercial |
$351.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$526.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$390.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$438.75
|
| Rate for Payer: Networks By Design Commercial |
$380.25
|
| Rate for Payer: Prime Health Services Commercial |
$497.25
|
|
|
HC THERAPEUTIC PROCEDURE GRP PT COMM MCARE
|
Facility
IP
|
$585.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
900417151
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$526.50 |
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Central Health Plan Commercial |
$468.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.00
|
| Rate for Payer: Galaxy Health WC |
$497.25
|
| Rate for Payer: Global Benefits Group Commercial |
$351.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$526.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$390.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$438.75
|
| Rate for Payer: Networks By Design Commercial |
$380.25
|
| Rate for Payer: Prime Health Services Commercial |
$497.25
|
|
|
HC THERAPEUTIC PROCEDURE GRP PT COMM MCARE
|
Facility
OP
|
$585.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
900417151
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$78.78 |
| Max. Negotiated Rate |
$526.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$78.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$497.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$321.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$321.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$351.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Central Health Plan Commercial |
$468.00
|
| Rate for Payer: Cigna of CA HMO |
$374.40
|
| Rate for Payer: Cigna of CA PPO |
$432.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$497.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$234.00
|
| Rate for Payer: Galaxy Health WC |
$497.25
|
| Rate for Payer: Global Benefits Group Commercial |
$351.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$526.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$438.75
|
| Rate for Payer: IEHP medi-cal |
$204.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$390.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.85
|
| Rate for Payer: Multiplan Commercial |
$438.75
|
| Rate for Payer: Networks By Design Commercial |
$380.25
|
| Rate for Payer: Prime Health Services Commercial |
$497.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$351.00
|
| Rate for Payer: Riverside University Health MISP |
$234.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$351.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$351.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$497.25
|
| Rate for Payer: Vantage Medical Group Senior |
$497.25
|
|
|
HC THERAPEUTIC RAD PORT IMAGE
|
Facility
IP
|
$1,055.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
909100309
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$211.00 |
| Max. Negotiated Rate |
$949.50 |
| Rate for Payer: Cash Price |
$474.75
|
| Rate for Payer: Central Health Plan Commercial |
$844.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$422.00
|
| Rate for Payer: Galaxy Health WC |
$896.75
|
| Rate for Payer: Global Benefits Group Commercial |
$633.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$949.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$703.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.00
|
| Rate for Payer: Multiplan Commercial |
$791.25
|
| Rate for Payer: Networks By Design Commercial |
$685.75
|
| Rate for Payer: Prime Health Services Commercial |
$896.75
|
|
|
HC THERAPEUTIC RAD PORT IMAGE
|
Facility
OP
|
$1,055.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
909100309
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$83.08 |
| Max. Negotiated Rate |
$1,675.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$83.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$896.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$580.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$580.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.96
|
| Rate for Payer: BCBS Transplant Transplant |
$633.00
|
| Rate for Payer: Blue Shield of California Commercial |
$651.99
|
| Rate for Payer: Blue Shield of California EPN |
$512.73
|
| Rate for Payer: Cash Price |
$474.75
|
| Rate for Payer: Cash Price |
$474.75
|
| Rate for Payer: Cash Price |
$474.75
|
| Rate for Payer: Central Health Plan Commercial |
$844.00
|
| Rate for Payer: Cigna of CA HMO |
$675.20
|
| Rate for Payer: Cigna of CA PPO |
$780.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$896.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$422.00
|
| Rate for Payer: Galaxy Health WC |
$896.75
|
| Rate for Payer: Global Benefits Group Commercial |
$633.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$949.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$791.25
|
| Rate for Payer: IEHP medi-cal |
$369.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$703.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.00
|
| Rate for Payer: Multiplan Commercial |
$791.25
|
| Rate for Payer: Networks By Design Commercial |
$685.75
|
| Rate for Payer: Prime Health Services Commercial |
$896.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$633.00
|
| Rate for Payer: Riverside University Health MISP |
$422.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$633.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$896.75
|
| Rate for Payer: Vantage Medical Group Senior |
$896.75
|
|
|
HC THERAPUTIC BRONCH SUB
|
Facility
OP
|
$5,007.00
|
|
|
Service Code
|
CPT 31646
|
| Hospital Charge Code |
900803511
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$510.18 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$510.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$765.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$561.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$510.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,004.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,149.40
|
| Rate for Payer: Blue Shield of California EPN |
$2,448.42
|
| Rate for Payer: Caremore Medicare Advantage |
$510.18
|
| Rate for Payer: Cash Price |
$2,253.15
|
| Rate for Payer: Cash Price |
$2,253.15
|
| Rate for Payer: Cash Price |
$2,253.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,005.60
|
| Rate for Payer: Cigna of CA HMO |
$3,204.48
|
| Rate for Payer: Cigna of CA PPO |
$3,705.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$510.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$510.18
|
| Rate for Payer: Galaxy Health WC |
$4,255.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,004.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,506.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,755.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$836.70
|
| Rate for Payer: IEHP medi-cal |
$841.80
|
| Rate for Payer: IEHP Medicare Advantage |
$510.18
|
| Rate for Payer: Innovage PACE Commercial |
$765.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,339.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,001.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$683.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$683.64
|
| Rate for Payer: Multiplan Commercial |
$3,755.25
