|
HC ULTRASOUND TRANSP KIDNEY W/DOPPLER
|
Facility
|
IP
|
$2,763.00
|
|
|
Service Code
|
CPT 76776
|
| Hospital Charge Code |
906601163
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$552.60 |
| Max. Negotiated Rate |
$2,486.70 |
| Rate for Payer: Adventist Health Commercial |
$552.60
|
| Rate for Payer: Cash Price |
$1,519.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,210.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,105.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,105.20
|
| Rate for Payer: Galaxy Health WC |
$2,348.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,657.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,486.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,842.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,052.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,710.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.60
|
| Rate for Payer: Multiplan Commercial |
$2,072.25
|
| Rate for Payer: Networks By Design Commercial |
$1,795.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,348.55
|
|
|
HC ULTRASOUND TRANSVAGINAL
|
Facility
|
OP
|
$2,366.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
906601205
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$116.36 |
| Max. Negotiated Rate |
$2,129.40 |
| Rate for Payer: Adventist Health Commercial |
$473.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,436.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$319.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,389.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1,436.16
|
| Rate for Payer: Blue Shield of California EPN |
$939.30
|
| Rate for Payer: Cash Price |
$1,301.30
|
| Rate for Payer: Cash Price |
$1,301.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,892.80
|
| Rate for Payer: Cigna of CA HMO |
$1,514.24
|
| Rate for Payer: Cigna of CA PPO |
$1,750.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$2,011.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,419.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,129.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$116.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,578.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$473.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,774.50
|
| Rate for Payer: Networks By Design Commercial |
$1,537.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$2,011.10
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,419.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,419.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC ULTRASOUND TRANSVAGINAL
|
Facility
|
IP
|
$2,366.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
906601205
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$473.20 |
| Max. Negotiated Rate |
$2,129.40 |
| Rate for Payer: Adventist Health Commercial |
$473.20
|
| Rate for Payer: Cash Price |
$1,301.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,892.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$946.40
|
| Rate for Payer: EPIC Health Plan Senior |
$946.40
|
| Rate for Payer: Galaxy Health WC |
$2,011.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,419.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,129.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,578.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$901.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,464.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$473.20
|
| Rate for Payer: Multiplan Commercial |
$1,774.50
|
| Rate for Payer: Networks By Design Commercial |
$1,537.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,011.10
|
|
|
HC ULTRASOUND TRANSVAGINAL OB
|
Facility
|
IP
|
$1,615.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
906601312
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$323.00 |
| Max. Negotiated Rate |
$1,453.50 |
| Rate for Payer: Adventist Health Commercial |
$323.00
|
| Rate for Payer: Cash Price |
$888.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,292.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.00
|
| Rate for Payer: EPIC Health Plan Senior |
$646.00
|
| Rate for Payer: Galaxy Health WC |
$1,372.75
|
| Rate for Payer: Global Benefits Group Commercial |
$969.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,453.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,077.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$615.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$999.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.00
|
| Rate for Payer: Multiplan Commercial |
$1,211.25
|
| Rate for Payer: Networks By Design Commercial |
$1,049.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,372.75
|
|
|
HC ULTRASOUND TRANSVAGINAL OB
|
Facility
|
OP
|
$1,615.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
906601312
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$1,453.50 |
| Rate for Payer: Adventist Health Commercial |
$323.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$980.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$325.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$948.49
|
| Rate for Payer: Blue Shield of California Commercial |
$980.30
|
| Rate for Payer: Blue Shield of California EPN |
$641.15
|
| Rate for Payer: Cash Price |
$888.25
|
| Rate for Payer: Cash Price |
$888.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,292.00
|
| Rate for Payer: Cigna of CA HMO |
$1,033.60
|
| Rate for Payer: Cigna of CA PPO |
$1,195.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,372.75
|
| Rate for Payer: Global Benefits Group Commercial |
$969.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,453.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$141.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,077.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,211.25
|
| Rate for Payer: Networks By Design Commercial |
$1,049.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,372.75
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$969.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$969.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC ULTRASOUND W/C 30 MIN OT
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 97128
