|
HC THERAPEUTIC PROCEDURE GRP PT COMM MCARE
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
900417151
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$94.60 |
| Max. Negotiated Rate |
$425.70 |
| Rate for Payer: Adventist Health Commercial |
$94.60
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Central Health Plan Commercial |
$378.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.20
|
| Rate for Payer: EPIC Health Plan Senior |
$189.20
|
| Rate for Payer: Galaxy Health WC |
$402.05
|
| Rate for Payer: Global Benefits Group Commercial |
$283.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$425.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$315.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$292.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.60
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
| Rate for Payer: Networks By Design Commercial |
$307.45
|
| Rate for Payer: Prime Health Services Commercial |
$402.05
|
|
|
HC THERAPEUTIC PROCEDURE GRP PT COMM MCARE
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
900417151
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.29 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$193.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$287.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$402.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$260.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$354.75
|
| 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 |
$212.85
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Central Health Plan Commercial |
$378.40
|
| Rate for Payer: Cigna of CA HMO |
$302.72
|
| Rate for Payer: Cigna of CA PPO |
$350.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$402.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$402.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$402.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.20
|
| Rate for Payer: EPIC Health Plan Senior |
$189.20
|
| Rate for Payer: Galaxy Health WC |
$402.05
|
| Rate for Payer: Global Benefits Group Commercial |
$283.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$425.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.29
|
| Rate for Payer: InnovAge PACE Commercial |
$236.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$315.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$292.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$331.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$331.10
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
| Rate for Payer: Networks By Design Commercial |
$307.45
|
| Rate for Payer: Prime Health Services Commercial |
$402.05
|
| Rate for Payer: Riverside University Health System MISP |
$189.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$283.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$283.80
|
| 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 |
$402.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$402.05
|
| Rate for Payer: Vantage Medical Group Senior |
$402.05
|
|
|
HC THERAPEUTIC RAD PORT IMAGE
|
Facility
|
OP
|
$1,395.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
909100309
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$16.89 |
| Max. Negotiated Rate |
$1,759.00 |
| Rate for Payer: Adventist Health Commercial |
$279.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$847.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,185.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$767.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,046.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.45
|
| Rate for Payer: Blue Shield of California Commercial |
$846.76
|
| Rate for Payer: Blue Shield of California EPN |
$553.82
|
| Rate for Payer: Cash Price |
$627.75
|
| Rate for Payer: Cash Price |
$627.75
|
| Rate for Payer: Cash Price |
$627.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,116.00
|
| Rate for Payer: Cigna of CA HMO |
$892.80
|
| Rate for Payer: Cigna of CA PPO |
$1,032.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,185.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,185.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,185.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$558.00
|
| Rate for Payer: EPIC Health Plan Senior |
$558.00
|
| Rate for Payer: Galaxy Health WC |
$1,185.75
|
| Rate for Payer: Global Benefits Group Commercial |
$837.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,255.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.89
|
| Rate for Payer: InnovAge PACE Commercial |
$697.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$930.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$863.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$976.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$976.50
|
| Rate for Payer: Multiplan Commercial |
$1,046.25
|
| Rate for Payer: Networks By Design Commercial |
$906.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,185.75
|
| Rate for Payer: Riverside University Health System MISP |
$558.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$837.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,185.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,185.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,185.75
|
|
|
HC THERAPEUTIC RAD PORT IMAGE
|
Facility
|
IP
|
$1,395.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
909100309
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.00 |
| Max. Negotiated Rate |
$1,255.50 |
| Rate for Payer: Adventist Health Commercial |
$279.00
|
| Rate for Payer: Cash Price |
$627.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,116.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$558.00
|
| Rate for Payer: EPIC Health Plan Senior |
$558.00
|
| Rate for Payer: Galaxy Health WC |
$1,185.75
|
| Rate for Payer: Global Benefits Group Commercial |
$837.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,255.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$930.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$531.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$863.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.00
|
| Rate for Payer: Multiplan Commercial |
$1,046.25
|
| Rate for Payer: Networks By Design Commercial |
$906.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,185.75
|
|
|
HC THERAPUTIC BRONCH SUB
|
Facility
|
IP
|
$5,897.00
|
|
|
Service Code
|
CPT 31646
|
| Hospital Charge Code |
900803511
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,179.40 |
| Max. Negotiated Rate |
$5,307.30 |
