|
HC EVAL SWALLOW/ORAL FUNC
|
Facility
|
IP
|
$986.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
905601753
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$197.20 |
| Max. Negotiated Rate |
$887.40 |
| Rate for Payer: Adventist Health Commercial |
$197.20
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Central Health Plan Commercial |
$788.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$690.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$394.40
|
| Rate for Payer: EPIC Health Plan Senior |
$394.40
|
| Rate for Payer: Galaxy Health WC |
$838.10
|
| Rate for Payer: Global Benefits Group Commercial |
$591.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$887.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$626.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$581.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.20
|
| Rate for Payer: Multiplan Commercial |
$739.50
|
| Rate for Payer: Networks By Design Commercial |
$640.90
|
| Rate for Payer: Prime Health Services Commercial |
$838.10
|
|
|
HC EVAL SWALLOW/ORAL FUNC MCAL
|
Facility
|
OP
|
$986.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
907000023
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$83.90 |
| Max. Negotiated Rate |
$887.40 |
| Rate for Payer: Adventist Health Commercial |
$404.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$402.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$838.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$542.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$739.50
|
| 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 |
$443.70
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Central Health Plan Commercial |
$788.80
|
| Rate for Payer: Cigna of CA HMO |
$631.04
|
| Rate for Payer: Cigna of CA PPO |
$729.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$838.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$838.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$838.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$690.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$394.40
|
| Rate for Payer: EPIC Health Plan Senior |
$394.40
|
| Rate for Payer: Galaxy Health WC |
$838.10
|
| Rate for Payer: Global Benefits Group Commercial |
$591.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$887.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$83.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$626.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$581.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$690.20
|
| Rate for Payer: Multiplan Commercial |
$739.50
|
| Rate for Payer: Networks By Design Commercial |
$640.90
|
| Rate for Payer: Prime Health Services Commercial |
$838.10
|
| Rate for Payer: Riverside University Health System MISP |
$394.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$591.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$591.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$838.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$838.10
|
| Rate for Payer: Vantage Medical Group Senior |
$838.10
|
|
|
HC EVAL SWALLOW/ORAL FUNC MCAL
|
Facility
|
IP
|
$986.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
907000023
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$197.20 |
| Max. Negotiated Rate |
$887.40 |
| Rate for Payer: Adventist Health Commercial |
$197.20
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Central Health Plan Commercial |
$788.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$690.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$394.40
|
| Rate for Payer: EPIC Health Plan Senior |
$394.40
|
| Rate for Payer: Galaxy Health WC |
$838.10
|
| Rate for Payer: Global Benefits Group Commercial |
$591.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$887.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$626.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$581.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.20
|
| Rate for Payer: Multiplan Commercial |
$739.50
|
| Rate for Payer: Networks By Design Commercial |
$640.90
|
| Rate for Payer: Prime Health Services Commercial |
$838.10
|
|
|
HC EVAL SWALLOW W RADIOLOGY MCAL
|
Facility
|
IP
|
$1,193.00
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
907000022
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$238.60 |
| Max. Negotiated Rate |
$1,073.70 |
| Rate for Payer: Adventist Health Commercial |
$238.60
|
| Rate for Payer: Cash Price |
$536.85
|
| Rate for Payer: Central Health Plan Commercial |
$954.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$835.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$477.20
|
| Rate for Payer: EPIC Health Plan Senior |
$477.20
|
| Rate for Payer: Galaxy Health WC |
$1,014.05
|
| Rate for Payer: Global Benefits Group Commercial |
$715.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,073.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$757.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$703.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.60
|
| Rate for Payer: Multiplan Commercial |
$894.75
|
| Rate for Payer: Networks By Design Commercial |
$775.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,014.05
|
|
|
HC EVAL SWALLOW W RADIOLOGY MCAL
|
Facility
|
OP
|
$1,193.00
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
907000022
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$68.71 |
| Max. Negotiated Rate |
$1,073.70 |
| Rate for Payer: Adventist Health Commercial |
$489.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$687.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,014.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$656.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$894.75
|
| 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 |
$536.85
|
| Rate for Payer: Cash Price |
$536.85
|
| Rate for Payer: Cash Price |
$536.85
|
| Rate for Payer: Central Health Plan Commercial |
$954.40
|
| Rate for Payer: Cigna of CA HMO |
$763.52
|
| Rate for Payer: Cigna of CA PPO |
$882.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,014.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,014.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,014.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$835.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$477.20
