|
HC AERO INHAL MDI/DPI SUB
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800331
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$473.40 |
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Central Health Plan Commercial |
$420.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.40
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$473.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.20
|
| Rate for Payer: Multiplan Commercial |
$394.50
|
| Rate for Payer: Networks By Design Commercial |
$341.90
|
| Rate for Payer: Prime Health Services Commercial |
$447.10
|
|
|
HC AERO INHAL MDI/DPI SUB
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800331
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$509.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$266.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$266.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$315.60
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$266.49
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Central Health Plan Commercial |
$420.80
|
| Rate for Payer: Cigna of CA HMO |
$336.64
|
| Rate for Payer: Cigna of CA PPO |
$389.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.74
|
| Rate for Payer: Dignity Health Media |
$266.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$359.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$266.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$266.49
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$473.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$394.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$437.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$439.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$266.49
|
| Rate for Payer: InnovAge PACE Commercial |
$399.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$357.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$357.10
|
| Rate for Payer: Multiplan Commercial |
$394.50
|
| Rate for Payer: Networks By Design Commercial |
$341.90
|
| Rate for Payer: Prime Health Services Commercial |
$447.10
|
| Rate for Payer: Prime Health Services Medicare |
$282.48
|
| Rate for Payer: Riverside University Health System MISP |
$293.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$315.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Vantage Medical Group Senior |
$266.49
|
|
|
HC AERO INHAL PENTAMIDINE TX
|
Facility
|
OP
|
$1,019.00
|
|
|
Service Code
|
CPT 94642
|
| Hospital Charge Code |
900800300
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$163.21 |
| Max. Negotiated Rate |
$917.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$266.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$248.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$266.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$285.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$611.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$266.49
|
| Rate for Payer: Cash Price |
$458.55
|
| Rate for Payer: Cash Price |
$458.55
|
| Rate for Payer: Cash Price |
$458.55
|
| Rate for Payer: Cash Price |
$458.55
|
| Rate for Payer: Central Health Plan Commercial |
$815.20
|
| Rate for Payer: Cigna of CA HMO |
$652.16
|
| Rate for Payer: Cigna of CA PPO |
$754.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.74
|
| Rate for Payer: Dignity Health Media |
$266.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$359.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$266.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$266.49
|
| Rate for Payer: Galaxy Health WC |
$866.15
|
| Rate for Payer: Global Benefits Group Commercial |
$611.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$917.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$764.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$437.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$439.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$266.49
|
| Rate for Payer: InnovAge PACE Commercial |
$399.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$679.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$357.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$357.10
|
| Rate for Payer: Multiplan Commercial |
$764.25
|
| Rate for Payer: Networks By Design Commercial |
$662.35
|
| Rate for Payer: Prime Health Services Commercial |
$866.15
|
| Rate for Payer: Prime Health Services Medicare |
$282.48
|
| Rate for Payer: Riverside University Health System MISP |
$293.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$611.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$611.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Vantage Medical Group Senior |
$266.49
|
|
|
HC AERO INHAL PENTAMIDINE TX
|
Facility
|
IP
|
$1,019.00
|
|
|
Service Code
|
CPT 94642
|
| Hospital Charge Code |
900800300
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$203.80 |
| Max. Negotiated Rate |
$917.10 |
| Rate for Payer: Cash Price |
$458.55
|
| Rate for Payer: Central Health Plan Commercial |
$815.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$407.60
|
| Rate for Payer: Galaxy Health WC |
$866.15
|
| Rate for Payer: Global Benefits Group Commercial |
$611.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$917.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$679.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.80
|
| Rate for Payer: Multiplan Commercial |
$764.25
|
| Rate for Payer: Networks By Design Commercial |
$662.35
|
| Rate for Payer: Prime Health Services Commercial |
$866.15
|
|
|
HC AERO INHAL SPUTUM IND INITIAL
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900801010
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$473.40 |
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Central Health Plan Commercial |
$420.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.40
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$473.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.20
|
| Rate for Payer: Multiplan Commercial |
$394.50
|
| Rate for Payer: Networks By Design Commercial |
$341.90
|
| Rate for Payer: Prime Health Services Commercial |
$447.10
|
|
|
HC AERO INHAL SPUTUM IND INITIAL
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900801010