| Rate for Payer: Adventist Health Commercial |
$1,179.40
|
| Rate for Payer: Cash Price |
$2,653.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,717.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,358.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,358.80
|
| Rate for Payer: Galaxy Health WC |
$5,012.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,538.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,307.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,933.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,246.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,650.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,179.40
|
| Rate for Payer: Multiplan Commercial |
$4,422.75
|
| Rate for Payer: Networks By Design Commercial |
$3,833.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,012.45
|
|
|
HC THERAPUTIC BRONCH SUB
|
Facility
|
OP
|
$5,897.00
|
|
|
Service Code
|
CPT 31646
|
| Hospital Charge Code |
900803511
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.27 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$1,179.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$493.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$740.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$542.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$493.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,603.07
|
| Rate for Payer: Blue Shield of California EPN |
$2,352.90
|
| Rate for Payer: Cash Price |
$2,653.65
|
| Rate for Payer: Cash Price |
$2,653.65
|
| Rate for Payer: Cash Price |
$2,653.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,717.60
|
| Rate for Payer: Cigna of CA HMO |
$3,774.08
|
| Rate for Payer: Cigna of CA PPO |
$4,363.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$740.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$542.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$666.08
|
| Rate for Payer: EPIC Health Plan Senior |
$493.39
|
| Rate for Payer: Galaxy Health WC |
$5,012.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,538.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,307.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$809.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$188.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$493.39
|
| Rate for Payer: InnovAge PACE Commercial |
$740.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,933.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$493.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,179.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$661.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$661.14
|
| Rate for Payer: Multiplan Commercial |
$4,422.75
|
| Rate for Payer: Networks By Design Commercial |
$3,833.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$493.39
|
| Rate for Payer: Prime Health Services Commercial |
$5,012.45
|
| Rate for Payer: Prime Health Services Medicare |
$522.99
|
| Rate for Payer: Riverside University Health System MISP |
$542.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,538.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,538.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,948.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,948.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,948.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,948.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$493.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$740.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$542.73
|
| Rate for Payer: Vantage Medical Group Senior |
$493.39
|
|
|
HC THER GROUP 6+
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
905103041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$94.60 |
| Max. Negotiated Rate |
$425.70 |
| Rate for Payer: Adventist Health Commercial |
$94.60
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Central Health Plan Commercial |
$378.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.20
|
| Rate for Payer: EPIC Health Plan Senior |
$189.20
|
| Rate for Payer: Galaxy Health WC |
$402.05
|
| Rate for Payer: Global Benefits Group Commercial |
$283.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$425.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$315.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$292.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.60
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
| Rate for Payer: Networks By Design Commercial |
$307.45
|
| Rate for Payer: Prime Health Services Commercial |
$402.05
|
|
|
HC THER GROUP 6+
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
905103041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.29 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$193.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$287.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$402.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$260.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$354.75
|
| 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 |
$212.85
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Central Health Plan Commercial |
$378.40
|
| Rate for Payer: Cigna of CA HMO |
$302.72
|
| Rate for Payer: Cigna of CA PPO |
$350.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$402.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$402.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$402.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.20
|
| Rate for Payer: EPIC Health Plan Senior |
$189.20
|
| Rate for Payer: Galaxy Health WC |
$402.05
|
| Rate for Payer: Global Benefits Group Commercial |
$283.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$425.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.29
|
| Rate for Payer: InnovAge PACE Commercial |
$236.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$315.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$292.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$331.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$331.10
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
| Rate for Payer: Networks By Design Commercial |
$307.45
|
| Rate for Payer: Prime Health Services Commercial |
$402.05
|
| Rate for Payer: Riverside University Health System MISP |
$189.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$283.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$283.80
|
| 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 |
$402.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$402.05
|
| Rate for Payer: Vantage Medical Group Senior |
$402.05
|
