|
HC AE EXT POWR LOCK ELBW SWTCH CN
|
Facility
|
OP
|
$22,596.00
|
|
|
Service Code
|
CPT L6950
|
| Hospital Charge Code |
905356950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,400.19 |
| Max. Negotiated Rate |
$20,336.40 |
| Rate for Payer: Adventist Health Commercial |
$9,264.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,206.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,427.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,947.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,270.63
|
| Rate for Payer: Blue Shield of California Commercial |
$17,466.71
|
| Rate for Payer: Blue Shield of California EPN |
$11,388.38
|
| Rate for Payer: Cash Price |
$12,427.80
|
| Rate for Payer: Cash Price |
$12,427.80
|
| Rate for Payer: Central Health Plan Commercial |
$18,076.80
|
| Rate for Payer: Cigna of CA HMO |
$15,817.20
|
| Rate for Payer: Cigna of CA PPO |
$15,817.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,206.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,206.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19,206.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,038.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,038.40
|
| Rate for Payer: Galaxy Health WC |
$19,206.60
|
| Rate for Payer: Global Benefits Group Commercial |
$13,557.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,336.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,575.17
|
| Rate for Payer: InnovAge PACE Commercial |
$11,298.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,071.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,367.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,986.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,264.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,817.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,817.20
|
| Rate for Payer: Multiplan Commercial |
$16,947.00
|
| Rate for Payer: Networks By Design Commercial |
$11,298.00
|
| Rate for Payer: Prime Health Services Commercial |
$19,206.60
|
| Rate for Payer: Riverside University Health System MISP |
$9,038.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,557.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,557.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,480.28
|
| Rate for Payer: United Healthcare All Other HMO |
$8,254.32
|
| Rate for Payer: United Healthcare HMO Rider |
$8,075.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,400.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,206.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,206.60
|
| Rate for Payer: Vantage Medical Group Senior |
$19,206.60
|
|
|
HC AE EXT PWR LOCK ELBW MYOELECTR
|
Facility
|
OP
|
$28,888.00
|
|
|
Service Code
|
CPT L6955
|
| Hospital Charge Code |
915356955
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,052.07 |
| Max. Negotiated Rate |
$25,999.20 |
| Rate for Payer: Adventist Health Commercial |
$11,844.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,554.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,888.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,666.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,965.92
|
| Rate for Payer: Blue Shield of California Commercial |
$22,330.42
|
| Rate for Payer: Blue Shield of California EPN |
$14,559.55
|
| Rate for Payer: Cash Price |
$15,888.40
|
| Rate for Payer: Cash Price |
$15,888.40
|
| Rate for Payer: Central Health Plan Commercial |
$23,110.40
|
| Rate for Payer: Cigna of CA HMO |
$20,221.60
|
| Rate for Payer: Cigna of CA PPO |
$20,221.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,554.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,554.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,554.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,555.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,555.20
|
| Rate for Payer: Galaxy Health WC |
$24,554.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17,332.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,999.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,052.07
|
| Rate for Payer: InnovAge PACE Commercial |
$14,444.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,268.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,999.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,881.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,844.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,221.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,221.60
|
| Rate for Payer: Multiplan Commercial |
$21,666.00
|
| Rate for Payer: Networks By Design Commercial |
$14,444.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,554.80
|
| Rate for Payer: Riverside University Health System MISP |
$11,555.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,332.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,332.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,841.67
|
| Rate for Payer: United Healthcare All Other HMO |
$10,552.79
|
| Rate for Payer: United Healthcare HMO Rider |
$10,324.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,460.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,554.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,554.80
|
| Rate for Payer: Vantage Medical Group Senior |
$24,554.80
|
|
|
HC AE EXT PWR LOCK ELBW MYOELECTR
|
Facility
|
IP
|
$28,888.00
|
|
|
Service Code
|
CPT L6955
|
| Hospital Charge Code |
915356955
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,777.60 |
| Max. Negotiated Rate |
$25,999.20 |
| Rate for Payer: Adventist Health Commercial |
$5,777.60
|
| Rate for Payer: Blue Shield of California Commercial |
$22,330.42
|
| Rate for Payer: Blue Shield of California EPN |
$14,559.55
|
| Rate for Payer: Cash Price |
$15,888.40
|
| Rate for Payer: Central Health Plan Commercial |
$23,110.40
|