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$509.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$266.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$266.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$315.60
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$266.49
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Central Health Plan Commercial |
$420.80
|
| Rate for Payer: Cigna of CA HMO |
$336.64
|
| Rate for Payer: Cigna of CA PPO |
$389.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.74
|
| Rate for Payer: Dignity Health Media |
$266.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$359.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$266.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$266.49
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$473.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$394.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$437.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$439.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$266.49
|
| Rate for Payer: InnovAge PACE Commercial |
$399.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$357.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$357.10
|
| Rate for Payer: Multiplan Commercial |
$394.50
|
| Rate for Payer: Networks By Design Commercial |
$341.90
|
| Rate for Payer: Prime Health Services Commercial |
$447.10
|
| Rate for Payer: Prime Health Services Medicare |
$282.48
|
| Rate for Payer: Riverside University Health System MISP |
$293.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$315.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Vantage Medical Group Senior |
$266.49
|
|
|
HC AERO INHAL SPUTUM IND SUB
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900801011
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$509.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$266.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$266.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$315.60
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$266.49
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Central Health Plan Commercial |
$420.80
|
| Rate for Payer: Cigna of CA HMO |
$336.64
|
| Rate for Payer: Cigna of CA PPO |
$389.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.74
|
| Rate for Payer: Dignity Health Media |
$266.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$359.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$266.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$266.49
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$473.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$394.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$437.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$439.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$266.49
|
| Rate for Payer: InnovAge PACE Commercial |
$399.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$357.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$357.10
|
| Rate for Payer: Multiplan Commercial |
$394.50
|
| Rate for Payer: Networks By Design Commercial |
$341.90
|
| Rate for Payer: Prime Health Services Commercial |
$447.10
|
| Rate for Payer: Prime Health Services Medicare |
$282.48
|
| Rate for Payer: Riverside University Health System MISP |
$293.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$315.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Vantage Medical Group Senior |
$266.49
|
|
|
HC AERO INHAL SPUTUM IND SUB
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900801011
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$473.40 |
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Central Health Plan Commercial |
$420.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.40
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$473.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.20
|
| Rate for Payer: Multiplan Commercial |
$394.50
|
| Rate for Payer: Networks By Design Commercial |
$341.90
|
| Rate for Payer: Prime Health Services Commercial |
$447.10
|
|
|
HC AERO INHAL SVN INITIAL
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$266.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$266.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.76
|
| Rate for Payer: Blue Distinction Transplant |
$315.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$266.49
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Central Health Plan Commercial |
$420.80
|
| Rate for Payer: Cigna of CA PPO |
$389.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.74
|
| Rate for Payer: Dignity Health Media |
$266.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$359.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$266.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$266.49
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$473.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$394.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$437.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$439.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$266.49
|
| Rate for Payer: InnovAge PACE Commercial |
$399.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$357.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$357.10
|
| Rate for Payer: Multiplan Commercial |
$394.50
|
| Rate for Payer: Networks By Design Commercial |
$341.90
|
| Rate for Payer: Prime Health Services Commercial |
$447.10
|
| Rate for Payer: Prime Health Services Medicare |
$282.48
|
| Rate for Payer: Riverside University Health System MISP |
$293.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.00
|
| Rate for Payer: United Healthcare All Other HMO |
$263.00
|
| Rate for Payer: United Healthcare HMO Rider |
$263.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Vantage Medical Group Senior |
$266.49
|
|
|
HC AERO INHAL SVN INITIAL
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800310
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$473.40 |
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Central Health Plan Commercial |
$420.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.40
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$473.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.20
|
| Rate for Payer: Multiplan Commercial |
$394.50
|
| Rate for Payer: Networks By Design Commercial |
$341.90
|
