|
HC TEST PHYSICAL PERF ADDL 15MIN PT
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 97691
|
| Hospital Charge Code |
903200168
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.40 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Adventist Health Commercial |
$33.40
|
| Rate for Payer: Cash Price |
$91.85
|
| Rate for Payer: Central Health Plan Commercial |
$133.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.80
|
| Rate for Payer: EPIC Health Plan Senior |
$66.80
|
| Rate for Payer: Galaxy Health WC |
$141.95
|
| Rate for Payer: Global Benefits Group Commercial |
$100.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$150.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.40
|
| Rate for Payer: Multiplan Commercial |
$125.25
|
| Rate for Payer: Networks By Design Commercial |
$108.55
|
| Rate for Payer: Prime Health Services Commercial |
$141.95
|
|
|
HC TEST PHYSICAL PERF ADDL 15MIN PT
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 97691
|
| Hospital Charge Code |
903200168
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$63.63 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$68.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$101.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$91.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$125.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$91.85
|
| Rate for Payer: Cash Price |
$91.85
|
| Rate for Payer: Cash Price |
$91.85
|
| Rate for Payer: Central Health Plan Commercial |
$133.60
|
| Rate for Payer: Cigna of CA HMO |
$106.88
|
| Rate for Payer: Cigna of CA PPO |
$123.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$141.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.80
|
| Rate for Payer: EPIC Health Plan Senior |
$66.80
|
| Rate for Payer: Galaxy Health WC |
$141.95
|
| Rate for Payer: Global Benefits Group Commercial |
$100.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$150.30
|
| Rate for Payer: InnovAge PACE Commercial |
$83.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$116.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$116.90
|
| Rate for Payer: Multiplan Commercial |
$125.25
|
| Rate for Payer: Networks By Design Commercial |
$108.55
|
| Rate for Payer: Prime Health Services Commercial |
$141.95
|
| Rate for Payer: Riverside University Health System MISP |
$66.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.20
|
| 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 |
$141.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.95
|
| Rate for Payer: Vantage Medical Group Senior |
$141.95
|
|
|
HC TEST PHYSICAL PERF INITIAL 30MIN OT
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 97690
|
| Hospital Charge Code |
903207690
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$59.05 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$63.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$131.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$85.25
|
| Rate for Payer: Cash Price |
$85.25
|
| Rate for Payer: Cash Price |
$85.25
|
| Rate for Payer: Central Health Plan Commercial |
$124.00
|
| Rate for Payer: Cigna of CA HMO |
$99.20
|
| Rate for Payer: Cigna of CA PPO |
$114.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$131.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$131.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$131.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.00
|
| Rate for Payer: EPIC Health Plan Senior |
$62.00
|
| Rate for Payer: Galaxy Health WC |
$131.75
|
| Rate for Payer: Global Benefits Group Commercial |
$93.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$139.50
|
| Rate for Payer: InnovAge PACE Commercial |
$77.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$103.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$95.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$108.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$108.50
|
| Rate for Payer: Multiplan Commercial |
$116.25
|
| Rate for Payer: Networks By Design Commercial |
$100.75
|
| Rate for Payer: Prime Health Services Commercial |
$131.75
|
| Rate for Payer: Riverside University Health System MISP |
$62.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.00
|
| 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 |
$131.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$131.75
|
| Rate for Payer: Vantage Medical Group Senior |
$131.75
|
|
|
HC TEST PHYSICAL PERF INITIAL 30MIN OT
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 97690
|
| Hospital Charge Code |
903207690
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Adventist Health Commercial |
$31.00
|
| Rate for Payer: Cash Price |
$85.25
|
| Rate for Payer: Central Health Plan Commercial |
$124.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.00
|
| Rate for Payer: EPIC Health Plan Senior |
$62.00
|
| Rate for Payer: Galaxy Health WC |
$131.75
|
| Rate for Payer: Global Benefits Group Commercial |
$93.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$139.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$103.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$95.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Multiplan Commercial |
$116.25
|
| Rate for Payer: Networks By Design Commercial |
$100.75
|
| Rate for Payer: Prime Health Services Commercial |
$131.75
|
|
|
HC TEST/PHYSICAL PERF INITIAL 30MIN PT
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 97690
|
| Hospital Charge Code |
903200167
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Adventist Health Commercial |
$31.00
|
| Rate for Payer: Cash Price |
$85.25
|
| Rate for Payer: Central Health Plan Commercial |
