|
HC CONT GLUC MNTR PT PROV EQP
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
CPT 95249
|
| Hospital Charge Code |
900095249
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$435.60 |
| Rate for Payer: Adventist Health Commercial |
$96.80
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Central Health Plan Commercial |
$387.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$338.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.60
|
| Rate for Payer: EPIC Health Plan Senior |
$193.60
|
| Rate for Payer: Galaxy Health WC |
$411.40
|
| Rate for Payer: Global Benefits Group Commercial |
$290.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$435.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$307.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$285.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.80
|
| Rate for Payer: Multiplan Commercial |
$363.00
|
| Rate for Payer: Networks By Design Commercial |
$314.60
|
| Rate for Payer: Prime Health Services Commercial |
$411.40
|
|
|
HC CONT INHAL TRT W/AERO 1ST HR
|
Facility
|
OP
|
$448.00
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
900800012
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Adventist Health Commercial |
$89.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$260.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$279.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Central Health Plan Commercial |
$358.40
|
| Rate for Payer: Cigna of CA HMO |
$286.72
|
| Rate for Payer: Cigna of CA PPO |
$331.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$313.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$380.80
|
| Rate for Payer: Global Benefits Group Commercial |
$268.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$403.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$284.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Networks By Design Commercial |
$291.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Prime Health Services Commercial |
$380.80
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$268.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$268.80
|
| 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 |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC CONT INHAL TRT W/AERO 1ST HR
|
Facility
|
IP
|
$448.00
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
900800012
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$403.20 |
| Rate for Payer: Adventist Health Commercial |
$89.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Central Health Plan Commercial |
$358.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$313.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.20
|
| Rate for Payer: EPIC Health Plan Senior |
$179.20
|
| Rate for Payer: Galaxy Health WC |
$380.80
|
| Rate for Payer: Global Benefits Group Commercial |
$268.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$403.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$284.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$264.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.60
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Networks By Design Commercial |
$291.20
|
| Rate for Payer: Prime Health Services Commercial |
$380.80
|
|
|
HC CONT INHAL TRT W/AERO ADD HR
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
900800013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$21.33 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Adventist Health Commercial |
$67.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$284.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$184.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$251.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$106.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Central Health Plan Commercial |
$268.00
|
| Rate for Payer: Cigna of CA HMO |
$214.40
|
| Rate for Payer: Cigna of CA PPO |
$247.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$284.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$284.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$234.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.00
|
| Rate for Payer: EPIC Health Plan Senior |
$134.00
|
| Rate for Payer: Galaxy Health WC |
$284.75
|
| Rate for Payer: Global Benefits Group Commercial |
$201.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$301.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$212.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$197.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$234.50
|
| Rate for Payer: Multiplan Commercial |
$251.25
|
| Rate for Payer: Networks By Design Commercial |
$217.75
|
| Rate for Payer: Prime Health Services Commercial |
$284.75
|
| Rate for Payer: Riverside University Health System MISP |
$134.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$284.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.75
|
| Rate for Payer: Vantage Medical Group Senior |
$284.75
|
|
|
HC CONT INHAL TRT W/AERO ADD HR
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
900800013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$67.00 |
| Max. Negotiated Rate |
$301.50 |
| Rate for Payer: Adventist Health Commercial |
$67.00
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Central Health Plan Commercial |
$268.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$234.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.00
|
| Rate for Payer: EPIC Health Plan Senior |
$134.00
|
| Rate for Payer: Galaxy Health WC |
$284.75
|
| Rate for Payer: Global Benefits Group Commercial |
$201.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$301.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$212.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$197.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Multiplan Commercial |
$251.25
|
| Rate for Payer: Networks By Design Commercial |
$217.75
|
| Rate for Payer: Prime Health Services Commercial |
$284.75
|
|
|
HC CONTINOUS RENAL REPLACE THERAPY
|
Facility
|
IP
|
$1,633.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
948000105
|
|
Hospital Revenue Code
|
880
|
| Min. Negotiated Rate |
$326.60 |
| Max. Negotiated Rate |
$1,469.70 |
| Rate for Payer: Adventist Health Commercial |
$326.60
|
| Rate for Payer: Cash Price |
$734.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,306.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,143.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$653.20
|
| Rate for Payer: EPIC Health Plan Senior |
$653.20
|
| Rate for Payer: Galaxy Health WC |
$1,388.05
|
| Rate for Payer: Global Benefits Group Commercial |
$979.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,469.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,036.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$963.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.60
|
| Rate for Payer: Multiplan Commercial |
$1,224.75
|
| Rate for Payer: Networks By Design Commercial |
$1,061.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,388.05
|
|
|
HC CONTINOUS RENAL REPLACE THERAPY
|
Facility
|
OP
|
$1,633.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
948000105
|
|
Hospital Revenue Code
|
880
|
| Min. Negotiated Rate |
$124.12 |
| Max. Negotiated Rate |
$1,469.70 |
| Rate for Payer: Adventist Health Commercial |
$326.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$536.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$479.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$805.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$590.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$536.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$790.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$949.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1,035.32
|
| Rate for Payer: Blue Shield of California EPN |