|
|
HC THER GROUP PARENT INFANT 60 MIN
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
905103014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$94.60 |
| Max. Negotiated Rate |
$425.70 |
| Rate for Payer: Adventist Health Commercial |
$94.60
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Central Health Plan Commercial |
$378.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.20
|
| Rate for Payer: EPIC Health Plan Senior |
$189.20
|
| Rate for Payer: Galaxy Health WC |
$402.05
|
| Rate for Payer: Global Benefits Group Commercial |
$283.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$425.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$315.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$292.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.60
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
| Rate for Payer: Networks By Design Commercial |
$307.45
|
| Rate for Payer: Prime Health Services Commercial |
$402.05
|
|
|
HC THER GROUP PARENT INFANT 60 MIN
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
905103014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.29 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$193.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$287.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$402.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$260.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$354.75
|
| 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 |
$212.85
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Central Health Plan Commercial |
$378.40
|
| Rate for Payer: Cigna of CA HMO |
$302.72
|
| Rate for Payer: Cigna of CA PPO |
$350.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$402.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$402.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$402.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.20
|
| Rate for Payer: EPIC Health Plan Senior |
$189.20
|
| Rate for Payer: Galaxy Health WC |
$402.05
|
| Rate for Payer: Global Benefits Group Commercial |
$283.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$425.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.29
|
| Rate for Payer: InnovAge PACE Commercial |
$236.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$315.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$292.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$331.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$331.10
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
| Rate for Payer: Networks By Design Commercial |
$307.45
|
| Rate for Payer: Prime Health Services Commercial |
$402.05
|
| Rate for Payer: Riverside University Health System MISP |
$189.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$283.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$283.80
|
| 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 |
$402.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$402.05
|
| Rate for Payer: Vantage Medical Group Senior |
$402.05
|
|
|
HC THERMAL DEST INRA BN INCL IG 1ST 2 VB LUM OR SAC
|
Facility
|
OP
|
$47,276.00
|
|
|
Service Code
|
CPT 64628
|
| Hospital Charge Code |
909050628
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$42,548.40 |
| Rate for Payer: Adventist Health Commercial |
$9,455.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$16,348.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,522.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17,983.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,348.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22,891.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,765.19
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$26,048.55
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$21,274.20
|
| Rate for Payer: Cash Price |
$21,274.20
|
| Rate for Payer: Cash Price |
$21,274.20
|
| Rate for Payer: Central Health Plan Commercial |
$37,820.80
|
| Rate for Payer: Cigna of CA HMO |
$30,256.64
|
| Rate for Payer: Cigna of CA PPO |
$34,984.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,522.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,983.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,348.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,070.58
|
| Rate for Payer: EPIC Health Plan Senior |
$16,348.58
|
| Rate for Payer: Galaxy Health WC |
$40,184.60
|
| Rate for Payer: Global Benefits Group Commercial |
$28,365.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$42,548.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26,811.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$672.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,348.58
|
| Rate for Payer: InnovAge PACE Commercial |
$24,522.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,533.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$742.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,348.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,455.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21,907.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21,907.10
|
| Rate for Payer: Multiplan Commercial |
$35,457.00
|
| Rate for Payer: Multiplan WC |
$26,048.55
|
| Rate for Payer: Networks By Design Commercial |
$30,729.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16,348.58
|
| Rate for Payer: Preferred Health Network WC |
$26,580.15
|
| Rate for Payer: Prime Health Services Commercial |
$40,184.60
|
| Rate for Payer: Prime Health Services Medicare |
$17,329.49
|
| Rate for Payer: Prime Health Services WC |
$25,782.75
|
| Rate for Payer: Riverside University Health System MISP |
$17,983.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,365.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$16,348.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,522.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,983.44
|
| Rate for Payer: Vantage Medical Group Senior |
$16,348.58
|
|
|
HC THERMAL DEST INRA BN INCL IG 1ST 2 VB LUM OR SAC
|
Facility
|
IP
|
$47,276.00
|
|
|
Service Code
|
CPT 64628
|
| Hospital Charge Code |
909050628
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,455.20 |
| Max. Negotiated Rate |
$42,548.40 |
| Rate for Payer: Adventist Health Commercial |
$9,455.20
|
| Rate for Payer: Cash Price |
$21,274.20
|
| Rate for Payer: Central Health Plan Commercial |
$37,820.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,910.40
|
| Rate for Payer: EPIC Health Plan Senior |
$18,910.40
|
| Rate for Payer: Galaxy Health WC |
$40,184.60
|
| Rate for Payer: Global Benefits Group Commercial |