$124.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.00
|
| Rate for Payer: EPIC Health Plan Senior |
$62.00
|
| Rate for Payer: Galaxy Health WC |
$131.75
|
| Rate for Payer: Global Benefits Group Commercial |
$93.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$139.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$103.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$95.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Multiplan Commercial |
$116.25
|
| Rate for Payer: Networks By Design Commercial |
$100.75
|
| Rate for Payer: Prime Health Services Commercial |
$131.75
|
|
|
HC TEST/PHYSICAL PERF INITIAL 30MIN PT
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 97690
|
| Hospital Charge Code |
903200167
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$59.05 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$63.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$131.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$85.25
|
| Rate for Payer: Cash Price |
$85.25
|
| Rate for Payer: Cash Price |
$85.25
|
| Rate for Payer: Central Health Plan Commercial |
$124.00
|
| Rate for Payer: Cigna of CA HMO |
$99.20
|
| Rate for Payer: Cigna of CA PPO |
$114.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$131.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$131.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$131.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.00
|
| Rate for Payer: EPIC Health Plan Senior |
$62.00
|
| Rate for Payer: Galaxy Health WC |
$131.75
|
| Rate for Payer: Global Benefits Group Commercial |
$93.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$139.50
|
| Rate for Payer: InnovAge PACE Commercial |
$77.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$103.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$95.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$108.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$108.50
|
| Rate for Payer: Multiplan Commercial |
$116.25
|
| Rate for Payer: Networks By Design Commercial |
$100.75
|
| Rate for Payer: Prime Health Services Commercial |
$131.75
|
| Rate for Payer: Riverside University Health System MISP |
$62.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.00
|
| 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 |
$131.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$131.75
|
| Rate for Payer: Vantage Medical Group Senior |
$131.75
|
|
|
HC TEST URINE VOLUME
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
900910797
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.76
|
| Rate for Payer: Blue Shield of California Commercial |
$15.78
|
| Rate for Payer: Blue Shield of California EPN |
$10.32
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Central Health Plan Commercial |
$20.80
|
| Rate for Payer: Cigna of CA HMO |
$16.64
|
| Rate for Payer: Cigna of CA PPO |
$19.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.91
|
| Rate for Payer: EPIC Health Plan Senior |
$3.64
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.64
|
| Rate for Payer: InnovAge PACE Commercial |
$5.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.88
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.64
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Medicare |
$3.86
|
| Rate for Payer: Riverside University Health System MISP |
$4.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.95
|
| Rate for Payer: United Healthcare All Other HMO |
$2.95
|
| Rate for Payer: United Healthcare HMO Rider |
$2.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3.64
|
|
|
HC TEST URINE VOLUME
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
900910797
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Central Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10.40
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
|
|
HC TETRACYCLINE E TEST
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912444
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
|
|
HC TETRACYCLINE E TEST
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912444
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$16.41 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.33
|
| Rate for Payer: Blue Shield of California Commercial |
$10.93
|
| Rate for Payer: Blue Shield of California EPN |
$7.15
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.41
|
| Rate for Payer: EPIC Health Plan Senior |
$4.75
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: InnovAge PACE Commercial |
$7.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.75
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Medicare |
$5.04
|
| Rate for Payer: Riverside University Health System MISP |
$5.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC THAKO PARAPODIUM
|
Facility
|
OP
|
$6,911.00
|
|
|
Service Code
|
CPT L1500
|
| Hospital Charge Code |
905351500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,263.35 |
| Max. Negotiated Rate |
$6,219.90 |
| Rate for Payer: Adventist Health Commercial |
$2,833.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,874.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,801.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,183.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,058.83
|
| Rate for Payer: Blue Shield of California Commercial |
$5,342.20
|
| Rate for Payer: Blue Shield of California EPN |
$3,483.14
|
| Rate for Payer: Cash Price |
$3,801.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,528.80
|
| Rate for Payer: Cigna of CA HMO |
$4,837.70
|
| Rate for Payer: Cigna of CA PPO |
