|
HC VITAMIN B12
|
Facility
IP
|
$244.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
900910830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Central Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.80
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Networks By Design Commercial |
$158.60
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
|
|
HC VITAMIN D TOTAL
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
900912240
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$262.68 |
| Rate for Payer: Adventist Health Medi-Cal |
$29.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$217.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$215.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$262.68
|
| Rate for Payer: BCBS Transplant Transplant |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$27.81
|
| Rate for Payer: Blue Shield of California EPN |
$21.87
|
| Rate for Payer: Caremore Medicare Advantage |
$29.60
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$29.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.60
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$33.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.54
|
| Rate for Payer: IEHP medi-cal |
$48.84
|
| Rate for Payer: IEHP Medicare Advantage |
$29.60
|
| Rate for Payer: Innovage PACE Commercial |
$44.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.66
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Prime Health Services Medicare |
$31.38
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: Riverside University Health MISP |
$32.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.98
|
| Rate for Payer: United Healthcare All Other HMO |
$23.98
|
| Rate for Payer: United Healthcare HMO Rider |
$23.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: Vantage Medical Group Senior |
$29.60
|
|
|
HC VITAMIN D TOTAL
|
Facility
IP
|
$64.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
900912240
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
|
|
HC VNUS ABLATION CATHETER
|
Facility
OP
|
$1,740.00
|
|
|
Service Code
|
CPT C1888
|
| Hospital Charge Code |
909080043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.00 |
| Max. Negotiated Rate |
$1,566.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$628.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,479.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$957.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$957.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$794.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$969.18
|
| Rate for Payer: BCBS Transplant Transplant |
$1,044.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,305.00
|
| Rate for Payer: Blue Shield of California EPN |
$946.56
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,392.00
|
| Rate for Payer: Cigna of CA HMO |
$1,218.00
|
| Rate for Payer: Cigna of CA PPO |
$1,218.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,479.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$696.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$696.00
|
| Rate for Payer: Galaxy Health WC |
$1,479.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,044.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,566.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,305.00
|
| Rate for Payer: IEHP medi-cal |
$609.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,160.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$348.00
|
| Rate for Payer: Multiplan Commercial |
$1,305.00
|
| Rate for Payer: Networks By Design Commercial |
$870.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,479.00
|
| Rate for Payer: Riverside University Health MISP |
$696.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,044.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,044.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$870.00
|
| Rate for Payer: United Healthcare All Other HMO |
$870.00
|
| Rate for Payer: United Healthcare HMO Rider |
$870.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$870.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,479.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,479.00
|
|
|
HC VNUS ABLATION CATHETER
|
Facility
IP
|
$1,740.00
|
|
|
Service Code
|
CPT C1888
|
| Hospital Charge Code |
909080043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.00 |
| Max. Negotiated Rate |
$1,566.00 |
| Rate for Payer: Blue Shield of California EPN |
$929.16
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,392.00
|
| Rate for Payer: Cigna of CA HMO |
$1,218.00
|
| Rate for Payer: Cigna of CA PPO |
$1,218.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$696.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$696.00
|
| Rate for Payer: Galaxy Health WC |
$1,479.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,044.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,566.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,160.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$348.00
|
| Rate for Payer: Multiplan Commercial |
$1,305.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,479.00
|
|
|
HC VOCATIONAL EVAL 10 DAY
|
Facility
IP
|
$267.00
|
|
| Hospital Charge Code |
903200103
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$240.30 |
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.80
|
| Rate for Payer: Galaxy Health WC |
$226.95
|
| Rate for Payer: Global Benefits Group Commercial |
$160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.40
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: Networks By Design Commercial |
$173.55
|