|
| Hospital Charge Code |
903207128
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$79.40 |
| Max. Negotiated Rate |
$357.30 |
| Rate for Payer: Adventist Health Commercial |
$79.40
|
| Rate for Payer: Cash Price |
$218.35
|
| Rate for Payer: Central Health Plan Commercial |
$317.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.80
|
| Rate for Payer: EPIC Health Plan Senior |
$158.80
|
| Rate for Payer: Galaxy Health WC |
$337.45
|
| Rate for Payer: Global Benefits Group Commercial |
$238.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$357.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$264.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$245.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.40
|
| Rate for Payer: Multiplan Commercial |
$297.75
|
| Rate for Payer: Networks By Design Commercial |
$258.05
|
| Rate for Payer: Prime Health Services Commercial |
$337.45
|
|
|
HC ULTRASOUND W/C 30 MIN OT
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
CPT 97128
|
| Hospital Charge Code |
903207128
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$151.26 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$162.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$241.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$337.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$297.75
|
| 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 |
$218.35
|
| Rate for Payer: Cash Price |
$218.35
|
| Rate for Payer: Cash Price |
$218.35
|
| Rate for Payer: Central Health Plan Commercial |
$317.60
|
| Rate for Payer: Cigna of CA HMO |
$254.08
|
| Rate for Payer: Cigna of CA PPO |
$293.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$337.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$337.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.80
|
| Rate for Payer: EPIC Health Plan Senior |
$158.80
|
| Rate for Payer: Galaxy Health WC |
$337.45
|
| Rate for Payer: Global Benefits Group Commercial |
$238.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$357.30
|
| Rate for Payer: InnovAge PACE Commercial |
$198.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$264.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$245.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$277.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$277.90
|
| Rate for Payer: Multiplan Commercial |
$297.75
|
| Rate for Payer: Networks By Design Commercial |
$258.05
|
| Rate for Payer: Prime Health Services Commercial |
$337.45
|
| Rate for Payer: Riverside University Health System MISP |
$158.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$238.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$238.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$337.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.45
|
| Rate for Payer: Vantage Medical Group Senior |
$337.45
|
|
|
HC UMBILICAL VEIN CATH NEWBORN
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
988136510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$44.19 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$91.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$386.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$250.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$341.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$220.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.22
|
| 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 |
$250.25
|
| Rate for Payer: Cash Price |
$250.25
|
| Rate for Payer: Cash Price |
$250.25
|
| Rate for Payer: Central Health Plan Commercial |
$364.00
|
| Rate for Payer: Cigna of CA HMO |
$291.20
|
| Rate for Payer: Cigna of CA PPO |
$336.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$386.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$386.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: EPIC Health Plan Senior |
$182.00
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$409.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.19
|
| Rate for Payer: InnovAge PACE Commercial |
$227.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$303.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$281.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.50
|
| Rate for Payer: Multiplan Commercial |
$341.25
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
| Rate for Payer: Riverside University Health System MISP |
$182.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.00
|
| 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 |
$386.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$386.75
|
| Rate for Payer: Vantage Medical Group Senior |
$386.75
|
|
|
HC UMBILICAL VEIN CATH NEWBORN
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
988136510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Adventist Health Commercial |
$91.00
|
| Rate for Payer: Cash Price |
$250.25
|
| Rate for Payer: Central Health Plan Commercial |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: EPIC Health Plan Senior |
$182.00
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$409.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$303.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$281.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.00
|
| Rate for Payer: Multiplan Commercial |
$341.25
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
|
|
HC UNLISTED MODALITY OT
|
Facility
|
OP
|
$303.00
|
|
|
Service Code
|
CPT 97039
|
| Hospital Charge Code |
905104039
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$24.54 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$124.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$257.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$166.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$227.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$166.65
|
| Rate for Payer: Cash Price |
$166.65
|
| Rate for Payer: Cash Price |
$166.65
|
| Rate for Payer: Cash Price |
$166.65
|
| Rate for Payer: Central Health Plan Commercial |
$242.40
|
| Rate for Payer: Cigna of CA HMO |
$193.92
|
| Rate for Payer: Cigna of CA PPO |