$4,837.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,874.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,874.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,874.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,764.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,764.40
|
| Rate for Payer: Galaxy Health WC |
$5,874.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,146.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,219.90
|
| Rate for Payer: InnovAge PACE Commercial |
$3,455.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,609.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,633.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,277.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,833.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,837.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,837.70
|
| Rate for Payer: Multiplan Commercial |
$5,183.25
|
| Rate for Payer: Networks By Design Commercial |
$3,455.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,874.35
|
| Rate for Payer: Riverside University Health System MISP |
$2,764.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,146.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,146.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,593.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,524.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,469.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,263.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,874.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,874.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,874.35
|
|
|
HC THAKO PARAPODIUM
|
Facility
|
IP
|
$6,911.00
|
|
|
Service Code
|
CPT L1500
|
| Hospital Charge Code |
905351500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,382.20 |
| Max. Negotiated Rate |
$6,219.90 |
| Rate for Payer: Adventist Health Commercial |
$1,382.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,342.20
|
| Rate for Payer: Blue Shield of California EPN |
$3,483.14
|
| Rate for Payer: Cash Price |
$3,801.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,528.80
|
| Rate for Payer: Cigna of CA HMO |
$4,837.70
|
| Rate for Payer: Cigna of CA PPO |
$4,837.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,764.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,764.40
|
| Rate for Payer: Galaxy Health WC |
$5,874.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,146.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,219.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,609.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,633.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,277.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,382.20
|
| Rate for Payer: Multiplan Commercial |
$5,183.25
|
| Rate for Payer: Networks By Design Commercial |
$4,492.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,874.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,593.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,524.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,469.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,263.35
|
|
|
HC THAKO STANDING FRAME
|
Facility
|
IP
|
$3,546.00
|
|
|
Service Code
|
CPT L1510
|
| Hospital Charge Code |
905351510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$709.20 |
| Max. Negotiated Rate |
$3,191.40 |
| Rate for Payer: Adventist Health Commercial |
$709.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,741.06
|
| Rate for Payer: Blue Shield of California EPN |
$1,787.18
|
| Rate for Payer: Cash Price |
$1,950.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,836.80
|
| Rate for Payer: Cigna of CA HMO |
$2,482.20
|
| Rate for Payer: Cigna of CA PPO |
$2,482.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,418.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,418.40
|
| Rate for Payer: Galaxy Health WC |
$3,014.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,127.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,191.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,365.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,351.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,194.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$709.20
|
| Rate for Payer: Multiplan Commercial |
$2,659.50
|
| Rate for Payer: Networks By Design Commercial |
$2,304.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,014.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,330.81
|
| Rate for Payer: United Healthcare All Other HMO |
$1,295.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1,267.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.32
|
|
|
HC THAKO STANDING FRAME
|
Facility
|
OP
|
$3,546.00
|
|
|
Service Code
|
CPT L1510
|
| Hospital Charge Code |
905351510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,161.32 |
| Max. Negotiated Rate |
$3,191.40 |
| Rate for Payer: Adventist Health Commercial |
$1,453.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,014.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,950.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,659.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,082.57
|
| Rate for Payer: Blue Shield of California Commercial |
$2,741.06
|
| Rate for Payer: Blue Shield of California EPN |
$1,787.18
|
| Rate for Payer: Cash Price |
$1,950.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,836.80
|
| Rate for Payer: Cigna of CA HMO |
$2,482.20
|
| Rate for Payer: Cigna of CA PPO |
$2,482.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,014.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,014.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,014.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,418.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,418.40
|