| Rate for Payer: Prime Health Services Commercial |
$226.95
|
|
|
HC VOCATIONAL EVAL 10 DAY
|
Facility
OP
|
$267.00
|
|
| Hospital Charge Code |
903200103
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$93.45 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$162.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$226.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$146.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$146.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$160.20
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| Rate for Payer: Cigna of CA HMO |
$170.88
|
| Rate for Payer: Cigna of CA PPO |
$197.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.80
|
| Rate for Payer: Galaxy Health WC |
$226.95
|
| Rate for Payer: Global Benefits Group Commercial |
$160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$200.25
|
| Rate for Payer: IEHP medi-cal |
$93.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.47
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: Networks By Design Commercial |
$173.55
|
| Rate for Payer: Prime Health Services Commercial |
$226.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$160.20
|
| Rate for Payer: Riverside University Health MISP |
$106.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.95
|
| Rate for Payer: Vantage Medical Group Senior |
$226.95
|
|
|
HC VOCATIONAL EVAL 1 DAY
|
Facility
OP
|
$435.00
|
|
| Hospital Charge Code |
903200100
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$152.25 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$264.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$239.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$239.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Central Health Plan Commercial |
$348.00
|
| Rate for Payer: Cigna of CA HMO |
$278.40
|
| Rate for Payer: Cigna of CA PPO |
$321.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$369.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$391.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$326.25
|
| Rate for Payer: IEHP medi-cal |
$152.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.35
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
| Rate for Payer: Networks By Design Commercial |
$282.75
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$261.00
|
| Rate for Payer: Riverside University Health MISP |
$174.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$261.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$261.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.75
|
| Rate for Payer: Vantage Medical Group Senior |
$369.75
|
|
|
HC VOCATIONAL EVAL 1 DAY
|
Facility
IP
|
$435.00
|
|
| Hospital Charge Code |
903200100
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$391.50 |
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Central Health Plan Commercial |
$348.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$391.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.00
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
| Rate for Payer: Networks By Design Commercial |
$282.75
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
|
|
HC VOCATIONAL EVAL 3 DAY
|
Facility
IP
|
$395.00
|
|
| Hospital Charge Code |
903200101
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$79.00 |
| Max. Negotiated Rate |
$355.50 |
| Rate for Payer: Cash Price |
$177.75
|
| Rate for Payer: Central Health Plan Commercial |
$316.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.00
|
| Rate for Payer: Galaxy Health WC |
$335.75
|
| Rate for Payer: Global Benefits Group Commercial |
$237.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$355.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$263.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.00
|
| Rate for Payer: Multiplan Commercial |
$296.25
|
| Rate for Payer: Networks By Design Commercial |
$256.75
|
| Rate for Payer: Prime Health Services Commercial |
$335.75
|
|
|
HC VOCATIONAL EVAL 3 DAY
|
Facility
OP
|
$395.00
|
|
| Hospital Charge Code |
903200101
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$138.25 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$239.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$335.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$217.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$217.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$177.75
|
| Rate for Payer: Cash Price |
$177.75
|
| Rate for Payer: Cash Price |
$177.75
|
| Rate for Payer: Central Health Plan Commercial |
$316.00
|
| Rate for Payer: Cigna of CA HMO |
$252.80
|
| Rate for Payer: Cigna of CA PPO |
$292.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$335.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$158.00
|
| Rate for Payer: Galaxy Health WC |
$335.75
|
| Rate for Payer: Global Benefits Group Commercial |
$237.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$355.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$296.25
|
| Rate for Payer: IEHP medi-cal |
$138.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$263.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.95
|
| Rate for Payer: Multiplan Commercial |
$296.25
|
| Rate for Payer: Networks By Design Commercial |
$256.75
|
| Rate for Payer: Prime Health Services Commercial |
$335.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$237.00
|
| Rate for Payer: Riverside University Health MISP |
$158.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$237.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$237.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.75
|
| Rate for Payer: Vantage Medical Group Senior |