$224.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$257.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$257.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$257.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.20
|
| Rate for Payer: EPIC Health Plan Senior |
$121.20
|
| Rate for Payer: Galaxy Health WC |
$257.55
|
| Rate for Payer: Global Benefits Group Commercial |
$181.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.54
|
| Rate for Payer: InnovAge PACE Commercial |
$151.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$212.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$212.10
|
| Rate for Payer: Multiplan Commercial |
$227.25
|
| Rate for Payer: Networks By Design Commercial |
$196.95
|
| Rate for Payer: Prime Health Services Commercial |
$257.55
|
| Rate for Payer: Riverside University Health System MISP |
$121.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.80
|
| 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 |
$257.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$257.55
|
| Rate for Payer: Vantage Medical Group Senior |
$257.55
|
|
|
HC UNLISTED MODALITY OT
|
Facility
|
IP
|
$303.00
|
|
|
Service Code
|
CPT 97039
|
| Hospital Charge Code |
905104039
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$60.60 |
| Max. Negotiated Rate |
$272.70 |
| Rate for Payer: Adventist Health Commercial |
$60.60
|
| Rate for Payer: Cash Price |
$166.65
|
| Rate for Payer: Central Health Plan Commercial |
$242.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.20
|
| Rate for Payer: EPIC Health Plan Senior |
$121.20
|
| Rate for Payer: Galaxy Health WC |
$257.55
|
| Rate for Payer: Global Benefits Group Commercial |
$181.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.60
|
| Rate for Payer: Multiplan Commercial |
$227.25
|
| Rate for Payer: Networks By Design Commercial |
$196.95
|
| Rate for Payer: Prime Health Services Commercial |
$257.55
|
|
|
HC UNLISTED MODALITY PT
|
Facility
|
IP
|
$303.00
|
|
|
Service Code
|
CPT 97039
|
| Hospital Charge Code |
905103127
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.60 |
| Max. Negotiated Rate |
$272.70 |
| Rate for Payer: Adventist Health Commercial |
$60.60
|
| Rate for Payer: Cash Price |
$166.65
|
| Rate for Payer: Central Health Plan Commercial |
$242.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.20
|
| Rate for Payer: EPIC Health Plan Senior |
$121.20
|
| Rate for Payer: Galaxy Health WC |
$257.55
|
| Rate for Payer: Global Benefits Group Commercial |
$181.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.60
|
| Rate for Payer: Multiplan Commercial |
$227.25
|
| Rate for Payer: Networks By Design Commercial |
$196.95
|
| Rate for Payer: Prime Health Services Commercial |
$257.55
|
|
|
HC UNLISTED MODALITY PT
|
Facility
|
OP
|
$303.00
|
|
|
Service Code
|
CPT 97039
|
| Hospital Charge Code |
905103127
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.54 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$124.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$257.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$166.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$227.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$166.65
|
| Rate for Payer: Cash Price |
$166.65
|
| Rate for Payer: Cash Price |
$166.65
|
| Rate for Payer: Cash Price |
$166.65
|
| Rate for Payer: Central Health Plan Commercial |
$242.40
|
| Rate for Payer: Cigna of CA HMO |
$193.92
|
| Rate for Payer: Cigna of CA PPO |
$224.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$257.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$257.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$257.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.20
|
| Rate for Payer: EPIC Health Plan Senior |
$121.20
|
| Rate for Payer: Galaxy Health WC |
$257.55
|
| Rate for Payer: Global Benefits Group Commercial |
$181.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.54
|
| Rate for Payer: InnovAge PACE Commercial |
$151.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$212.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$212.10
|
| Rate for Payer: Multiplan Commercial |
$227.25
|
| Rate for Payer: Networks By Design Commercial |
$196.95
|
| Rate for Payer: Prime Health Services Commercial |
$257.55
|
| Rate for Payer: Riverside University Health System MISP |
$121.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.80
|
| 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 |
$257.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$257.55
|
| Rate for Payer: Vantage Medical Group Senior |
$257.55
|
|
|
HC UNLISTED MODALITY PT COMM MCARE
|
Facility
|
OP
|
$303.00
|
|
|
Service Code
|
CPT 97039
|
| Hospital Charge Code |
900417039
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.54 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$124.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$257.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$166.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$227.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$166.65
|
| Rate for Payer: Cash Price |
$166.65
|
| Rate for Payer: Cash Price |
$166.65
|
| Rate for Payer: Cash Price |
$166.65
|
| Rate for Payer: Central Health Plan Commercial |
$242.40
|
| Rate for Payer: Cigna of CA HMO |
$193.92
|
| Rate for Payer: Cigna of CA PPO |
$224.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$257.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$257.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$257.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.20
|
| Rate for Payer: EPIC Health Plan Senior |
$121.20
|
| Rate for Payer: Galaxy Health WC |
$257.55
|
| Rate for Payer: Global Benefits Group Commercial |
$181.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.54
|
| Rate for Payer: InnovAge PACE Commercial |
$151.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$212.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$212.10
|
| Rate for Payer: Multiplan Commercial |
$227.25
|
| Rate for Payer: Networks By Design Commercial |
$196.95
|
| Rate for Payer: Prime Health Services Commercial |
$257.55
|
| Rate for Payer: Riverside University Health System MISP |
$121.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.80
|