| Rate for Payer: Galaxy Health WC |
$3,014.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,127.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,191.40
|
| Rate for Payer: InnovAge PACE Commercial |
$1,773.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,365.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,351.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,194.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,453.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,482.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,482.20
|
| Rate for Payer: Multiplan Commercial |
$2,659.50
|
| Rate for Payer: Networks By Design Commercial |
$1,773.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,014.10
|
| Rate for Payer: Riverside University Health System MISP |
$1,418.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,127.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,127.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,330.81
|
| Rate for Payer: United Healthcare All Other HMO |
$1,295.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1,267.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,014.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,014.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3,014.10
|
|
|
HC THAKO SWIVEL WALKER
|
Facility
|
IP
|
$11,058.00
|
|
|
Service Code
|
CPT L1520
|
| Hospital Charge Code |
905351520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,211.60 |
| Max. Negotiated Rate |
$9,952.20 |
| Rate for Payer: Adventist Health Commercial |
$2,211.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,547.83
|
| Rate for Payer: Blue Shield of California EPN |
$5,573.23
|
| Rate for Payer: Cash Price |
$6,081.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,846.40
|
| Rate for Payer: Cigna of CA HMO |
$7,740.60
|
| Rate for Payer: Cigna of CA PPO |
$7,740.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,423.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,423.20
|
| Rate for Payer: Galaxy Health WC |
$9,399.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,634.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,952.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,375.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,213.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,844.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,211.60
|
| Rate for Payer: Multiplan Commercial |
$8,293.50
|
| Rate for Payer: Networks By Design Commercial |
$7,187.70
|
| Rate for Payer: Prime Health Services Commercial |
$9,399.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,150.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4,039.49
|
| Rate for Payer: United Healthcare HMO Rider |
$3,952.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,621.49
|
|
|
HC THAKO SWIVEL WALKER
|
Facility
|
OP
|
$11,058.00
|
|
|
Service Code
|
CPT L1520
|
| Hospital Charge Code |
905351520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,621.49 |
| Max. Negotiated Rate |
$9,952.20 |
| Rate for Payer: Adventist Health Commercial |
$4,533.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,399.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,081.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,293.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,494.36
|
| Rate for Payer: Blue Shield of California Commercial |
$8,547.83
|
| Rate for Payer: Blue Shield of California EPN |
$5,573.23
|
| Rate for Payer: Cash Price |
$6,081.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,846.40
|
| Rate for Payer: Cigna of CA HMO |
$7,740.60
|
| Rate for Payer: Cigna of CA PPO |
$7,740.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,399.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,399.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,399.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,423.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,423.20
|
| Rate for Payer: Galaxy Health WC |
$9,399.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,634.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,952.20
|
| Rate for Payer: InnovAge PACE Commercial |
$5,529.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,375.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,213.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,844.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,533.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,740.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,740.60
|
| Rate for Payer: Multiplan Commercial |
$8,293.50
|
| Rate for Payer: Networks By Design Commercial |
$5,529.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,399.30
|
| Rate for Payer: Riverside University Health System MISP |
$4,423.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,634.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,634.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,150.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4,039.49
|
| Rate for Payer: United Healthcare HMO Rider |
$3,952.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,621.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,399.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,399.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9,399.30
|
|
|
HC THAL-QUICK 18FR CHEST TUBE
|
Facility
|
OP
|
$889.13
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901698529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.83 |
| Max. Negotiated Rate |
$800.22 |
| Rate for Payer: Adventist Health Commercial |