| Rate for Payer: Cigna of CA HMO |
$20,221.60
|
| Rate for Payer: Cigna of CA PPO |
$20,221.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,555.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,555.20
|
| Rate for Payer: Galaxy Health WC |
$24,554.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17,332.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,999.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,268.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,006.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,881.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,777.60
|
| Rate for Payer: Multiplan Commercial |
$21,666.00
|
| Rate for Payer: Networks By Design Commercial |
$18,777.20
|
| Rate for Payer: Prime Health Services Commercial |
$24,554.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,841.67
|
| Rate for Payer: United Healthcare All Other HMO |
$10,552.79
|
| Rate for Payer: United Healthcare HMO Rider |
$10,324.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,460.82
|
|
|
HC AE EXT PWR LOCK ELBW MYOELECTR
|
Facility
|
IP
|
$28,888.00
|
|
|
Service Code
|
CPT L6955
|
| Hospital Charge Code |
905356955
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,777.60 |
| Max. Negotiated Rate |
$25,999.20 |
| Rate for Payer: Adventist Health Commercial |
$5,777.60
|
| Rate for Payer: Blue Shield of California Commercial |
$22,330.42
|
| Rate for Payer: Blue Shield of California EPN |
$14,559.55
|
| Rate for Payer: Cash Price |
$15,888.40
|
| Rate for Payer: Central Health Plan Commercial |
$23,110.40
|
| Rate for Payer: Cigna of CA HMO |
$20,221.60
|
| Rate for Payer: Cigna of CA PPO |
$20,221.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,555.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,555.20
|
| Rate for Payer: Galaxy Health WC |
$24,554.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17,332.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,999.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,268.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,006.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,881.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,777.60
|
| Rate for Payer: Multiplan Commercial |
$21,666.00
|
| Rate for Payer: Networks By Design Commercial |
$18,777.20
|
| Rate for Payer: Prime Health Services Commercial |
$24,554.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,841.67
|
| Rate for Payer: United Healthcare All Other HMO |
$10,552.79
|
| Rate for Payer: United Healthcare HMO Rider |
$10,324.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,460.82
|
|
|
HC AE EXT PWR LOCK ELBW MYOELECTR
|
Facility
|
OP
|
$28,888.00
|
|
|
Service Code
|
CPT L6955
|
| Hospital Charge Code |
905356955
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,052.07 |
| Max. Negotiated Rate |
$25,999.20 |
| Rate for Payer: Adventist Health Commercial |
$11,844.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,554.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,888.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,666.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,965.92
|
| Rate for Payer: Blue Shield of California Commercial |
$22,330.42
|
| Rate for Payer: Blue Shield of California EPN |
$14,559.55
|
| Rate for Payer: Cash Price |
$15,888.40
|
| Rate for Payer: Cash Price |
$15,888.40
|
| Rate for Payer: Central Health Plan Commercial |
$23,110.40
|
| Rate for Payer: Cigna of CA HMO |
$20,221.60
|
| Rate for Payer: Cigna of CA PPO |
$20,221.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,554.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,554.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,554.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,555.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,555.20
|
| Rate for Payer: Galaxy Health WC |
$24,554.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17,332.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,999.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,052.07
|
| Rate for Payer: InnovAge PACE Commercial |
$14,444.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,268.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,999.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,881.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,844.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,221.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,221.60
|
| Rate for Payer: Multiplan Commercial |
$21,666.00
|
| Rate for Payer: Networks By Design Commercial |
$14,444.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,554.80
|
| Rate for Payer: Riverside University Health System MISP |
$11,555.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,332.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,332.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,841.67
|
| Rate for Payer: United Healthcare All Other HMO |
$10,552.79
|
| Rate for Payer: United Healthcare HMO Rider |
$10,324.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,460.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,554.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,554.80
|
| Rate for Payer: Vantage Medical Group Senior |
$24,554.80
|
|
|
HC AERO INHAL MDI/DPI INITIAL
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800330
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Adventist Health Commercial |
$115.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$349.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.91
|
| 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 |
$316.25
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Central Health Plan Commercial |
$460.00
|
| Rate for Payer: Cigna of CA HMO |
$368.00
|
| Rate for Payer: Cigna of CA PPO |