|
| Rate for Payer: EPIC Health Plan Senior |
$477.20
|
| Rate for Payer: Galaxy Health WC |
$1,014.05
|
| Rate for Payer: Global Benefits Group Commercial |
$715.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,073.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$68.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$757.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$75.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$703.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$489.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$835.10
|
| Rate for Payer: Multiplan Commercial |
$894.75
|
| Rate for Payer: Networks By Design Commercial |
$775.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,014.05
|
| Rate for Payer: Riverside University Health System MISP |
$477.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$715.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$715.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,014.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,014.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,014.05
|
|
|
HC EVAL VOICE/AUG COMM DVC
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
CPT 92597
|
| Hospital Charge Code |
905601812
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$772.20 |
| Rate for Payer: Adventist Health Commercial |
$171.60
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Central Health Plan Commercial |
$686.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$600.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.20
|
| Rate for Payer: EPIC Health Plan Senior |
$343.20
|
| Rate for Payer: Galaxy Health WC |
$729.30
|
| Rate for Payer: Global Benefits Group Commercial |
$514.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$772.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$544.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$506.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.60
|
| Rate for Payer: Multiplan Commercial |
$643.50
|
| Rate for Payer: Networks By Design Commercial |
$557.70
|
| Rate for Payer: Prime Health Services Commercial |
$729.30
|
|
|
HC EVAL VOICE/AUG COMM DVC
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
CPT 92597
|
| Hospital Charge Code |
905601812
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$140.85 |
| Max. Negotiated Rate |
$772.20 |
| Rate for Payer: Adventist Health Commercial |
$351.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$589.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$729.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$471.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$643.50
|
| 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 |
$386.10
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Central Health Plan Commercial |
$686.40
|
| Rate for Payer: Cigna of CA HMO |
$549.12
|
| Rate for Payer: Cigna of CA PPO |
$634.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$729.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$729.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$729.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$600.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.20
|
| Rate for Payer: EPIC Health Plan Senior |
$343.20
|
| Rate for Payer: Galaxy Health WC |
$729.30
|
| Rate for Payer: Global Benefits Group Commercial |
$514.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$772.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$140.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$544.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$155.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$506.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$600.60
|
| Rate for Payer: Multiplan Commercial |
$643.50
|
| Rate for Payer: Networks By Design Commercial |
$557.70
|
| Rate for Payer: Prime Health Services Commercial |
$729.30
|
| Rate for Payer: Riverside University Health System MISP |
$343.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$514.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$514.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$729.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$729.30
|
| Rate for Payer: Vantage Medical Group Senior |
$729.30
|
|
|
HC EVASC ST RPR THRC/AA ACRS BR
|
Facility
|
IP
|
$4,048.00
|
|
|
Service Code
|
CPT 33894
|
| Hospital Charge Code |
909033894
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$809.60 |
| Max. Negotiated Rate |
$3,643.20 |
| Rate for Payer: Adventist Health Commercial |
$809.60
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,238.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,833.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,619.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,619.20
|
| Rate for Payer: Galaxy Health WC |
$3,440.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,428.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,643.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,570.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,388.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$809.60
|
| Rate for Payer: Multiplan Commercial |
$3,036.00
|
| Rate for Payer: Networks By Design Commercial |
$2,631.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,440.80
|
|
|
HC EVASC ST RPR THRC/AA ACRS BR
|
Facility
|
OP
|
$4,048.00
|
|
|
Service Code
|
CPT 33894
|
| Hospital Charge Code |
909033894
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$809.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$809.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,440.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,226.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,036.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,238.40
|
| Rate for Payer: Cigna of CA HMO |
$2,590.72
|
| Rate for Payer: Cigna of CA PPO |
$2,995.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,440.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,440.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,440.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,833.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,619.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,619.20
|
| Rate for Payer: Galaxy Health WC |
