|
HC COMMON CAROTID NECK UNI
|
Facility
|
IP
|
$9,868.00
|
|
|
Service Code
|
CPT 36222
|
| Hospital Charge Code |
909020145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,973.60 |
| Max. Negotiated Rate |
$8,881.20 |
| Rate for Payer: Cash Price |
$4,440.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,894.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,947.20
|
| Rate for Payer: Galaxy Health WC |
$8,387.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,920.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,881.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,581.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,759.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,973.60
|
| Rate for Payer: Multiplan Commercial |
$7,401.00
|
| Rate for Payer: Networks By Design Commercial |
$6,414.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,387.80
|
|
|
HC COMMON CAROTID NECK UNI
|
Facility
|
OP
|
$9,868.00
|
|
|
Service Code
|
CPT 36222
|
| Hospital Charge Code |
909020145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$452.01 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,920.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$4,440.60
|
| Rate for Payer: Cash Price |
$4,440.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,894.40
|
| Rate for Payer: Cigna of CA PPO |
$7,302.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$8,387.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,920.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,881.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,401.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,581.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,973.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$7,401.00
|
| Rate for Payer: Networks By Design Commercial |
$6,414.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,387.80
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,920.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC COMMON CAROTID NECK UNI
|
Facility
|
OP
|
$9,868.00
|
|
|
Service Code
|
CPT 36222
|
| Hospital Charge Code |
906820220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$452.01 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,920.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$4,440.60
|
| Rate for Payer: Cash Price |
$4,440.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,894.40
|
| Rate for Payer: Cigna of CA PPO |
$7,302.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$8,387.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,920.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,881.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,401.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,581.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,973.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$7,401.00
|
| Rate for Payer: Networks By Design Commercial |
$6,414.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,387.80
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,920.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC COMMON CAROTID NECK UNI
|
Facility
|
IP
|
$9,868.00
|
|
|
Service Code
|
CPT 36222
|
| Hospital Charge Code |
906820220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,973.60 |
| Max. Negotiated Rate |
$8,881.20 |
| Rate for Payer: Cash Price |
$4,440.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,894.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,947.20
|
| Rate for Payer: Galaxy Health WC |
$8,387.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,920.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,881.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,581.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,759.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,973.60
|
| Rate for Payer: Multiplan Commercial |
$7,401.00
|
| Rate for Payer: Networks By Design Commercial |
$6,414.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,387.80
|
|
|
HC COMM/WORK REINTEGRATION 15 MIN MCAL
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
901300068
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$237.60 |
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Central Health Plan Commercial |
$211.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$237.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.80
|
| Rate for Payer: Multiplan Commercial |
$198.00
|
| Rate for Payer: Networks By Design Commercial |
$171.60
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
|
|
HC COMM/WORK REINTEGRATION 15 MIN MCAL
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
901300068
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$116.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$145.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$158.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Central Health Plan Commercial |
$211.20
|
| Rate for Payer: Cigna of CA HMO |
$168.96
|
| Rate for Payer: Cigna of CA PPO |
$195.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$224.40
|
| Rate for Payer: Dignity Health Media |
$224.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$237.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$198.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$92.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.24
|
| Rate for Payer: Multiplan Commercial |
$198.00
|
| Rate for Payer: Networks By Design Commercial |
$171.60
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: Riverside University Health System MISP |
$105.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Vantage Medical Group Senior |
$224.40
|
|
|
HC COMM/WORK REINTEGRATION 15 MIN OT
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
905104153
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$237.60 |
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Central Health Plan Commercial |
$211.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$237.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.80
|
| Rate for Payer: Multiplan Commercial |
$198.00
|
| Rate for Payer: Networks By Design Commercial |
$171.60
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
|
|
HC COMM/WORK REINTEGRATION 15 MIN OT
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
905104153
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$116.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$145.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$158.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Central Health Plan Commercial |
$211.20
|
| Rate for Payer: Cigna of CA HMO |
$168.96
|
| Rate for Payer: Cigna of CA PPO |
$195.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$224.40
|
| Rate for Payer: Dignity Health Media |
$224.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$237.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$198.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$92.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.24
|
| Rate for Payer: Multiplan Commercial |
$198.00
|
| Rate for Payer: Networks By Design Commercial |
$171.60
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: Riverside University Health System MISP |
$105.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Vantage Medical Group Senior |
$224.40
|
|
|
HC COMM/WORK REINTEGRATION 15 MIN PT
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
905103153
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$116.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$145.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$158.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Central Health Plan Commercial |
$211.20
|
| Rate for Payer: Cigna of CA HMO |
$168.96
|
| Rate for Payer: Cigna of CA PPO |
$195.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$224.40
|
| Rate for Payer: Dignity Health Media |