$425.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.88
|
| Rate for Payer: EPIC Health Plan Senior |
$258.43
|
| Rate for Payer: Galaxy Health WC |
$488.75
|
| Rate for Payer: Global Benefits Group Commercial |
$345.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$517.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: InnovAge PACE Commercial |
$387.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$383.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$346.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$346.30
|
| Rate for Payer: Multiplan Commercial |
$431.25
|
| Rate for Payer: Networks By Design Commercial |
$373.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.43
|
| Rate for Payer: Prime Health Services Commercial |
$488.75
|
| Rate for Payer: Prime Health Services Medicare |
$273.94
|
| Rate for Payer: Riverside University Health System MISP |
$284.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$345.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$345.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC AERO INHAL MDI/DPI INITIAL
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800330
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$115.00 |
| Max. Negotiated Rate |
$517.50 |
| Rate for Payer: Adventist Health Commercial |
$115.00
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Central Health Plan Commercial |
$460.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.00
|
| Rate for Payer: EPIC Health Plan Senior |
$230.00
|
| Rate for Payer: Galaxy Health WC |
$488.75
|
| Rate for Payer: Global Benefits Group Commercial |
$345.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$517.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$383.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.00
|
| Rate for Payer: Multiplan Commercial |
$431.25
|
| Rate for Payer: Networks By Design Commercial |
$373.75
|
| Rate for Payer: Prime Health Services Commercial |
$488.75
|
|
|
HC AERO INHAL MDI/DPI SUB
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800331
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Adventist Health Commercial |
$115.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$349.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.91
|
| 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 |
$316.25
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Central Health Plan Commercial |
$460.00
|
| Rate for Payer: Cigna of CA HMO |
$368.00
|
| Rate for Payer: Cigna of CA PPO |
$425.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.88
|
| Rate for Payer: EPIC Health Plan Senior |
$258.43
|
| Rate for Payer: Galaxy Health WC |
$488.75
|
| Rate for Payer: Global Benefits Group Commercial |
$345.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$517.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: InnovAge PACE Commercial |
$387.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$383.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$346.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$346.30
|
| Rate for Payer: Multiplan Commercial |
$431.25
|
| Rate for Payer: Networks By Design Commercial |
$373.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.43
|
| Rate for Payer: Prime Health Services Commercial |
$488.75
|
| Rate for Payer: Prime Health Services Medicare |
$273.94
|
| Rate for Payer: Riverside University Health System MISP |
$284.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$345.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$345.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC AERO INHAL MDI/DPI SUB
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800331
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$115.00 |
| Max. Negotiated Rate |
$517.50 |
| Rate for Payer: Adventist Health Commercial |
$115.00
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Central Health Plan Commercial |
$460.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.00
|
| Rate for Payer: EPIC Health Plan Senior |
$230.00
|
| Rate for Payer: Galaxy Health WC |
$488.75
|
| Rate for Payer: Global Benefits Group Commercial |
$345.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$517.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$383.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.00
|
| Rate for Payer: Multiplan Commercial |
$431.25
|
| Rate for Payer: Networks By Design Commercial |
$373.75
|
| Rate for Payer: Prime Health Services Commercial |
$488.75
|
|
|
HC AERO INHAL PENTAMIDINE TX
|
Facility
|
IP
|
$1,113.00
|
|
|
Service Code
|
CPT 94642
|
| Hospital Charge Code |
900800300
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$222.60 |
| Max. Negotiated Rate |
$1,001.70 |
| Rate for Payer: Adventist Health Commercial |
$222.60
|
| Rate for Payer: Cash Price |
$612.15
|
| Rate for Payer: Central Health Plan Commercial |
$890.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$445.20
|
| Rate for Payer: EPIC Health Plan Senior |
$445.20
|
| Rate for Payer: Galaxy Health WC |
$946.05
|
| Rate for Payer: Global Benefits Group Commercial |
$667.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,001.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$742.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$688.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.60
|
| Rate for Payer: Multiplan Commercial |
$834.75
|
| Rate for Payer: Networks By Design Commercial |
$723.45
|
| Rate for Payer: Prime Health Services Commercial |
$946.05
|
|
|
HC AERO INHAL PENTAMIDINE TX
|
Facility
|
OP
|
$1,113.00
|
|
|
Service Code
|
CPT 94642
|
| Hospital Charge Code |
900800300
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$147.75 |
| Max. Negotiated Rate |
$1,001.70 |
| Rate for Payer: Adventist Health Commercial |