$28,365.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$42,548.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,533.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,012.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,263.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,455.20
|
| Rate for Payer: Multiplan Commercial |
$35,457.00
|
| Rate for Payer: Networks By Design Commercial |
$30,729.40
|
| Rate for Payer: Prime Health Services Commercial |
$40,184.60
|
|
|
HC THERMAL DEST INRA BN INCL IG EA ADDL VB LUM OR SAC
|
Facility
|
IP
|
$23,638.00
|
|
|
Service Code
|
CPT 64629
|
| Hospital Charge Code |
909050629
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,727.60 |
| Max. Negotiated Rate |
$21,274.20 |
| Rate for Payer: Adventist Health Commercial |
$4,727.60
|
| Rate for Payer: Cash Price |
$10,637.10
|
| Rate for Payer: Central Health Plan Commercial |
$18,910.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,455.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9,455.20
|
| Rate for Payer: Galaxy Health WC |
$20,092.30
|
| Rate for Payer: Global Benefits Group Commercial |
$14,182.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,274.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,766.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,006.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,631.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,727.60
|
| Rate for Payer: Multiplan Commercial |
$17,728.50
|
| Rate for Payer: Networks By Design Commercial |
$15,364.70
|
| Rate for Payer: Prime Health Services Commercial |
$20,092.30
|
|
|
HC THERMAL DEST INRA BN INCL IG EA ADDL VB LUM OR SAC
|
Facility
|
OP
|
$23,638.00
|
|
|
Service Code
|
CPT 64629
|
| Hospital Charge Code |
909050629
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$309.93 |
| Max. Negotiated Rate |
$21,274.20 |
| Rate for Payer: Adventist Health Commercial |
$4,727.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,092.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,000.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,728.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,445.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,882.60
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$10,637.10
|
| Rate for Payer: Cash Price |
$10,637.10
|
| Rate for Payer: Cash Price |
$10,637.10
|
| Rate for Payer: Central Health Plan Commercial |
$18,910.40
|
| Rate for Payer: Cigna of CA HMO |
$15,128.32
|
| Rate for Payer: Cigna of CA PPO |
$17,492.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,092.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,092.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20,092.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,455.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9,455.20
|
| Rate for Payer: Galaxy Health WC |
$20,092.30
|
| Rate for Payer: Global Benefits Group Commercial |
$14,182.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,274.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$309.93
|
| Rate for Payer: InnovAge PACE Commercial |
$11,819.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,766.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,631.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,727.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,546.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,546.60
|
| Rate for Payer: Multiplan Commercial |
$17,728.50
|
| Rate for Payer: Networks By Design Commercial |
$15,364.70
|
| Rate for Payer: Prime Health Services Commercial |
$20,092.30
|
| Rate for Payer: Riverside University Health System MISP |
$9,455.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,182.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,092.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,092.30
|
| Rate for Payer: Vantage Medical Group Senior |
$20,092.30
|
|
|
HC THERMODILUTION CONGENITAL
|
Facility
|
IP
|
$3,319.00
|
|
|
Service Code
|
CPT 93561
|
| Hospital Charge Code |
906811494
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$663.80 |
| Max. Negotiated Rate |
$2,987.10 |
| Rate for Payer: Adventist Health Commercial |
$663.80
|
| Rate for Payer: Cash Price |
$1,493.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,655.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,327.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,327.60
|
| Rate for Payer: Galaxy Health WC |
$2,821.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,991.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,987.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,213.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,264.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,054.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$663.80
|
| Rate for Payer: Multiplan Commercial |
$2,489.25
|
| Rate for Payer: Networks By Design Commercial |
$2,157.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,821.15
|
|
|
HC THERMODILUTION CONGENITAL
|
Facility
|
OP
|
$3,319.00
|
|
|
Service Code
|
CPT 93561
|
| Hospital Charge Code |
906811494
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$663.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$663.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,821.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,825.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,489.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,607.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,949.25
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,493.55
|
| Rate for Payer: Cash Price |
$1,493.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,655.20
|
| Rate for Payer: Cigna of CA HMO |
$2,157.35
|
| Rate for Payer: Cigna of CA PPO |
$2,456.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,821.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,821.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,821.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,327.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,327.60
|
| Rate for Payer: Galaxy Health WC |
$2,821.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,991.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,987.10
|
| Rate for Payer: InnovAge PACE Commercial |
$1,659.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,213.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,264.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,054.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$663.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,323.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,323.30