$651.57
|
| Rate for Payer: Cash Price |
$734.85
|
| Rate for Payer: Cash Price |
$734.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,306.40
|
| Rate for Payer: Cigna of CA HMO |
$1,045.12
|
| Rate for Payer: Cigna of CA PPO |
$1,208.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$805.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$590.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$536.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,143.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$885.51
|
| Rate for Payer: EPIC Health Plan Senior |
$590.34
|
| Rate for Payer: Galaxy Health WC |
$1,388.05
|
| Rate for Payer: Global Benefits Group Commercial |
$979.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,469.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$880.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$124.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$536.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,036.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$751.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$719.14
|
| Rate for Payer: Multiplan Commercial |
$1,224.75
|
| Rate for Payer: Networks By Design Commercial |
$1,061.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$536.67
|
| Rate for Payer: Prime Health Services Commercial |
$1,388.05
|
| Rate for Payer: Prime Health Services Medicare |
$568.87
|
| Rate for Payer: Riverside University Health System MISP |
$590.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$979.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$979.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$816.50
|
| Rate for Payer: United Healthcare All Other HMO |
$816.50
|
| Rate for Payer: United Healthcare HMO Rider |
$816.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$816.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$536.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$805.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$590.34
|
| Rate for Payer: Vantage Medical Group Senior |
$536.67
|
|
|
HC CONT OROPHARYN HEMOR, SIMPLE
|
Facility
|
IP
|
$971.00
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
900501252
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$194.20 |
| Max. Negotiated Rate |
$873.90 |
| Rate for Payer: Adventist Health Commercial |
$194.20
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Central Health Plan Commercial |
$776.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$679.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.40
|
| Rate for Payer: EPIC Health Plan Senior |
$388.40
|
| Rate for Payer: Galaxy Health WC |
$825.35
|
| Rate for Payer: Global Benefits Group Commercial |
$582.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$873.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$616.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$572.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.20
|
| Rate for Payer: Multiplan Commercial |
$728.25
|
| Rate for Payer: Networks By Design Commercial |
$631.15
|
| Rate for Payer: Prime Health Services Commercial |
$825.35
|
|
|
HC CONT OROPHARYN HEMOR, SIMPLE
|
Facility
|
OP
|
$971.00
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
900501252
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.77 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$194.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,030.97
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Central Health Plan Commercial |
$776.80
|
| Rate for Payer: Cigna of CA HMO |
$621.44
|
| Rate for Payer: Cigna of CA PPO |
$718.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$679.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.56
|
| Rate for Payer: EPIC Health Plan Senior |
$763.04
|
| Rate for Payer: Galaxy Health WC |
$825.35
|
| Rate for Payer: Global Benefits Group Commercial |
$582.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$873.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,137.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$616.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$929.52
|
| Rate for Payer: Multiplan Commercial |
$728.25
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$631.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$693.67
|
| Rate for Payer: Preferred Health Network WC |
$1,052.01
|
| Rate for Payer: Prime Health Services Commercial |
$825.35
|
| Rate for Payer: Prime Health Services Medicare |
$735.29
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Riverside University Health System MISP |
$763.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$582.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$485.50
|
| Rate for Payer: United Healthcare All Other HMO |
$485.50
|
| Rate for Payer: United Healthcare HMO Rider |
$485.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$485.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$693.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
HC CONT OROPHARYN HEMOR, SIMPLE
|
Facility
|
IP
|
$971.00
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
900501252
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.20 |
| Max. Negotiated Rate |
$873.90 |
| Rate for Payer: Adventist Health Commercial |
$194.20
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Central Health Plan Commercial |
$776.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$679.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.40
|
| Rate for Payer: EPIC Health Plan Senior |
$388.40
|
| Rate for Payer: Galaxy Health WC |
$825.35
|
| Rate for Payer: Global Benefits Group Commercial |
$582.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$873.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$616.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$572.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.20
|
| Rate for Payer: Multiplan Commercial |
$728.25
|
| Rate for Payer: Networks By Design Commercial |
$631.15
|
| Rate for Payer: Prime Health Services Commercial |
$825.35
|
|
|
HC CONT OROPHARYN HEMOR, SIMPLE
|
Facility
|
OP
|
$971.00
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
900501252
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$140.77 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$398.11
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,004.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,030.97
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Central Health Plan Commercial |
$776.80
|
| Rate for Payer: Cigna of CA HMO |
$621.44
|
| Rate for Payer: Cigna of CA PPO |
$718.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$679.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.56
|
| Rate for Payer: EPIC Health Plan Senior |
$763.04
|
| Rate for Payer: Galaxy Health WC |
$825.35
|
| Rate for Payer: Global Benefits Group Commercial |
$582.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$873.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,137.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$616.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$929.52
|
| Rate for Payer: Multiplan Commercial |
$728.25
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$631.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$693.67
|
| Rate for Payer: Preferred Health Network WC |
$1,052.01
|
| Rate for Payer: Prime Health Services Commercial |
$825.35
|
| Rate for Payer: Prime Health Services Medicare |
$735.29
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Riverside University Health System MISP |
$763.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$582.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$582.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$693.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
HC CONTRAST BATH 15MIN OT