$335.75
|
|
|
HC VOCATIONAL EVAL 5 DAY
|
Facility
IP
|
$372.00
|
|
| Hospital Charge Code |
903200102
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$334.80 |
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Central Health Plan Commercial |
$297.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.80
|
| Rate for Payer: Galaxy Health WC |
$316.20
|
| Rate for Payer: Global Benefits Group Commercial |
$223.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$334.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$248.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.40
|
| Rate for Payer: Multiplan Commercial |
$279.00
|
| Rate for Payer: Networks By Design Commercial |
$241.80
|
| Rate for Payer: Prime Health Services Commercial |
$316.20
|
|
|
HC VOCATIONAL EVAL 5 DAY
|
Facility
OP
|
$372.00
|
|
| Hospital Charge Code |
903200102
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$225.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$316.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$204.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$204.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$223.20
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Central Health Plan Commercial |
$297.60
|
| Rate for Payer: Cigna of CA HMO |
$238.08
|
| Rate for Payer: Cigna of CA PPO |
$275.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$316.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$148.80
|
| Rate for Payer: Galaxy Health WC |
$316.20
|
| Rate for Payer: Global Benefits Group Commercial |
$223.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$334.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$279.00
|
| Rate for Payer: IEHP medi-cal |
$130.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$248.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.52
|
| Rate for Payer: Multiplan Commercial |
$279.00
|
| Rate for Payer: Networks By Design Commercial |
$241.80
|
| Rate for Payer: Prime Health Services Commercial |
$316.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$223.20
|
| Rate for Payer: Riverside University Health MISP |
$148.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$223.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$223.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$316.20
|
| Rate for Payer: Vantage Medical Group Senior |
$316.20
|
|
|
HC VOCATIONAL EVAL 8 DAY
|
Facility
IP
|
$267.00
|
|
| Hospital Charge Code |
903200104
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$240.30 |
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.80
|
| Rate for Payer: Galaxy Health WC |
$226.95
|
| Rate for Payer: Global Benefits Group Commercial |
$160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.40
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: Networks By Design Commercial |
$173.55
|
| Rate for Payer: Prime Health Services Commercial |
$226.95
|
|
|
HC VOCATIONAL EVAL 8 DAY
|
Facility
OP
|
$267.00
|
|
| Hospital Charge Code |
903200104
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$93.45 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$162.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$226.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$146.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$146.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$160.20
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| Rate for Payer: Cigna of CA HMO |
$170.88
|
| Rate for Payer: Cigna of CA PPO |
$197.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.80
|
| Rate for Payer: Galaxy Health WC |
$226.95
|
| Rate for Payer: Global Benefits Group Commercial |
$160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$200.25
|
| Rate for Payer: IEHP medi-cal |
$93.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.47
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: Networks By Design Commercial |
$173.55
|
| Rate for Payer: Prime Health Services Commercial |
$226.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$160.20
|
| Rate for Payer: Riverside University Health MISP |
$106.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.95
|
| Rate for Payer: Vantage Medical Group Senior |
$226.95
|
|
|
HC VOIDING CYSTOGRAM
|
Facility
IP
|
$1,999.00
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
909301428
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$399.80 |
| Max. Negotiated Rate |
$1,799.10 |
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,599.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$799.60
|
| Rate for Payer: Galaxy Health WC |
$1,699.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,199.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,799.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,333.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.80
|
| Rate for Payer: Multiplan Commercial |
$1,499.25
|
| Rate for Payer: Networks By Design Commercial |
$1,299.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,699.15
|
|
|
HC VOIDING CYSTOGRAM
|
Facility
OP
|
$1,999.00
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
909301428
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$399.80 |
| Max. Negotiated Rate |
$1,799.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$515.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,080.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$441.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,181.01
|
| Rate for Payer: BCBS Transplant Transplant |
$1,199.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,235.38
|
| Rate for Payer: Blue Shield of California EPN |