|
| Rate for Payer: Multiplan Commercial |
$2,489.25
|
| Rate for Payer: Networks By Design Commercial |
$2,157.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,821.15
|
| Rate for Payer: Riverside University Health System MISP |
$1,327.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,991.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,991.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,659.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,659.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,659.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,821.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,821.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,821.15
|
|
|
HC THERMODILUTION CONGENITAL ADDL
|
Facility
|
IP
|
$1,660.00
|
|
|
Service Code
|
CPT 93562
|
| Hospital Charge Code |
906811495
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$332.00 |
| Max. Negotiated Rate |
$1,494.00 |
| Rate for Payer: Adventist Health Commercial |
$332.00
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,328.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$664.00
|
| Rate for Payer: EPIC Health Plan Senior |
$664.00
|
| Rate for Payer: Galaxy Health WC |
$1,411.00
|
| Rate for Payer: Global Benefits Group Commercial |
$996.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,494.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,107.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$632.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,027.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.00
|
| Rate for Payer: Multiplan Commercial |
$1,245.00
|
| Rate for Payer: Networks By Design Commercial |
$1,079.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,411.00
|
|
|
HC THERMODILUTION CONGENITAL ADDL
|
Facility
|
OP
|
$1,660.00
|
|
|
Service Code
|
CPT 93562
|
| Hospital Charge Code |
906811495
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$332.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$332.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,411.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$913.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,245.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$803.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$974.92
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,328.00
|
| Rate for Payer: Cigna of CA HMO |
$1,079.00
|
| Rate for Payer: Cigna of CA PPO |
$1,228.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,411.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,411.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,411.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$664.00
|
| Rate for Payer: EPIC Health Plan Senior |
$664.00
|
| Rate for Payer: Galaxy Health WC |
$1,411.00
|
| Rate for Payer: Global Benefits Group Commercial |
$996.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,494.00
|
| Rate for Payer: InnovAge PACE Commercial |
$830.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,107.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$632.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,027.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,162.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,162.00
|
| Rate for Payer: Multiplan Commercial |
$1,245.00
|
| Rate for Payer: Networks By Design Commercial |
$1,079.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,411.00
|
| Rate for Payer: Riverside University Health System MISP |
$664.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$996.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$996.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$830.00
|
| Rate for Payer: United Healthcare All Other HMO |
$830.00
|
| Rate for Payer: United Healthcare HMO Rider |
$830.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$830.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,411.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,411.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,411.00
|
|
|
HC THERMODILUTION CONG EVAL DEFECTS
|
Facility
|
OP
|
$2,840.00
|
|
|
Service Code
|
CPT 93598
|
| Hospital Charge Code |
906811598
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$568.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$568.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,414.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,562.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,130.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,375.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,667.93
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,272.00
|
| Rate for Payer: Cigna of CA HMO |
$1,846.00
|
| Rate for Payer: Cigna of CA PPO |
$2,101.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,414.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,414.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,414.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,136.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,136.00
|
| Rate for Payer: Galaxy Health WC |
$2,414.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,704.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,556.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,420.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,894.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,757.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$568.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,988.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,988.00
|
| Rate for Payer: Multiplan Commercial |
$2,130.00
|
| Rate for Payer: Networks By Design Commercial |
$1,846.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,414.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,136.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,704.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,704.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,414.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,414.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,414.00
|
|
|
HC THERMODILUTION CONG EVAL DEFECTS
|
Facility
|
OP
|
$3,341.00
|
|
|
Service Code
|
CPT 93598
|
| Hospital Charge Code |
906820098
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$668.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,839.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,837.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,505.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,617.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,962.17