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
905104124
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Central Health Plan Commercial |
$89.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$100.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.40
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
|
|
HC CONTRAST BATH 15MIN OT
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
905104124
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$13.47 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$45.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Central Health Plan Commercial |
$89.60
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$95.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$100.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$78.40
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Riverside University Health System MISP |
$44.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.20
|
| Rate for Payer: Vantage Medical Group Senior |
$95.20
|
|
|
HC CONTRAST BATHS 15 MIN MCAL
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
901300051
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Central Health Plan Commercial |
$89.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$100.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.40
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
|
|
HC CONTRAST BATHS 15 MIN MCAL
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
900400028
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.47 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$45.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Central Health Plan Commercial |
$89.60
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$95.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$100.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$78.40
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Riverside University Health System MISP |
$44.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.20
|
| Rate for Payer: Vantage Medical Group Senior |
$95.20
|
|
|
HC CONTRAST BATHS 15 MIN MCAL
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
900400028
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Central Health Plan Commercial |
$89.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$100.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.40
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
|
|
HC CONTRAST BATHS 15 MIN MCAL
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
901300051
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$13.47 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$45.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Central Health Plan Commercial |
$89.60
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$95.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$100.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$78.40
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Riverside University Health System MISP |
$44.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.20
|
| Rate for Payer: Vantage Medical Group Senior |
$95.20
|
|
|
HC CONTRAST BATHS 15 MIN MCARE COMM
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
900407034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.47 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$45.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Central Health Plan Commercial |
$89.60
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$95.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$100.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$78.40
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Riverside University Health System MISP |
$44.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.20
|
| Rate for Payer: Vantage Medical Group Senior |
$95.20
|
|
|
HC CONTRAST BATHS 15 MIN MCARE COMM
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
900407034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Central Health Plan Commercial |
$89.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$100.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.40
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
|
|
HC CONTRAST BATHS 15 MIN PT
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
900417034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Central Health Plan Commercial |
$89.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$100.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.40
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
|
|
HC CONTRAST BATHS 15 MIN PT
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
900417034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.47 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$45.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Central Health Plan Commercial |
$89.60
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$95.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$100.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$78.40
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Riverside University Health System MISP |
$44.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.20
|
| Rate for Payer: Vantage Medical Group Senior |
$95.20
|
|
|
HC CONTRAST BATHS 15 MIN PT
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
905103124
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.47 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$45.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Central Health Plan Commercial |
$89.60
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$95.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$100.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$78.40
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Riverside University Health System MISP |
$44.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.20
|
| Rate for Payer: Vantage Medical Group Senior |
$95.20
|
|
|
HC CONTRAST BATHS 15 MIN PT
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
905103124
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Central Health Plan Commercial |
$89.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$100.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.40
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
|
|
HC CONVERT INSTEP TO VELCRO CLOSU
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT L3580
|
| Hospital Charge Code |
905353580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Blue Shield of California Commercial |
$104.26
|
| Rate for Payer: Blue Shield of California EPN |
$65.52
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Central Health Plan Commercial |
$104.00
|
| Rate for Payer: Cigna of CA HMO |
$91.00
|
| Rate for Payer: Cigna of CA PPO |
$91.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Senior |
$52.00
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.79
|
| Rate for Payer: United Healthcare All Other HMO |
$47.49
|
| Rate for Payer: United Healthcare HMO Rider |
$46.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.58
|
|
|
HC CONVERT INSTEP TO VELCRO CLOSU
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT L3580
|
| Hospital Charge Code |
915353580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Blue Shield of California Commercial |
$104.26
|
| Rate for Payer: Blue Shield of California EPN |
$65.52
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Central Health Plan Commercial |
$104.00
|
| Rate for Payer: Cigna of CA HMO |
$91.00
|
| Rate for Payer: Cigna of CA PPO |
$91.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Senior |
$52.00
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.79
|
| Rate for Payer: United Healthcare All Other HMO |
$47.49
|
| Rate for Payer: United Healthcare HMO Rider |
$46.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.58
|
|