$177.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$755.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$489.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$666.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$405.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$492.31
|
| Rate for Payer: Blue Shield of California Commercial |
$687.30
|
| Rate for Payer: Blue Shield of California EPN |
$448.12
|
| Rate for Payer: Cash Price |
$489.02
|
| Rate for Payer: Central Health Plan Commercial |
$711.30
|
| Rate for Payer: Cigna of CA HMO |
$622.39
|
| Rate for Payer: Cigna of CA PPO |
$622.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$755.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$755.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$755.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$355.65
|
| Rate for Payer: EPIC Health Plan Senior |
$355.65
|
| Rate for Payer: Galaxy Health WC |
$755.76
|
| Rate for Payer: Global Benefits Group Commercial |
$533.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$800.22
|
| Rate for Payer: InnovAge PACE Commercial |
$444.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$593.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$338.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$550.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$622.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$622.39
|
| Rate for Payer: Multiplan Commercial |
$666.85
|
| Rate for Payer: Networks By Design Commercial |
$444.56
|
| Rate for Payer: Prime Health Services Commercial |
$755.76
|
| Rate for Payer: Riverside University Health System MISP |
$355.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$533.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$533.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$333.69
|
| Rate for Payer: United Healthcare All Other HMO |
$324.80
|
| Rate for Payer: United Healthcare HMO Rider |
$317.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$755.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$755.76
|
| Rate for Payer: Vantage Medical Group Senior |
$755.76
|
|
|
HC THAL-QUICK 18FR CHEST TUBE
|
Facility
|
IP
|
$889.13
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901698529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.83 |
| Max. Negotiated Rate |
$800.22 |
| Rate for Payer: Adventist Health Commercial |
$177.83
|
| Rate for Payer: Blue Shield of California Commercial |
$687.30
|
| Rate for Payer: Blue Shield of California EPN |
$448.12
|
| Rate for Payer: Cash Price |
$489.02
|
| Rate for Payer: Central Health Plan Commercial |
$711.30
|
| Rate for Payer: Cigna of CA HMO |
$622.39
|
| Rate for Payer: Cigna of CA PPO |
$622.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$355.65
|
| Rate for Payer: EPIC Health Plan Senior |
$355.65
|
| Rate for Payer: Galaxy Health WC |
$755.76
|
| Rate for Payer: Global Benefits Group Commercial |
$533.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$800.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$593.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$338.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$550.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.83
|
| Rate for Payer: Multiplan Commercial |
$666.85
|
| Rate for Payer: Networks By Design Commercial |
$444.56
|
| Rate for Payer: Prime Health Services Commercial |
$755.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$333.69
|
| Rate for Payer: United Healthcare All Other HMO |
$324.80
|
| Rate for Payer: United Healthcare HMO Rider |
$317.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.19
|
|
|
HC THAWING COMPONENT
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT 86927
|
| Hospital Charge Code |
900904700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$270.90 |
| Rate for Payer: Adventist Health Commercial |
$60.20
|
| Rate for Payer: Cash Price |
$165.55
|
| Rate for Payer: Central Health Plan Commercial |
$240.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.40
|
| Rate for Payer: EPIC Health Plan Senior |
$120.40
|
| Rate for Payer: Galaxy Health WC |
$255.85
|
| Rate for Payer: Global Benefits Group Commercial |
$180.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$186.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.20
|
| Rate for Payer: Multiplan Commercial |
$225.75
|
| Rate for Payer: Networks By Design Commercial |
$195.65
|
| Rate for Payer: Prime Health Services Commercial |
$255.85
|
|
|
HC THAWING COMPONENT
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT 86927
|
| Hospital Charge Code |
900904700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.29 |
| Max. Negotiated Rate |
$357.08 |
| Rate for Payer: Adventist Health Commercial |
$60.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$217.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$182.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.29
|
| Rate for Payer: Blue Shield of California Commercial |
$182.71
|
| Rate for Payer: Blue Shield of California EPN |
$119.50
|
| Rate for Payer: Cash Price |
$165.55
|
| Rate for Payer: Cash Price |
$165.55
|
| Rate for Payer: Central Health Plan Commercial |
$240.80
|
| Rate for Payer: Cigna of CA HMO |
$192.64
|
| Rate for Payer: Cigna of CA PPO |
$222.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$255.85
|
| Rate for Payer: Global Benefits Group Commercial |
$180.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: InnovAge PACE Commercial |
$326.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$291.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$225.75
|
| Rate for Payer: Networks By Design Commercial |
$195.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$217.73
|
| Rate for Payer: Prime Health Services Commercial |
$255.85
|