| Rate for Payer: Prime Health Services Commercial |
$447.10
|
|
|
HC AERO INHAL SVN INITIAL
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$473.40 |
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Central Health Plan Commercial |
$420.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.40
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$473.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.20
|
| Rate for Payer: Multiplan Commercial |
$394.50
|
| Rate for Payer: Networks By Design Commercial |
$341.90
|
| Rate for Payer: Prime Health Services Commercial |
$447.10
|
|
|
HC AERO INHAL SVN INITIAL
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800310
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$509.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$266.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$266.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$315.60
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$266.49
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Central Health Plan Commercial |
$420.80
|
| Rate for Payer: Cigna of CA HMO |
$336.64
|
| Rate for Payer: Cigna of CA PPO |
$389.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.74
|
| Rate for Payer: Dignity Health Media |
$266.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$359.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$266.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$266.49
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$473.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$394.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$437.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$439.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$266.49
|
| Rate for Payer: InnovAge PACE Commercial |
$399.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$357.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$357.10
|
| Rate for Payer: Multiplan Commercial |
$394.50
|
| Rate for Payer: Networks By Design Commercial |
$341.90
|
| Rate for Payer: Prime Health Services Commercial |
$447.10
|
| Rate for Payer: Prime Health Services Medicare |
$282.48
|
| Rate for Payer: Riverside University Health System MISP |
$293.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$315.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Vantage Medical Group Senior |
$266.49
|
|
|
HC AERO INHAL SVN SUB
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800311
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$473.40 |
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Central Health Plan Commercial |
$420.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.40
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$473.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.20
|
| Rate for Payer: Multiplan Commercial |
$394.50
|
| Rate for Payer: Networks By Design Commercial |
$341.90
|
| Rate for Payer: Prime Health Services Commercial |
$447.10
|
|
|
HC AERO INHAL SVN SUB
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800311
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$509.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$266.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$266.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$315.60
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$266.49
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Central Health Plan Commercial |
$420.80
|
| Rate for Payer: Cigna of CA HMO |
$336.64
|
| Rate for Payer: Cigna of CA PPO |
$389.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.74
|
| Rate for Payer: Dignity Health Media |
$266.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$359.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$266.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$266.49
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$473.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$394.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$437.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$439.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$266.49
|
| Rate for Payer: InnovAge PACE Commercial |
$399.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$357.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$357.10
|
| Rate for Payer: Multiplan Commercial |
$394.50
|
| Rate for Payer: Networks By Design Commercial |
$341.90
|
| Rate for Payer: Prime Health Services Commercial |
$447.10
|
| Rate for Payer: Prime Health Services Medicare |
$282.48
|
| Rate for Payer: Riverside University Health System MISP |
$293.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$315.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Vantage Medical Group Senior |
$266.49
|
|
|
HC AFB FLUOROCHROME STAIN CONCEN
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900911546
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Central Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.40
|
| Rate for Payer: Galaxy Health WC |
$119.85
|
| Rate for Payer: Global Benefits Group Commercial |
$84.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.20
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
| Rate for Payer: Networks By Design Commercial |
$91.65
|
| Rate for Payer: Prime Health Services Commercial |
$119.85
|
|
|
HC AFB FLUOROCHROME STAIN CONCEN
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900911546
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$47.67 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.08
|
| 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 |
$47.67
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.36
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Caremore Medicare Advantage |
$5.39
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.08
|
| Rate for Payer: Dignity Health Media |
$5.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.39
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.39
|
| Rate for Payer: InnovAge PACE Commercial |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| 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 |
$4.00
|
| 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 |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| 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 |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Other HMO |