$971.51
|
| Rate for Payer: Caremore Medicare Advantage |
$515.32
|
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,599.20
|
| Rate for Payer: Cigna of CA HMO |
$1,279.36
|
| Rate for Payer: Cigna of CA PPO |
$1,479.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,699.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,199.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,799.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,499.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$845.12
|
| Rate for Payer: IEHP medi-cal |
$850.28
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Innovage PACE Commercial |
$772.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,333.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,499.25
|
| Rate for Payer: Networks By Design Commercial |
$1,299.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,699.15
|
| Rate for Payer: Prime Health Services Medicare |
$546.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,199.40
|
| Rate for Payer: Riverside University Health MISP |
$566.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,199.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,199.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.78
|
| Rate for Payer: United Healthcare All Other HMO |
$815.78
|
| Rate for Payer: United Healthcare HMO Rider |
$815.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$815.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC VOIDING CYSTO URETHROGRAM
|
Facility
OP
|
$1,155.00
|
|
|
Service Code
|
CPT 74455
|
| Hospital Charge Code |
909001902
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$1,039.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$306.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$413.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$328.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$400.62
|
| Rate for Payer: BCBS Transplant Transplant |
$693.00
|
| Rate for Payer: Blue Shield of California Commercial |
$713.79
|
| Rate for Payer: Blue Shield of California EPN |
$561.33
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$519.75
|
| Rate for Payer: Cash Price |
$519.75
|
| Rate for Payer: Central Health Plan Commercial |
$924.00
|
| Rate for Payer: Cigna of CA HMO |
$739.20
|
| Rate for Payer: Cigna of CA PPO |
$854.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$981.75
|
| Rate for Payer: Global Benefits Group Commercial |
$693.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,039.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$866.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$502.10
|
| Rate for Payer: IEHP medi-cal |
$505.16
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Innovage PACE Commercial |
$459.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$770.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$866.25
|
| Rate for Payer: Networks By Design Commercial |
$750.75
|
| Rate for Payer: Prime Health Services Commercial |
$981.75
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$693.00
|
| Rate for Payer: Riverside University Health MISP |
$336.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$693.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$693.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC VOIDING CYSTO URETHROGRAM
|
Facility
IP
|
$1,155.00
|
|
|
Service Code
|
CPT 74455
|
| Hospital Charge Code |
909001902
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$1,039.50 |
| Rate for Payer: Cash Price |
$519.75
|
| Rate for Payer: Central Health Plan Commercial |
$924.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$462.00
|
| Rate for Payer: Galaxy Health WC |
$981.75
|
| Rate for Payer: Global Benefits Group Commercial |
$693.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,039.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$770.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.00
|
| Rate for Payer: Multiplan Commercial |
$866.25
|
| Rate for Payer: Networks By Design Commercial |
$750.75
|
| Rate for Payer: Prime Health Services Commercial |
$981.75
|
|
|
HC VULVECTOMY SIMPLE PRTL
|
Facility
IP
|
$8,745.00
|
|
|
Service Code
|
CPT 56620
|
| Hospital Charge Code |
900500620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,749.00 |
| Max. Negotiated Rate |
$7,870.50 |
| Rate for Payer: Cash Price |
$3,935.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,996.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,498.00
|
| Rate for Payer: Galaxy Health WC |
$7,433.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,247.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,870.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,832.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,749.00
|
| Rate for Payer: Multiplan Commercial |
$6,558.75
|
| Rate for Payer: Networks By Design Commercial |
$5,684.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,433.25
|
|
|
HC VULVECTOMY SIMPLE PRTL
|
Facility
OP
|
$8,745.00
|
|
|
Service Code
|
CPT 56620
|
| Hospital Charge Code |
900500620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,749.00 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,906.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,247.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$3,906.18
|
| Rate for Payer: Cash Price |
$3,935.25
|
| Rate for Payer: Cash Price |
$3,935.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,996.00
|
| Rate for Payer: Cigna of CA PPO |