| 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 |
$257.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$257.55
|
| Rate for Payer: Vantage Medical Group Senior |
$257.55
|
|
|
HC UNLISTED MODALITY PT COMM MCARE
|
Facility
|
IP
|
$303.00
|
|
|
Service Code
|
CPT 97039
|
| Hospital Charge Code |
900417039
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.60 |
| Max. Negotiated Rate |
$272.70 |
| Rate for Payer: Adventist Health Commercial |
$60.60
|
| Rate for Payer: Cash Price |
$166.65
|
| Rate for Payer: Central Health Plan Commercial |
$242.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.20
|
| Rate for Payer: EPIC Health Plan Senior |
$121.20
|
| Rate for Payer: Galaxy Health WC |
$257.55
|
| Rate for Payer: Global Benefits Group Commercial |
$181.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.60
|
| Rate for Payer: Multiplan Commercial |
$227.25
|
| Rate for Payer: Networks By Design Commercial |
$196.95
|
| Rate for Payer: Prime Health Services Commercial |
$257.55
|
|
|
HC UNLISTED OCULAR MUSCLE PROCEDU
|
Facility
|
OP
|
$7,339.00
|
|
|
Service Code
|
CPT 67399
|
| Hospital Charge Code |
900501657
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$379.82 |
| Max. Negotiated Rate |
$8,581.00 |
| Rate for Payer: Adventist Health Commercial |
$1,467.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$379.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$605.18
|
| Rate for Payer: Cash Price |
$4,036.45
|
| Rate for Payer: Cash Price |
$4,036.45
|
| Rate for Payer: Cash Price |
$4,036.45
|
| Rate for Payer: Cash Price |
$4,036.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,871.20
|
| Rate for Payer: Cigna of CA HMO |
$4,696.96
|
| Rate for Payer: Cigna of CA PPO |
$5,430.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$379.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.76
|
| Rate for Payer: EPIC Health Plan Senior |
$379.82
|
| Rate for Payer: Galaxy Health WC |
$6,238.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,403.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,605.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$622.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$379.82
|
| Rate for Payer: InnovAge PACE Commercial |
$569.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,895.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,467.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$508.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$508.96
|
| Rate for Payer: Multiplan Commercial |
$5,504.25
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$4,770.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$379.82
|
| Rate for Payer: Preferred Health Network WC |
$617.53
|
| Rate for Payer: Prime Health Services Commercial |
$6,238.15
|
| Rate for Payer: Prime Health Services Medicare |
$402.61
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Riverside University Health System MISP |
$417.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,403.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,669.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,669.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,669.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,669.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$379.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Vantage Medical Group Senior |
$379.82
|
|
|
HC UNLISTED OCULAR MUSCLE PROCEDU
|
Facility
|
IP
|
$7,339.00
|
|
|
Service Code
|
CPT 67399
|
| Hospital Charge Code |
900501657
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,467.80 |
| Max. Negotiated Rate |
$6,605.10 |
| Rate for Payer: Adventist Health Commercial |
$1,467.80
|
| Rate for Payer: Cash Price |
$4,036.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,871.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,935.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,935.60
|
| Rate for Payer: Galaxy Health WC |
$6,238.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,403.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,605.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,895.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,796.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,542.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,467.80
|
| Rate for Payer: Multiplan Commercial |
$5,504.25
|
| Rate for Payer: Networks By Design Commercial |
$4,770.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,238.15
|
|
|
HC UNLISTED PROCEDURE, LARYNX
|
Facility
|
IP
|
$6,623.00
|
|
|
Service Code
|
CPT 31599
|
| Hospital Charge Code |
900501561
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,324.60 |
| Max. Negotiated Rate |
$5,960.70 |
| Rate for Payer: Adventist Health Commercial |
$1,324.60
|
| Rate for Payer: Cash Price |
$3,642.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,298.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,649.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,649.20
|
| Rate for Payer: Galaxy Health WC |
$5,629.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,973.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,960.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,417.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,523.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,099.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,324.60
|
| Rate for Payer: Multiplan Commercial |
$4,967.25
|
| Rate for Payer: Networks By Design Commercial |
$4,304.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,629.55
|
|
|
HC UNLISTED PROCEDURE, LARYNX
|
Facility
|
OP
|
$6,623.00
|
|
|
Service Code
|
CPT 31599
|
| Hospital Charge Code |
900501561
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.06 |
| Max. Negotiated Rate |
$8,581.00 |
| Rate for Payer: Adventist Health Commercial |
$1,324.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$470.13
|
| Rate for Payer: Cash Price |
$3,642.65
|
| Rate for Payer: Cash Price |
$3,642.65
|
| Rate for Payer: Cash Price |
$3,642.65
|
| Rate for Payer: Cash Price |
$3,642.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,298.40
|
| Rate for Payer: Cigna of CA HMO |
$4,238.72
|
| Rate for Payer: Cigna of CA PPO |