$3,440.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,428.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,643.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,388.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,570.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,534.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,388.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$809.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,833.60
|
| Rate for Payer: Multiplan Commercial |
$3,036.00
|
| Rate for Payer: Networks By Design Commercial |
$2,631.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,440.80
|
| Rate for Payer: Riverside University Health System MISP |
$1,619.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,428.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,024.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,440.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,440.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,440.80
|
|
|
HC EVASC ST RPR THRC/AA NO CRSG BR
|
Facility
|
OP
|
$4,048.00
|
|
|
Service Code
|
CPT 33895
|
| Hospital Charge Code |
909033895
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$220.92 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$809.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,440.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,226.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,036.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,238.40
|
| Rate for Payer: Cigna of CA HMO |
$2,590.72
|
| Rate for Payer: Cigna of CA PPO |
$2,995.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,440.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,440.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,440.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,833.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,619.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,619.20
|
| Rate for Payer: Galaxy Health WC |
$3,440.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,428.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,643.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$220.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,570.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$244.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,388.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$809.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,833.60
|
| Rate for Payer: Multiplan Commercial |
$3,036.00
|
| Rate for Payer: Networks By Design Commercial |
$2,631.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,440.80
|
| Rate for Payer: Riverside University Health System MISP |
$1,619.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,428.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,024.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,440.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,440.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,440.80
|
|
|
HC EVASC ST RPR THRC/AA NO CRSG BR
|
Facility
|
IP
|
$4,048.00
|
|
|
Service Code
|
CPT 33895
|
| Hospital Charge Code |
909033895
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$809.60 |
| Max. Negotiated Rate |
$3,643.20 |
| Rate for Payer: Adventist Health Commercial |
$809.60
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,238.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,833.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,619.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,619.20
|
| Rate for Payer: Galaxy Health WC |
$3,440.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,428.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,643.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,570.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,388.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$809.60
|
| Rate for Payer: Multiplan Commercial |
$3,036.00
|
| Rate for Payer: Networks By Design Commercial |
$2,631.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,440.80
|
|
|
HC EVENT MONITOR HOOK UP
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
912000115
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$1,477.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$314.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.80
|
| Rate for Payer: Blue Shield of California Commercial |
$75.60
|
| Rate for Payer: Blue Shield of California EPN |
$47.64
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$56.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Medicare |
$50.88
|
| Rate for Payer: Riverside University Health System MISP |
$52.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,477.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,006.00
|
| Rate for Payer: United Healthcare HMO Rider |
$765.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$701.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Vantage Medical Group Senior |
$48.00
|
|
|
HC EVENT MONITOR HOOK UP
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
912000115
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC EVEROLIMUS B
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
900913691
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.60
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
|
|
HC EVEROLIMUS B
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
900913691
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.73
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$60.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$60.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.48
|
| Rate for Payer: Blue Shield of California Commercial |
$55.44
|
| Rate for Payer: Blue Shield of California Commercial |
$137.34
|
| Rate for Payer: Blue Shield of California EPN |
$34.94
|
| Rate for Payer: Blue Shield of California EPN |
$86.55
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: Cigna of CA HMO |
$56.32
|
| Rate for Payer: Cigna of CA HMO |
$139.52
|
| Rate for Payer: Cigna of CA PPO |
$65.12
|
| Rate for Payer: Cigna of CA PPO |
$161.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.65
|
| Rate for Payer: EPIC Health Plan Senior |
$15.10
|
| Rate for Payer: EPIC Health Plan Senior |
$15.10
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.73