|
| Rate for Payer: Networks By Design Commercial |
$3,254.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,255.95
|
| Rate for Payer: Prime Health Services Medicare |
$540.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,004.20
|
| Rate for Payer: Riverside University Health MISP |
$561.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,004.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,004.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,503.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,503.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,503.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,503.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.20
|
| Rate for Payer: Vantage Medical Group Senior |
$510.18
|
|
|
HC THERAPUTIC BRONCH SUB
|
Facility
IP
|
$5,007.00
|
|
|
Service Code
|
CPT 31646
|
| Hospital Charge Code |
900803511
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,001.40 |
| Max. Negotiated Rate |
$4,506.30 |
| Rate for Payer: Cash Price |
$2,253.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,005.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,002.80
|
| Rate for Payer: Galaxy Health WC |
$4,255.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,004.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,506.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,339.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,001.40
|
| Rate for Payer: Multiplan Commercial |
$3,755.25
|
| Rate for Payer: Networks By Design Commercial |
$3,254.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,255.95
|
|
|
HC THER GROUP 6+
|
Facility
OP
|
$585.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
905103041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$78.78 |
| Max. Negotiated Rate |
$526.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$78.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$497.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$321.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$321.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$351.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Central Health Plan Commercial |
$468.00
|
| Rate for Payer: Cigna of CA HMO |
$374.40
|
| Rate for Payer: Cigna of CA PPO |
$432.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$497.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$234.00
|
| Rate for Payer: Galaxy Health WC |
$497.25
|
| Rate for Payer: Global Benefits Group Commercial |
$351.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$526.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$438.75
|
| Rate for Payer: IEHP medi-cal |
$204.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$390.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.85
|
| Rate for Payer: Multiplan Commercial |
$438.75
|
| Rate for Payer: Networks By Design Commercial |
$380.25
|
| Rate for Payer: Prime Health Services Commercial |
$497.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$351.00
|
| Rate for Payer: Riverside University Health MISP |
$234.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$351.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$351.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$497.25
|
| Rate for Payer: Vantage Medical Group Senior |
$497.25
|
|
|
HC THER GROUP 6+
|
Facility
IP
|
$585.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
905103041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$526.50 |
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Central Health Plan Commercial |
$468.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.00
|
| Rate for Payer: Galaxy Health WC |
$497.25
|
| Rate for Payer: Global Benefits Group Commercial |
$351.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$526.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$390.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$438.75
|
| Rate for Payer: Networks By Design Commercial |
$380.25
|
| Rate for Payer: Prime Health Services Commercial |
$497.25
|
|
|
HC THER GROUP PARENT INFANT 60 MIN
|
Facility
IP
|
$585.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
905103014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$526.50 |
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Central Health Plan Commercial |
$468.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.00
|
| Rate for Payer: Galaxy Health WC |
$497.25
|
| Rate for Payer: Global Benefits Group Commercial |
$351.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$526.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$390.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$438.75
|
| Rate for Payer: Networks By Design Commercial |
$380.25
|
| Rate for Payer: Prime Health Services Commercial |
$497.25
|
|
|
HC THER GROUP PARENT INFANT 60 MIN
|
Facility
OP
|
$585.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
905103014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$78.78 |
| Max. Negotiated Rate |
$526.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$78.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$497.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$321.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$321.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$351.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Central Health Plan Commercial |
$468.00
|
| Rate for Payer: Cigna of CA HMO |
$374.40
|
| Rate for Payer: Cigna of CA PPO |
$432.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$497.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$234.00
|
| Rate for Payer: Galaxy Health WC |
$497.25
|
| Rate for Payer: Global Benefits Group Commercial |
$351.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$526.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$438.75
|
| Rate for Payer: IEHP medi-cal |
$204.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$390.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.85
|
| Rate for Payer: Multiplan Commercial |
$438.75
|
| Rate for Payer: Networks By Design Commercial |
$380.25
|
| Rate for Payer: Prime Health Services Commercial |
$497.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$351.00
|
| Rate for Payer: Riverside University Health MISP |
$234.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$351.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$351.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$497.25
|
| Rate for Payer: Vantage Medical Group Senior |
$497.25
|
|
|
HC THERMODILUTION CONG EVAL DEFECTS
|
Facility
IP
|
$3,517.00
|
|
|
Service Code
|
CPT 93598
|
| Hospital Charge Code |
906820098
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$703.40 |
| Max. Negotiated Rate |
$3,165.30 |
| Rate for Payer: Cash Price |
$1,582.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,813.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,406.80
|
| Rate for Payer: Galaxy Health WC |
$2,989.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,110.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,165.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,345.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$703.40
|
| Rate for Payer: Multiplan Commercial |
$2,637.75
|
| Rate for Payer: Networks By Design Commercial |
$2,286.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,989.45
|
|