$4,901.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$5,629.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,973.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,960.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: InnovAge PACE Commercial |
$442.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,417.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,324.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$395.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$4,967.25
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$4,304.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$295.06
|
| Rate for Payer: Preferred Health Network WC |
$479.72
|
| Rate for Payer: Prime Health Services Commercial |
$5,629.55
|
| Rate for Payer: Prime Health Services Medicare |
$312.76
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Riverside University Health System MISP |
$324.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,973.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,311.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,311.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,311.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,311.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC UNLISTED TX PROC 15MIN MCAL
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 97139
|
| Hospital Charge Code |
900400056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$63.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$132.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$132.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.16
|
| Rate for Payer: InnovAge PACE Commercial |
$78.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Riverside University Health System MISP |
$62.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$132.60
|
| Rate for Payer: Vantage Medical Group Senior |
$132.60
|
|
|
HC UNLISTED TX PROC 15MIN MCAL
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 97139
|
| Hospital Charge Code |
900400056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
|
|
HC UNLISTED TX PROC 15 MIN PT
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 97139
|
| Hospital Charge Code |
900407139
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$63.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$132.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$132.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.16
|
| Rate for Payer: InnovAge PACE Commercial |
$78.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Riverside University Health System MISP |
$62.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$132.60
|
| Rate for Payer: Vantage Medical Group Senior |
$132.60
|
|
|
HC UNLISTED TX PROC 15 MIN PT
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 97139
|
| Hospital Charge Code |
900407139
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
|
|
HC UNLIST PROC CONJUNCTIVA
|
Facility
|
OP
|
$2,222.00
|
|
|
Service Code
|
CPT 68399
|
| Hospital Charge Code |
900501500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$379.82 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$444.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$379.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$605.18
|
| Rate for Payer: Cash Price |
$1,222.10
|
| Rate for Payer: Cash Price |
$1,222.10
|
| Rate for Payer: Cash Price |
$1,222.10
|
| Rate for Payer: Cash Price |
$1,222.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,777.60
|
| Rate for Payer: Cigna of CA HMO |
$1,422.08
|
| Rate for Payer: Cigna of CA PPO |
$1,644.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$379.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.76
|
| Rate for Payer: EPIC Health Plan Senior |
$379.82
|
| Rate for Payer: Galaxy Health WC |
$1,888.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,333.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,999.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$622.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$379.82
|
| Rate for Payer: InnovAge PACE Commercial |
$569.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,482.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$508.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$508.96
|
| Rate for Payer: Multiplan Commercial |
$1,666.50
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$1,444.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$379.82
|
| Rate for Payer: Preferred Health Network WC |
$617.53
|
| Rate for Payer: Prime Health Services Commercial |
$1,888.70
|
| Rate for Payer: Prime Health Services Medicare |
$402.61
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Riverside University Health System MISP |
$417.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,333.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,111.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,111.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,111.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,111.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$379.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Vantage Medical Group Senior |
$379.82
|
|
|
HC UNLIST PROC CONJUNCTIVA
|
Facility
|
IP
|
$2,222.00
|
|
|
Service Code
|
CPT 68399
|
| Hospital Charge Code |
900501500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$444.40 |
| Max. Negotiated Rate |
$1,999.80 |
| Rate for Payer: Adventist Health Commercial |
$444.40
|
| Rate for Payer: Cash Price |
$1,222.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,777.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$888.80
|
| Rate for Payer: EPIC Health Plan Senior |
$888.80
|
| Rate for Payer: Galaxy Health WC |
$1,888.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,333.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,999.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,482.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$846.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,375.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.40
|
| Rate for Payer: Multiplan Commercial |
$1,666.50
|
| Rate for Payer: Networks By Design Commercial |
$1,444.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,888.70
|
|