$4.36
|
| Rate for Payer: United Healthcare HMO Rider |
$4.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
HC AFB FLUOROCHROME STAIN DIRECT
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900911545
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$47.67 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.08
|
| 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 |
$47.67
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.36
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Caremore Medicare Advantage |
$5.39
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.08
|
| Rate for Payer: Dignity Health Media |
$5.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.39
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.39
|
| Rate for Payer: InnovAge PACE Commercial |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| 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 |
$4.00
|
| 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 |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| 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 |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Other HMO |
$4.36
|
| Rate for Payer: United Healthcare HMO Rider |
$4.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
HC AFB FLUOROCHROME STAIN DIRECT
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900911545
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Central Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.40
|
| Rate for Payer: Galaxy Health WC |
$119.85
|
| Rate for Payer: Global Benefits Group Commercial |
$84.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.20
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
| Rate for Payer: Networks By Design Commercial |
$91.65
|
| Rate for Payer: Prime Health Services Commercial |
$119.85
|
|
|
HC AFB ZIEHL-NEELSEN STAIN
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900911544
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$47.67 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.08
|
| 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 |
$47.67
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.36
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Caremore Medicare Advantage |
$5.39
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.08
|
| Rate for Payer: Dignity Health Media |
$5.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.39
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.39
|
| Rate for Payer: InnovAge PACE Commercial |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| 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 |
$4.00
|
| 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 |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| 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 |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Other HMO |
$4.36
|
| Rate for Payer: United Healthcare HMO Rider |
$4.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
HC AFB ZIEHL-NEELSEN STAIN
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900911544
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Central Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.40
|
| Rate for Payer: Galaxy Health WC |
$119.85
|
| Rate for Payer: Global Benefits Group Commercial |
$84.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.20
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
| Rate for Payer: Networks By Design Commercial |
$91.65
|
| Rate for Payer: Prime Health Services Commercial |
$119.85
|
|
|
HC AFO CUSTOM FITTED PLASTIC
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT L1930
|
| Hospital Charge Code |
905351930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$101.80 |
| Max. Negotiated Rate |
$458.10 |
| Rate for Payer: Blue Shield of California EPN |
$271.81
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Central Health Plan Commercial |
$407.20
|
| Rate for Payer: Cigna of CA HMO |
$356.30
|
| Rate for Payer: Cigna of CA PPO |
$356.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$203.60
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$458.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.80
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
| Rate for Payer: Networks By Design Commercial |
$254.50
|
| Rate for Payer: Prime Health Services Commercial |
$432.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$192.20
|
| Rate for Payer: United Healthcare All Other HMO |
$187.72
|
| Rate for Payer: United Healthcare HMO Rider |
$183.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$167.97
|
|
|
HC AFO CUSTOM FITTED PLASTIC
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT L1930
|
| Hospital Charge Code |
905351930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$178.15 |
| Max. Negotiated Rate |
$458.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$432.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$279.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$279.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$246.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$300.72
|
| Rate for Payer: Blue Distinction Transplant |
$305.40
|
| Rate for Payer: Blue Shield of California Commercial |
$381.75
|
| Rate for Payer: Blue Shield of California EPN |
$276.90
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Central Health Plan Commercial |
$407.20
|
| Rate for Payer: Cigna of CA HMO |
$356.30
|
| Rate for Payer: Cigna of CA PPO |
$356.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$432.65
|
| Rate for Payer: Dignity Health Media |
$432.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$432.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$203.60
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$458.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$381.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$178.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.69
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
| Rate for Payer: Networks By Design Commercial |
$254.50
|
| Rate for Payer: Prime Health Services Commercial |
$432.65
|
| Rate for Payer: Riverside University Health System MISP |
$203.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$305.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$305.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$254.50