$222.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$675.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$285.00
|
| 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 |
$612.15
|
| Rate for Payer: Cash Price |
$612.15
|
| Rate for Payer: Cash Price |
$612.15
|
| Rate for Payer: Cash Price |
$612.15
|
| Rate for Payer: Central Health Plan Commercial |
$890.40
|
| Rate for Payer: Cigna of CA HMO |
$712.32
|
| Rate for Payer: Cigna of CA PPO |
$823.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.88
|
| Rate for Payer: EPIC Health Plan Senior |
$258.43
|
| Rate for Payer: Galaxy Health WC |
$946.05
|
| Rate for Payer: Global Benefits Group Commercial |
$667.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,001.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$147.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: InnovAge PACE Commercial |
$387.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$742.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$346.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$346.30
|
| Rate for Payer: Multiplan Commercial |
$834.75
|
| Rate for Payer: Networks By Design Commercial |
$723.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.43
|
| Rate for Payer: Prime Health Services Commercial |
$946.05
|
| Rate for Payer: Prime Health Services Medicare |
$273.94
|
| Rate for Payer: Riverside University Health System MISP |
$284.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$667.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$667.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC AERO INHAL SPUTUM IND INITIAL
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900801010
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$115.00 |
| Max. Negotiated Rate |
$517.50 |
| Rate for Payer: Adventist Health Commercial |
$115.00
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Central Health Plan Commercial |
$460.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.00
|
| Rate for Payer: EPIC Health Plan Senior |
$230.00
|
| Rate for Payer: Galaxy Health WC |
$488.75
|
| Rate for Payer: Global Benefits Group Commercial |
$345.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$517.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$383.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.00
|
| Rate for Payer: Multiplan Commercial |
$431.25
|
| Rate for Payer: Networks By Design Commercial |
$373.75
|
| Rate for Payer: Prime Health Services Commercial |
$488.75
|
|
|
HC AERO INHAL SPUTUM IND INITIAL
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900801010
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Adventist Health Commercial |
$115.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$349.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.91
|
| 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 |
$316.25
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Central Health Plan Commercial |
$460.00
|
| Rate for Payer: Cigna of CA HMO |
$368.00
|
| Rate for Payer: Cigna of CA PPO |
$425.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.88
|
| Rate for Payer: EPIC Health Plan Senior |
$258.43
|
| Rate for Payer: Galaxy Health WC |
$488.75
|
| Rate for Payer: Global Benefits Group Commercial |
$345.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$517.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: InnovAge PACE Commercial |
$387.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$383.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$346.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$346.30
|
| Rate for Payer: Multiplan Commercial |
$431.25
|
| Rate for Payer: Networks By Design Commercial |
$373.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.43
|
| Rate for Payer: Prime Health Services Commercial |
$488.75
|
| Rate for Payer: Prime Health Services Medicare |
$273.94
|
| Rate for Payer: Riverside University Health System MISP |
$284.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$345.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$345.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC AERO INHAL SPUTUM IND SUB
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900801011
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Adventist Health Commercial |
$115.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$349.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.91
|
| 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 |
$316.25
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Central Health Plan Commercial |
$460.00
|
| Rate for Payer: Cigna of CA HMO |
$368.00
|
| Rate for Payer: Cigna of CA PPO |
$425.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.88
|
| Rate for Payer: EPIC Health Plan Senior |
$258.43
|
| Rate for Payer: Galaxy Health WC |
$488.75
|
| Rate for Payer: Global Benefits Group Commercial |
$345.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$517.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: InnovAge PACE Commercial |
$387.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$383.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$346.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$346.30
|
| Rate for Payer: Multiplan Commercial |
$431.25
|
| Rate for Payer: Networks By Design Commercial |
$373.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.43
|
| Rate for Payer: Prime Health Services Commercial |
$488.75
|
| Rate for Payer: Prime Health Services Medicare |
$273.94
|
| Rate for Payer: Riverside University Health System MISP |
$284.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$345.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$345.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC AERO INHAL SPUTUM IND SUB
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900801011