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.73
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
| Rate for Payer: Prime Health Services Medicare |
$14.55
|
| Rate for Payer: Prime Health Services Medicare |
$14.55
|
| Rate for Payer: Riverside University Health System MISP |
$15.10
|
| Rate for Payer: Riverside University Health System MISP |
$15.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO |
$11.12
|
| Rate for Payer: United Healthcare HMO Rider |
$11.12
|
| Rate for Payer: United Healthcare HMO Rider |
$11.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
|
|
HC EV FEM POP ARTERIAL REVASC
|
Facility
|
OP
|
$24,677.00
|
|
|
Service Code
|
CPT 0505T
|
| Hospital Charge Code |
909000505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$4,935.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,847.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$11,104.65
|
| Rate for Payer: Cash Price |
$11,104.65
|
| Rate for Payer: Cash Price |
$11,104.65
|
| Rate for Payer: Central Health Plan Commercial |
$19,741.60
|
| Rate for Payer: Cigna of CA HMO |
$15,793.28
|
| Rate for Payer: Cigna of CA PPO |
$18,260.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,273.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Galaxy Health WC |
$20,975.45
|
| Rate for Payer: Global Benefits Group Commercial |
$14,806.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,209.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,669.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,957.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,935.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$18,507.75
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$16,040.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Preferred Health Network WC |
$23,427.23
|
| Rate for Payer: Prime Health Services Commercial |
$20,975.45
|
| Rate for Payer: Prime Health Services Medicare |
$15,738.63
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Riverside University Health System MISP |
$16,332.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,806.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,338.50
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC EV FEM POP ARTERIAL REVASC
|
Facility
|
IP
|
$24,677.00
|
|
|
Service Code
|
CPT 0505T
|
| Hospital Charge Code |
909000505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,935.40 |
| Max. Negotiated Rate |
$22,209.30 |
| Rate for Payer: Adventist Health Commercial |
$4,935.40
|
| Rate for Payer: Cash Price |
$11,104.65
|
| Rate for Payer: Central Health Plan Commercial |
$19,741.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,273.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,870.80
|
| Rate for Payer: EPIC Health Plan Senior |
$9,870.80
|
| Rate for Payer: Galaxy Health WC |
$20,975.45
|
| Rate for Payer: Global Benefits Group Commercial |
$14,806.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,209.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,669.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,559.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,935.40
|
| Rate for Payer: Multiplan Commercial |
$18,507.75
|
| Rate for Payer: Networks By Design Commercial |
$16,040.05
|
| Rate for Payer: Prime Health Services Commercial |
$20,975.45
|
|
|
HC EVL/TRTMT MH OR SUB USE DISORDER REMOTE 15-29 MIN
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT C7900
|
| Hospital Charge Code |
907807900
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Central Health Plan Commercial |
$84.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.00
|
| Rate for Payer: EPIC Health Plan Senior |
$42.00
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.95
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
|
|
HC EVL/TRTMT MH OR SUB USE DISORDER REMOTE 15-29 MIN
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT C7900
|
| Hospital Charge Code |
907807900
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.08
|
| Rate for Payer: Blue Shield of California Commercial |
$66.57
|
| Rate for Payer: Blue Shield of California EPN |
$41.90
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Central Health Plan Commercial |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$77.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.51
|
| Rate for Payer: EPIC Health Plan Senior |
$53.01
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$79.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.57
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.19
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
| Rate for Payer: Prime Health Services Medicare |
$51.08
|
| Rate for Payer: Riverside University Health System MISP |
$53.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Vantage Medical Group Senior |
$48.19
|
|
|
HC EVL/TRTMT MH OR SUB USE DISORDER REMOTE 30-60 MIN
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT C7901
|
| Hospital Charge Code |
907807901
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$240.30 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$130.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$162.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$130.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.31
|
| Rate for Payer: Blue Shield of California Commercial |
$169.28
|
| Rate for Payer: Blue Shield of California EPN |
$106.53
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| Rate for Payer: Cigna of CA HMO |
$170.88
|
| Rate for Payer: Cigna of CA PPO |
$197.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$186.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.59
|
| Rate for Payer: EPIC Health Plan Senior |
$143.73
|
| Rate for Payer: Galaxy Health WC |
$226.95
|
| Rate for Payer: Global Benefits Group Commercial |
$160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$214.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$130.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$169.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$175.08
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: Networks By Design Commercial |
$173.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$130.66
|
| Rate for Payer: Prime Health Services Commercial |
$226.95
|
| Rate for Payer: Prime Health Services Medicare |