$6,471.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$7,433.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,247.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,870.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,558.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,406.14
|
| Rate for Payer: IEHP medi-cal |
$6,445.20
|
| Rate for Payer: IEHP Medicare Advantage |
$3,906.18
|
| Rate for Payer: Innovage PACE Commercial |
$5,859.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,832.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,749.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,234.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$6,558.75
|
| Rate for Payer: Networks By Design Commercial |
$5,684.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,433.25
|
| Rate for Payer: Prime Health Services Medicare |
$4,140.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,247.00
|
| Rate for Payer: Riverside University Health MISP |
$4,296.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,247.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC VZV AB
|
Facility
IP
|
$204.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900913532
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
|
|
HC VZV AB
|
Facility
OP
|
$27.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900913532
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$114.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.34
|
| Rate for Payer: BCBS Transplant Transplant |
$16.20
|
| Rate for Payer: Blue Shield of California Commercial |
$16.69
|
| Rate for Payer: Blue Shield of California EPN |
$13.12
|
| Rate for Payer: Caremore Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Central Health Plan Commercial |
$21.60
|
| Rate for Payer: Cigna of CA HMO |
$17.28
|
| Rate for Payer: Cigna of CA PPO |
$19.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$20.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: IEHP medi-cal |
$21.25
|
| Rate for Payer: IEHP Medicare Advantage |
$12.88
|
| Rate for Payer: Innovage PACE Commercial |
$19.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: Networks By Design Commercial |
$17.55
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Prime Health Services Medicare |
$13.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16.20
|
| Rate for Payer: Riverside University Health MISP |
$14.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC WADA MONITORING
|
Facility
OP
|
$5,350.00
|
|
|
Service Code
|
CPT 95958
|
| Hospital Charge Code |
900600700
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$514.75 |
| Max. Negotiated Rate |
$4,815.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,306.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,453.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,959.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,436.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,306.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$514.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,160.78
|
| Rate for Payer: BCBS Transplant Transplant |
$3,210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,306.30
|
| Rate for Payer: Blue Shield of California EPN |
$2,600.10
|
| Rate for Payer: Caremore Medicare Advantage |
$1,306.33
|
| Rate for Payer: Cash Price |
$2,407.50
|
| Rate for Payer: Cash Price |
$2,407.50
|
| Rate for Payer: Cash Price |
$2,407.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,280.00
|
| Rate for Payer: Cigna of CA HMO |
$3,424.00
|
| Rate for Payer: Cigna of CA PPO |
$3,959.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,959.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,763.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,306.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,306.33
|
| Rate for Payer: Galaxy Health WC |
$4,547.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,815.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,012.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,142.38
|
| Rate for Payer: IEHP medi-cal |
$2,155.44
|
| Rate for Payer: IEHP Medicare Advantage |
$1,306.33
|
| Rate for Payer: Innovage PACE Commercial |
$1,959.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,568.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,306.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,070.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,750.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,750.48
|
| Rate for Payer: Multiplan Commercial |
$4,012.50
|
| Rate for Payer: Networks By Design Commercial |
$3,477.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,547.50
|
| Rate for Payer: Prime Health Services Medicare |
$1,384.71
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,210.00
|
| Rate for Payer: Riverside University Health MISP |
$1,436.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,959.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,436.96
|
| Rate for Payer: Vantage Medical Group Senior |
$1,306.33
|
|
|
HC WADA MONITORING
|
Facility
IP
|
$5,350.00
|
|
|
Service Code
|
CPT 95958
|
| Hospital Charge Code |
900600700
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,070.00 |
| Max. Negotiated Rate |
$4,815.00 |
| Rate for Payer: Cash Price |
$2,407.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,140.00
|
| Rate for Payer: Galaxy Health WC |
$4,547.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,815.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,568.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,070.00
|
| Rate for Payer: Multiplan Commercial |
$4,012.50
|
| Rate for Payer: Networks By Design Commercial |
$3,477.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,547.50
|
|