$224.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$237.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$198.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$92.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.24
|
| Rate for Payer: Multiplan Commercial |
$198.00
|
| Rate for Payer: Networks By Design Commercial |
$171.60
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: Riverside University Health System MISP |
$105.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Vantage Medical Group Senior |
$224.40
|
|
|
HC COMM/WORK REINTEGRATION 15 MIN PT
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
905103153
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$237.60 |
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Central Health Plan Commercial |
$211.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$237.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.80
|
| Rate for Payer: Multiplan Commercial |
$198.00
|
| Rate for Payer: Networks By Design Commercial |
$171.60
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
|
|
HC COMM/WORK REINTEGRATION 15 MIN PT COMM MCARE
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
900417537
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$116.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$145.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$158.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Central Health Plan Commercial |
$211.20
|
| Rate for Payer: Cigna of CA HMO |
$168.96
|
| Rate for Payer: Cigna of CA PPO |
$195.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$224.40
|
| Rate for Payer: Dignity Health Media |
$224.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$237.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$198.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$92.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.24
|
| Rate for Payer: Multiplan Commercial |
$198.00
|
| Rate for Payer: Networks By Design Commercial |
$171.60
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: Riverside University Health System MISP |
$105.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Vantage Medical Group Senior |
$224.40
|
|
|
HC COMM/WORK REINTEGRATION 15 MIN PT COMM MCARE
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
900417537
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$237.60 |
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Central Health Plan Commercial |
$211.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$237.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.80
|
| Rate for Payer: Multiplan Commercial |
$198.00
|
| Rate for Payer: Networks By Design Commercial |
$171.60
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
|
|
HC COMPASS IAP KIT
|
Facility
|
IP
|
$453.91
|
|
| Hospital Charge Code |
901698466
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.78 |
| Max. Negotiated Rate |
$408.52 |
| Rate for Payer: Cash Price |
$204.26
|
| Rate for Payer: Central Health Plan Commercial |
$363.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$181.56
|
| Rate for Payer: Galaxy Health WC |
$385.82
|
| Rate for Payer: Global Benefits Group Commercial |
$272.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$408.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$302.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.78
|
| Rate for Payer: Multiplan Commercial |
$340.43
|
| Rate for Payer: Networks By Design Commercial |
$295.04
|
| Rate for Payer: Prime Health Services Commercial |
$385.82
|
|
|
HC COMPASS IAP KIT
|
Facility
|
OP
|
$453.91
|
|
| Hospital Charge Code |
901698466
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.78 |
| Max. Negotiated Rate |
$408.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$275.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$385.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$249.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$249.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$219.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$268.17
|
| Rate for Payer: Blue Distinction Transplant |
$272.35
|
| Rate for Payer: Blue Shield of California Commercial |
$285.51
|
| Rate for Payer: Blue Shield of California EPN |
$221.96
|
| Rate for Payer: Cash Price |
$204.26
|
| Rate for Payer: Central Health Plan Commercial |
$363.13
|
| Rate for Payer: Cigna of CA HMO |
$290.50
|
| Rate for Payer: Cigna of CA PPO |
$335.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$385.82
|
| Rate for Payer: Dignity Health Media |
$385.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$385.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$181.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$181.56
|
| Rate for Payer: Galaxy Health WC |
$385.82
|
| Rate for Payer: Global Benefits Group Commercial |
$272.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$408.52
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$340.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$158.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$302.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.78
|
| Rate for Payer: Multiplan Commercial |
$340.43
|
| Rate for Payer: Networks By Design Commercial |
$295.04
|
| Rate for Payer: Prime Health Services Commercial |
$385.82
|
| Rate for Payer: Riverside University Health System MISP |
$181.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$272.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$272.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$226.96
|
| Rate for Payer: United Healthcare All Other HMO |
$226.96
|
| Rate for Payer: United Healthcare HMO Rider |
$226.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$226.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$385.82
|
| Rate for Payer: Vantage Medical Group Senior |
$385.82
|
|
|
HC COMPASS IAP MINAL PRESSURE KIT
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901698469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC COMPASS IAP MINAL PRESSURE KIT
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901698469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$319.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.66
|
| Rate for Payer: Blue Distinction Transplant |
$348.00
|
| Rate for Payer: Blue Shield of California Commercial |
$364.82
|
| Rate for Payer: Blue Shield of California EPN |
$283.62
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Media |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$435.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$203.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC COMPLEMENT C-3
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900910841
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$106.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.52
|
| Rate for Payer: Blue Distinction Transplant |
$21.60
|
| Rate for Payer: Blue Shield of California Commercial |
$22.25
|
| Rate for Payer: Blue Shield of California EPN |
$17.50
|
| Rate for Payer: Caremore Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Media |
$12.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.20
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: InnovAge PACE Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Medicare |
$12.72
|
| Rate for Payer: Riverside University Health System MISP |
$13.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.72
|
| Rate for Payer: United Healthcare All Other HMO |
$9.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
|
|
HC COMPLEMENT C-3
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900910841
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Central Health Plan Commercial |
$152.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.00
|
| Rate for Payer: Galaxy Health WC |
$161.50
|
| Rate for Payer: Global Benefits Group Commercial |