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$115.00 |
| Max. Negotiated Rate |
$517.50 |
| Rate for Payer: Adventist Health Commercial |
$115.00
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Central Health Plan Commercial |
$460.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.00
|
| Rate for Payer: EPIC Health Plan Senior |
$230.00
|
| Rate for Payer: Galaxy Health WC |
$488.75
|
| Rate for Payer: Global Benefits Group Commercial |
$345.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$517.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$383.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.00
|
| Rate for Payer: Multiplan Commercial |
$431.25
|
| Rate for Payer: Networks By Design Commercial |
$373.75
|
| Rate for Payer: Prime Health Services Commercial |
$488.75
|
|
|
HC AERO INHAL SVN INITIAL
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800310
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Adventist Health Commercial |
$115.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$349.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.91
|
| 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 |
$316.25
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Central Health Plan Commercial |
$460.00
|
| Rate for Payer: Cigna of CA HMO |
$368.00
|
| Rate for Payer: Cigna of CA PPO |
$425.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.88
|
| Rate for Payer: EPIC Health Plan Senior |
$258.43
|
| Rate for Payer: Galaxy Health WC |
$488.75
|
| Rate for Payer: Global Benefits Group Commercial |
$345.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$517.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: InnovAge PACE Commercial |
$387.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$383.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$346.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$346.30
|
| Rate for Payer: Multiplan Commercial |
$431.25
|
| Rate for Payer: Networks By Design Commercial |
$373.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.43
|
| Rate for Payer: Prime Health Services Commercial |
$488.75
|
| Rate for Payer: Prime Health Services Medicare |
$273.94
|
| Rate for Payer: Riverside University Health System MISP |
$284.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$345.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$345.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC AERO INHAL SVN INITIAL
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800310
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$115.00 |
| Max. Negotiated Rate |
$517.50 |
| Rate for Payer: Adventist Health Commercial |
$115.00
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Central Health Plan Commercial |
$460.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.00
|
| Rate for Payer: EPIC Health Plan Senior |
$230.00
|
| Rate for Payer: Galaxy Health WC |
$488.75
|
| Rate for Payer: Global Benefits Group Commercial |
$345.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$517.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$383.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.00
|
| Rate for Payer: Multiplan Commercial |
$431.25
|
| Rate for Payer: Networks By Design Commercial |
$373.75
|
| Rate for Payer: Prime Health Services Commercial |
$488.75
|
|
|
HC AERO INHAL SVN INITIAL
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$115.00 |
| Max. Negotiated Rate |
$517.50 |
| Rate for Payer: Adventist Health Commercial |
$115.00
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Central Health Plan Commercial |
$460.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.00
|
| Rate for Payer: EPIC Health Plan Senior |
$230.00
|
| Rate for Payer: Galaxy Health WC |
$488.75
|
| Rate for Payer: Global Benefits Group Commercial |
$345.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$517.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$383.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.00
|
| Rate for Payer: Multiplan Commercial |
$431.25
|
| Rate for Payer: Networks By Design Commercial |
$373.75
|
| Rate for Payer: Prime Health Services Commercial |
$488.75
|
|
|
HC AERO INHAL SVN INITIAL
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$115.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$337.70
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$411.77
|
| 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 |
$316.25
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Central Health Plan Commercial |
$460.00
|
| Rate for Payer: Cigna of CA HMO |
$368.00
|
| Rate for Payer: Cigna of CA PPO |
$425.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.88
|
| Rate for Payer: EPIC Health Plan Senior |
$258.43
|
| Rate for Payer: Galaxy Health WC |
$488.75
|
| Rate for Payer: Global Benefits Group Commercial |
$345.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$517.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: InnovAge PACE Commercial |
$387.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$383.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$346.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$346.30
|
| Rate for Payer: Multiplan Commercial |
$431.25
|
| Rate for Payer: Multiplan WC |
$411.77
|
| Rate for Payer: Networks By Design Commercial |
$373.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.43
|
| Rate for Payer: Preferred Health Network WC |
$420.17
|
| Rate for Payer: Prime Health Services Commercial |
$488.75
|
| Rate for Payer: Prime Health Services Medicare |
$273.94
|
| Rate for Payer: Prime Health Services WC |
$407.56
|
| Rate for Payer: Riverside University Health System MISP |
$284.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$345.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$287.50