$138.50
|
| Rate for Payer: Riverside University Health System MISP |
$143.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$130.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Vantage Medical Group Senior |
$130.66
|
|
|
HC EVL/TRTMT MH OR SUB USE DISORDER REMOTE 30-60 MIN
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT C7901
|
| Hospital Charge Code |
907807901
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$240.30 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$186.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.80
|
| Rate for Payer: EPIC Health Plan Senior |
$106.80
|
| Rate for Payer: Galaxy Health WC |
$226.95
|
| Rate for Payer: Global Benefits Group Commercial |
$160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$169.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$157.53
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: Networks By Design Commercial |
$173.55
|
| Rate for Payer: Prime Health Services Commercial |
$226.95
|
|
|
HC EVL/TRTMT MH OR SUB USE DISORDER REMOTE EA ADD 15 MIN
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT C7902
|
| Hospital Charge Code |
907807902
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Central Health Plan Commercial |
$106.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.20
|
| Rate for Payer: EPIC Health Plan Senior |
$53.20
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$84.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$78.47
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: Networks By Design Commercial |
$86.45
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
|
|
HC EVL/TRTMT MH OR SUB USE DISORDER REMOTE EA ADD 15 MIN
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT C7902
|
| Hospital Charge Code |
907807902
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$64.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.37
|
| Rate for Payer: Blue Shield of California Commercial |
$84.32
|
| Rate for Payer: Blue Shield of California EPN |
$53.07
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Central Health Plan Commercial |
$106.40
|
| Rate for Payer: Cigna of CA HMO |
$85.12
|
| Rate for Payer: Cigna of CA PPO |
$98.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$113.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$113.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.20
|
| Rate for Payer: EPIC Health Plan Senior |
$53.20
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$84.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$78.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$93.10
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: Networks By Design Commercial |
$86.45
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
| Rate for Payer: Riverside University Health System MISP |
$53.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.05
|
| Rate for Payer: Vantage Medical Group Senior |
$113.05
|
|
|
HC EV REVASC FPVT STNT TA UNI COMPLEX LSN EA ADD VSL
|
Facility
|
IP
|
$28,728.00
|
|
|
Service Code
|
CPT 37278
|
| Hospital Charge Code |
906811844
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,745.60 |
| Max. Negotiated Rate |
$25,855.20 |
| Rate for Payer: Adventist Health Commercial |
$5,745.60
|
| Rate for Payer: Cash Price |
$12,927.60
|
| Rate for Payer: Central Health Plan Commercial |
$22,982.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,109.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,491.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,491.20
|
| Rate for Payer: Galaxy Health WC |
$24,418.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17,236.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,855.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,242.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,949.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,745.60
|
| Rate for Payer: Multiplan Commercial |
$21,546.00
|
| Rate for Payer: Networks By Design Commercial |
$18,673.20
|
| Rate for Payer: Prime Health Services Commercial |
$24,418.80
|
|
|
HC EV REVASC FPVT STNT TA UNI COMPLEX LSN EA ADD VSL
|
Facility
|
OP
|
$28,728.00
|
|
|
Service Code
|
CPT 37278
|
| Hospital Charge Code |
906811844
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$5,745.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,418.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,800.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,546.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$12,927.60
|
| Rate for Payer: Cash Price |
$12,927.60
|
| Rate for Payer: Central Health Plan Commercial |
$22,982.40
|
| Rate for Payer: Cigna of CA HMO |
$18,385.92
|
| Rate for Payer: Cigna of CA PPO |
$21,258.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,418.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,418.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,418.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,109.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,491.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,491.20
|
| Rate for Payer: Galaxy Health WC |
$24,418.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17,236.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,855.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,242.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,428.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,949.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,745.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20,109.60
|
| Rate for Payer: Multiplan Commercial |
$21,546.00
|
| Rate for Payer: Networks By Design Commercial |
$18,673.20
|
| Rate for Payer: Prime Health Services Commercial |
$24,418.80
|
| Rate for Payer: Riverside University Health System MISP |
$11,491.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,236.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,364.00
|
| Rate for Payer: United Healthcare All Other HMO |
$14,364.00
|
| Rate for Payer: United Healthcare HMO Rider |
$14,364.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,364.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,418.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,418.80
|
| Rate for Payer: Vantage Medical Group Senior |
$24,418.80
|
|