| Rate for Payer: Prime Health Services Medicare |
$230.79
|
| Rate for Payer: Riverside University Health System MISP |
$239.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC THAWING COMPONENT CRYO
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904698
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$270.90 |
| Rate for Payer: Adventist Health Commercial |
$60.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$31.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$182.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$145.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.78
|
| Rate for Payer: Blue Shield of California Commercial |
$182.71
|
| Rate for Payer: Blue Shield of California EPN |
$119.50
|
| Rate for Payer: Cash Price |
$165.55
|
| Rate for Payer: Cash Price |
$165.55
|
| Rate for Payer: Central Health Plan Commercial |
$240.80
|
| Rate for Payer: Cigna of CA HMO |
$192.64
|
| Rate for Payer: Cigna of CA PPO |
$222.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.01
|
| Rate for Payer: EPIC Health Plan Senior |
$31.12
|
| Rate for Payer: Galaxy Health WC |
$255.85
|
| Rate for Payer: Global Benefits Group Commercial |
$180.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$51.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: InnovAge PACE Commercial |
$46.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.70
|
| Rate for Payer: Multiplan Commercial |
$225.75
|
| Rate for Payer: Networks By Design Commercial |
$195.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$31.12
|
| Rate for Payer: Prime Health Services Commercial |
$255.85
|
| Rate for Payer: Prime Health Services Medicare |
$32.99
|
| Rate for Payer: Riverside University Health System MISP |
$34.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$31.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC THAWING COMPONENT CRYO
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904698
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$270.90 |
| Rate for Payer: Adventist Health Commercial |
$60.20
|
| Rate for Payer: Cash Price |
$165.55
|
| Rate for Payer: Central Health Plan Commercial |
$240.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.40
|
| Rate for Payer: EPIC Health Plan Senior |
$120.40
|
| Rate for Payer: Galaxy Health WC |
$255.85
|
| Rate for Payer: Global Benefits Group Commercial |
$180.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$186.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.20
|
| Rate for Payer: Multiplan Commercial |
$225.75
|
| Rate for Payer: Networks By Design Commercial |
$195.65
|
| Rate for Payer: Prime Health Services Commercial |
$255.85
|
|
|
HC THEOPHYLLINE
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
900910457
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC THEOPHYLLINE
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
900910457
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.46 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.89
|
| Rate for Payer: Blue Shield of California Commercial |
$72.84
|
| Rate for Payer: Blue Shield of California EPN |
$47.64
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.09
|
| Rate for Payer: EPIC Health Plan Senior |
$14.14
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.14
|
| Rate for Payer: InnovAge PACE Commercial |
$21.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.95
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.14
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Medicare |
$14.99
|
| Rate for Payer: Riverside University Health System MISP |
$15.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.46
|
| Rate for Payer: United Healthcare All Other HMO |
$11.46
|
| Rate for Payer: United Healthcare HMO Rider |
$11.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.55
|
| Rate for Payer: Vantage Medical Group Senior |
$14.14
|
|
|
HC THERAPEUTIC ACTIVITY 15 MIN MCAL
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
901300061
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$96.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$143.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$200.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$129.80
|
| Rate for Payer: Cash Price |
$129.80
|
| Rate for Payer: Cash Price |
$129.80
|
| Rate for Payer: Cash Price |
$129.80
|
| Rate for Payer: Central Health Plan Commercial |
$188.80
|
| Rate for Payer: Cigna of CA HMO |
$151.04
|
| Rate for Payer: Cigna of CA PPO |
$174.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$200.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$200.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.40
|
| Rate for Payer: EPIC Health Plan Senior |
$94.40
|
| Rate for Payer: Galaxy Health WC |
$200.60
|
| Rate for Payer: Global Benefits Group Commercial |
$141.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$212.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.16
|
| Rate for Payer: InnovAge PACE Commercial |
$118.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$157.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$146.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$165.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$165.20
|
| Rate for Payer: Multiplan Commercial |
$177.00
|
| Rate for Payer: Networks By Design Commercial |
$153.40
|
| Rate for Payer: Prime Health Services Commercial |
$200.60
|
| Rate for Payer: Riverside University Health System MISP |
$94.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.60
|
| 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 |
$200.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$200.60
|
| Rate for Payer: Vantage Medical Group Senior |
$200.60
|
|