|
| Rate for Payer: United Healthcare All Other HMO |
$287.50
|
| Rate for Payer: United Healthcare HMO Rider |
$287.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$287.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC AERO INHAL SVN SUB
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800311
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$115.00 |
| Max. Negotiated Rate |
$517.50 |
| Rate for Payer: Adventist Health Commercial |
$115.00
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Central Health Plan Commercial |
$460.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.00
|
| Rate for Payer: EPIC Health Plan Senior |
$230.00
|
| Rate for Payer: Galaxy Health WC |
$488.75
|
| Rate for Payer: Global Benefits Group Commercial |
$345.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$517.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$383.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.00
|
| Rate for Payer: Multiplan Commercial |
$431.25
|
| Rate for Payer: Networks By Design Commercial |
$373.75
|
| Rate for Payer: Prime Health Services Commercial |
$488.75
|
|
|
HC AERO INHAL SVN SUB
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800311
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Adventist Health Commercial |
$115.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$349.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.91
|
| 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 |
$316.25
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Central Health Plan Commercial |
$460.00
|
| Rate for Payer: Cigna of CA HMO |
$368.00
|
| Rate for Payer: Cigna of CA PPO |
$425.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.88
|
| Rate for Payer: EPIC Health Plan Senior |
$258.43
|
| Rate for Payer: Galaxy Health WC |
$488.75
|
| Rate for Payer: Global Benefits Group Commercial |
$345.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$517.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: InnovAge PACE Commercial |
$387.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$383.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$346.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$346.30
|
| Rate for Payer: Multiplan Commercial |
$431.25
|
| Rate for Payer: Networks By Design Commercial |
$373.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.43
|
| Rate for Payer: Prime Health Services Commercial |
$488.75
|
| Rate for Payer: Prime Health Services Medicare |
$273.94
|
| Rate for Payer: Riverside University Health System MISP |
$284.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$345.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$345.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC AFB FLUOROCHROME STAIN CONCEN
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900911546
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.93
|
| Rate for Payer: Blue Shield of California Commercial |
$34.60
|
| Rate for Payer: Blue Shield of California EPN |
$22.63
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Central Health Plan Commercial |
$45.60
|
| Rate for Payer: Cigna of CA HMO |
$36.48
|
| Rate for Payer: Cigna of CA PPO |
$42.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.39
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.39
|
| Rate for Payer: InnovAge PACE Commercial |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.22
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.39
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
| Rate for Payer: Prime Health Services Medicare |
$5.71
|
| Rate for Payer: Riverside University Health System MISP |
$5.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.37
|
| Rate for Payer: United Healthcare All Other HMO |
$4.37
|
| Rate for Payer: United Healthcare HMO Rider |
$4.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
HC AFB FLUOROCHROME STAIN CONCEN
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900911546
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Central Health Plan Commercial |
$45.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: EPIC Health Plan Senior |
$22.80
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.40
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
|
|
HC AFB FLUOROCHROME STAIN DIRECT
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900911545
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Central Health Plan Commercial |
$45.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: EPIC Health Plan Senior |
$22.80
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.40
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
|
|
HC AFB FLUOROCHROME STAIN DIRECT
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900911545
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.93
|
| Rate for Payer: Blue Shield of California Commercial |
$34.60
|
| Rate for Payer: Blue Shield of California EPN |
$22.63
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Central Health Plan Commercial |
$45.60
|
| Rate for Payer: Cigna of CA HMO |
$36.48
|
| Rate for Payer: Cigna of CA PPO |
$42.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.39
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.39
|
| Rate for Payer: InnovAge PACE Commercial |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.22
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.39
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
| Rate for Payer: Prime Health Services Medicare |
$5.71
|
| Rate for Payer: Riverside University Health System MISP |
$5.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.37
|
| Rate for Payer: United Healthcare All Other HMO |
$4.37
|
| Rate for Payer: United Healthcare HMO Rider |
$4.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