$114.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Multiplan Commercial |
$142.50
|
| Rate for Payer: Networks By Design Commercial |
$123.50
|
| Rate for Payer: Prime Health Services Commercial |
$161.50
|
|
|
HC COMPLEMENT C-4
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900910979
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Central Health Plan Commercial |
$152.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.00
|
| Rate for Payer: Galaxy Health WC |
$161.50
|
| Rate for Payer: Global Benefits Group Commercial |
$114.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Multiplan Commercial |
$142.50
|
| Rate for Payer: Networks By Design Commercial |
$123.50
|
| Rate for Payer: Prime Health Services Commercial |
$161.50
|
|
|
HC COMPLEMENT C-4
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900910979
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$106.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.52
|
| Rate for Payer: Blue Distinction Transplant |
$21.60
|
| Rate for Payer: Blue Shield of California Commercial |
$22.25
|
| Rate for Payer: Blue Shield of California EPN |
$17.50
|
| Rate for Payer: Caremore Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Media |
$12.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.20
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: InnovAge PACE Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Medicare |
$12.72
|
| Rate for Payer: Riverside University Health System MISP |
$13.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.72
|
| Rate for Payer: United Healthcare All Other HMO |
$9.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
|
|
HC COMPLEMENT TOTAL
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
900910842
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$180.24 |
| Rate for Payer: Adventist Health Medi-Cal |
$20.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$147.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.24
|
| Rate for Payer: Blue Distinction Transplant |
$36.00
|
| Rate for Payer: Blue Shield of California Commercial |
$37.08
|
| Rate for Payer: Blue Shield of California EPN |
$29.16
|
| Rate for Payer: Caremore Medicare Advantage |
$20.32
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.48
|
| Rate for Payer: Dignity Health Media |
$20.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.32
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.32
|
| Rate for Payer: InnovAge PACE Commercial |
$30.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.23
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Prime Health Services Medicare |
$21.54
|
| Rate for Payer: Riverside University Health System MISP |
$22.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.46
|
| Rate for Payer: United Healthcare All Other HMO |
$16.46
|
| Rate for Payer: United Healthcare HMO Rider |
$16.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.35
|
| Rate for Payer: Vantage Medical Group Senior |
$20.32
|
|
|
HC COMPLEMENT TOTAL
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
900910842
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$245.70 |
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Central Health Plan Commercial |
$218.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: Galaxy Health WC |
$232.05
|
| Rate for Payer: Global Benefits Group Commercial |
$163.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
| Rate for Payer: Networks By Design Commercial |
$177.45
|
| Rate for Payer: Prime Health Services Commercial |
$232.05
|
|
|
HC COMPLEX PUSHABLE COIL
|
Facility
|
OP
|
$370.00
|
|
| Hospital Charge Code |
909081803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$314.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$203.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$168.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.09
|
| Rate for Payer: Blue Distinction Transplant |
$222.00
|
| Rate for Payer: Blue Shield of California Commercial |
$277.50
|
| Rate for Payer: Blue Shield of California EPN |
$201.28
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Central Health Plan Commercial |
$296.00
|
| Rate for Payer: Cigna of CA HMO |
$259.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$314.50
|
| Rate for Payer: Dignity Health Media |
$314.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$314.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$148.00
|
| Rate for Payer: Galaxy Health WC |
$314.50
|
| Rate for Payer: Global Benefits Group Commercial |
$222.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$333.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$277.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$129.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$246.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.00
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: Networks By Design Commercial |
$185.00
|
| Rate for Payer: Prime Health Services Commercial |
$314.50
|
| Rate for Payer: Riverside University Health System MISP |
$148.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$222.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$222.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$185.00
|
| Rate for Payer: United Healthcare All Other HMO |
$185.00
|
| Rate for Payer: United Healthcare HMO Rider |
$185.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$185.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$314.50
|
| Rate for Payer: Vantage Medical Group Senior |
$314.50
|
|
|
HC COMPLEX PUSHABLE COIL
|
Facility
|
IP
|
$370.00
|
|
| Hospital Charge Code |
909081803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Blue Shield of California EPN |
$197.58
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Central Health Plan Commercial |
$296.00
|
| Rate for Payer: Cigna of CA HMO |
$259.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$148.00
|
| Rate for Payer: Galaxy Health WC |
$314.50
|
| Rate for Payer: Global Benefits Group Commercial |
$222.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$333.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$246.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.00
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: Prime Health Services Commercial |
$314.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$139.71
|
| Rate for Payer: United Healthcare All Other HMO |
$136.46
|
| Rate for Payer: United Healthcare HMO Rider |
$133.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$122.10
|
|
|
HC COMPOSITE ELASTIC
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
903203946
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$148.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$84.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.39
|
| Rate for Payer: Blue Distinction Transplant |
$105.00
|
| Rate for Payer: Blue Shield of California Commercial |
$131.25
|
| Rate for Payer: Blue Shield of California EPN |
$95.20
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: Cigna of CA HMO |
$122.50
|
| Rate for Payer: Cigna of CA PPO |
$122.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$148.75
|
| Rate for Payer: Dignity Health Media |
$148.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$131.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$61.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.75
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$87.50
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| Rate for Payer: Riverside University Health System MISP |
$70.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$87.50
|
| Rate for Payer: United Healthcare All Other HMO |
$87.50
|
| Rate for Payer: United Healthcare HMO Rider |
$87.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.75
|
| Rate for Payer: Vantage Medical Group Senior |
$148.75
|
|