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,503.45
|
| Rate for Payer: Cash Price |
$1,503.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,672.80
|
| Rate for Payer: Cigna of CA HMO |
$2,171.65
|
| Rate for Payer: Cigna of CA PPO |
$2,472.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,839.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,839.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,839.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,336.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,336.40
|
| Rate for Payer: Galaxy Health WC |
$2,839.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,004.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,006.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,670.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,228.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,068.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,338.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,338.70
|
| Rate for Payer: Multiplan Commercial |
$2,505.75
|
| Rate for Payer: Networks By Design Commercial |
$2,171.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,839.85
|
| Rate for Payer: Riverside University Health System MISP |
$1,336.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,004.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,004.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,839.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,839.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,839.85
|
|
|
HC THERMODILUTION CONG EVAL DEFECTS
|
Facility
|
IP
|
$3,341.00
|
|
|
Service Code
|
CPT 93598
|
| Hospital Charge Code |
906820098
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$3,006.90 |
| Rate for Payer: Adventist Health Commercial |
$668.20
|
| Rate for Payer: Cash Price |
$1,503.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,672.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,336.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,336.40
|
| Rate for Payer: Galaxy Health WC |
$2,839.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,004.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,006.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,228.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,272.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,068.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.20
|
| Rate for Payer: Multiplan Commercial |
$2,505.75
|
| Rate for Payer: Networks By Design Commercial |
$2,171.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,839.85
|
|
|
HC THERMODILUTION CONG EVAL DEFECTS
|
Facility
|
IP
|
$2,840.00
|
|
|
Service Code
|
CPT 93598
|
| Hospital Charge Code |
906811598
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$568.00 |
| Max. Negotiated Rate |
$2,556.00 |
| Rate for Payer: Adventist Health Commercial |
$568.00
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,272.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,136.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,136.00
|
| Rate for Payer: Galaxy Health WC |
$2,414.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,704.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,556.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,894.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,082.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,757.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$568.00
|
| Rate for Payer: Multiplan Commercial |
$2,130.00
|
| Rate for Payer: Networks By Design Commercial |
$1,846.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,414.00
|
|
|
HC THIOCYANATE SERUM
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 84430
|
| Hospital Charge Code |
900910463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$101.80 |
| Max. Negotiated Rate |
$458.10 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Central Health Plan Commercial |
$407.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.60
|
| Rate for Payer: EPIC Health Plan Senior |
$203.60
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$458.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.80
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
| Rate for Payer: Networks By Design Commercial |
$330.85
|
| Rate for Payer: Prime Health Services Commercial |
$432.65
|
|
|
HC THIOCYANATE SERUM
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 84430
|
| Hospital Charge Code |
900910463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$84.63 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$84.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.18
|
| Rate for Payer: Blue Shield of California Commercial |
$30.35
|
| Rate for Payer: Blue Shield of California EPN |
$19.85
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.70
|
| Rate for Payer: EPIC Health Plan Senior |
$11.63
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.63
|
| Rate for Payer: InnovAge PACE Commercial |
$17.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.58
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.63
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$12.33
|
| Rate for Payer: Riverside University Health System MISP |
$12.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.42
|
| Rate for Payer: United Healthcare All Other HMO |
$9.42
|
| Rate for Payer: United Healthcare HMO Rider |
$9.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.79
|
| Rate for Payer: Vantage Medical Group Senior |
$11.63
|
|
|
HC THORACENTESIS ASPIRATN W GUID
|
Facility
|
IP
|
$5,764.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
909020158
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,152.80 |
| Max. Negotiated Rate |
$5,187.60 |
| Rate for Payer: Adventist Health Commercial |
$1,152.80
|
| Rate for Payer: Cash Price |
$2,593.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,611.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,305.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,305.60
|
| Rate for Payer: Galaxy Health WC |
$4,899.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,187.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,844.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,196.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,567.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,152.80
|
| Rate for Payer: Multiplan Commercial |
$4,323.00
|
| Rate for Payer: Networks By Design Commercial |
$3,746.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,899.40
|
|