|
| Rate for Payer: United Healthcare All Other HMO |
$254.50
|
| Rate for Payer: United Healthcare HMO Rider |
$254.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$254.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$432.65
|
| Rate for Payer: Vantage Medical Group Senior |
$432.65
|
|
|
HC AFO DBL UPRIGHT BK
|
Facility
|
OP
|
$1,414.00
|
|
|
Service Code
|
CPT L1990
|
| Hospital Charge Code |
905351990
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$494.90 |
| Max. Negotiated Rate |
$1,272.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,201.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$777.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$684.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$835.39
|
| Rate for Payer: Blue Distinction Transplant |
$848.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,060.50
|
| Rate for Payer: Blue Shield of California EPN |
$769.22
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,131.20
|
| Rate for Payer: Cigna of CA HMO |
$989.80
|
| Rate for Payer: Cigna of CA PPO |
$989.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,201.90
|
| Rate for Payer: Dignity Health Media |
$1,201.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,201.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$565.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$565.60
|
| Rate for Payer: Galaxy Health WC |
$1,201.90
|
| Rate for Payer: Global Benefits Group Commercial |
$848.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,272.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,060.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$494.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$943.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$522.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$579.74
|
| Rate for Payer: Multiplan Commercial |
$1,060.50
|
| Rate for Payer: Networks By Design Commercial |
$707.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,201.90
|
| Rate for Payer: Riverside University Health System MISP |
$565.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$848.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$848.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$707.00
|
| Rate for Payer: United Healthcare All Other HMO |
$707.00
|
| Rate for Payer: United Healthcare HMO Rider |
$707.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$707.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,201.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,201.90
|
|
|
HC AFO DBL UPRIGHT BK
|
Facility
|
IP
|
$1,414.00
|
|
|
Service Code
|
CPT L1990
|
| Hospital Charge Code |
905351990
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$282.80 |
| Max. Negotiated Rate |
$1,272.60 |
| Rate for Payer: Blue Shield of California EPN |
$755.08
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,131.20
|
| Rate for Payer: Cigna of CA HMO |
$989.80
|
| Rate for Payer: Cigna of CA PPO |
$989.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$565.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$565.60
|
| Rate for Payer: Galaxy Health WC |
$1,201.90
|
| Rate for Payer: Global Benefits Group Commercial |
$848.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,272.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$943.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$538.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.80
|
| Rate for Payer: Multiplan Commercial |
$1,060.50
|
| Rate for Payer: Networks By Design Commercial |
$707.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,201.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$533.93
|
| Rate for Payer: United Healthcare All Other HMO |
$521.48
|
| Rate for Payer: United Healthcare HMO Rider |
$510.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$466.62
|
|
|
HC AFO FLOOR REACTION
|
Facility
|
OP
|
$1,990.00
|
|
|
Service Code
|
CPT L1945
|
| Hospital Charge Code |
905351945
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$696.50 |
| Max. Negotiated Rate |
$1,791.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,691.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,094.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,094.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$963.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,175.69
|
| Rate for Payer: Blue Distinction Transplant |
$1,194.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,492.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,082.56
|
| Rate for Payer: Cash Price |
$895.50
|
| Rate for Payer: Cash Price |
$895.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,592.00
|
| Rate for Payer: Cigna of CA HMO |
$1,393.00
|
| Rate for Payer: Cigna of CA PPO |
$1,393.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,691.50
|
| Rate for Payer: Dignity Health Media |
$1,691.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,691.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$796.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$796.00
|
| Rate for Payer: Galaxy Health WC |
$1,691.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,194.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,791.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,492.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$696.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,327.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,053.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$815.90
|
| Rate for Payer: Multiplan Commercial |
$1,492.50
|
| Rate for Payer: Networks By Design Commercial |
$995.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,691.50
|
| Rate for Payer: Riverside University Health System MISP |
$796.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,194.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,194.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$995.00
|
| Rate for Payer: United Healthcare All Other HMO |
$995.00
|
| Rate for Payer: United Healthcare HMO Rider |
$995.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$995.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,691.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,691.50
|
|
