|
HC HSV 1&2 PCR
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
900912307
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Central Health Plan Commercial |
$200.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
|
|
HC HSV 1&2 PCR
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
900912307
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$247.04 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.14
|
| Rate for Payer: Blue Shield of California Commercial |
$139.61
|
| Rate for Payer: Blue Shield of California EPN |
$91.31
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Central Health Plan Commercial |
$184.00
|
| Rate for Payer: Cigna of CA HMO |
$147.20
|
| Rate for Payer: Cigna of CA PPO |
$170.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$42.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: InnovAge PACE Commercial |
$52.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$149.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC HSV 1 IGG
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900913540
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Central Health Plan Commercial |
$188.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
|
|
HC HSV 1 IGG
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900913540
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$70.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.47
|
| Rate for Payer: Blue Shield of California Commercial |
$70.41
|
| Rate for Payer: Blue Shield of California EPN |
$46.05
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Central Health Plan Commercial |
$92.80
|
| Rate for Payer: Cigna of CA HMO |
$74.24
|
| Rate for Payer: Cigna of CA PPO |
$85.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.81
|
| Rate for Payer: EPIC Health Plan Senior |
$13.19
|
| Rate for Payer: Galaxy Health WC |
$98.60
|
| Rate for Payer: Global Benefits Group Commercial |
$69.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$104.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: InnovAge PACE Commercial |
$19.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$77.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$87.00
|
| Rate for Payer: Networks By Design Commercial |
$75.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.19
|
| Rate for Payer: Prime Health Services Commercial |
$98.60
|
| Rate for Payer: Prime Health Services Medicare |
$13.98
|
| Rate for Payer: Riverside University Health System MISP |
$14.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.68
|
| Rate for Payer: United Healthcare All Other HMO |
$10.68
|
| Rate for Payer: United Healthcare HMO Rider |
$10.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC HSV 2 IGG
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900913541
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$140.71 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$19.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.56
|
| Rate for Payer: Blue Shield of California Commercial |
$72.84
|
| 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: 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 |
$29.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.12
|
| Rate for Payer: EPIC Health Plan Senior |
$19.35
|
| 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 |
$31.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.35
|
| Rate for Payer: InnovAge PACE Commercial |
$29.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.93
|
| 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 |
$19.35
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Medicare |
$20.51
|
| Rate for Payer: Riverside University Health System MISP |
$21.29
|
| 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 |
$15.68
|
| Rate for Payer: United Healthcare All Other HMO |
$15.68
|
| Rate for Payer: United Healthcare HMO Rider |
$15.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC HSV 2 IGG
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900913541
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Central Health Plan Commercial |
$188.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
|
|
HC HUMERUS
|
Facility
|
OP
|
$1,046.00
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
909001508
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$941.40 |
| Rate for Payer: Adventist Health Commercial |
$209.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$635.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$118.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.09
|
| Rate for Payer: Blue Shield of California Commercial |
$634.92
|
| Rate for Payer: Blue Shield of California EPN |
$415.26
|
| Rate for Payer: Cash Price |
$470.70
|
| Rate for Payer: Cash Price |
$470.70
|
| Rate for Payer: Central Health Plan Commercial |
$836.80
|
| Rate for Payer: Cigna of CA HMO |
$669.44
|
| Rate for Payer: Cigna of CA PPO |
$774.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$889.10
|
| Rate for Payer: Global Benefits Group Commercial |
$627.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$941.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$697.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$784.50
|
| Rate for Payer: Networks By Design Commercial |
$679.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$889.10
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$627.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$627.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC HUMERUS
|
Facility
|
IP
|
$1,046.00
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
909001508
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$209.20 |
| Max. Negotiated Rate |
$941.40 |
| Rate for Payer: Adventist Health Commercial |
$209.20
|
| Rate for Payer: Cash Price |
$470.70
|
| Rate for Payer: Central Health Plan Commercial |
$836.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$418.40
|
| Rate for Payer: EPIC Health Plan Senior |
$418.40
|
| Rate for Payer: Galaxy Health WC |
$889.10
|
| Rate for Payer: Global Benefits Group Commercial |
$627.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$941.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$697.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$398.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.20
|
| Rate for Payer: Multiplan Commercial |
$784.50
|
| Rate for Payer: Networks By Design Commercial |
$679.90
|
| Rate for Payer: Prime Health Services Commercial |
$889.10
|
|
|
HC HYDRATION INFUSION EA ADDL HR
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
910196361
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.11 |
| Max. Negotiated Rate |
$180.90 |
| Rate for Payer: Adventist Health Commercial |
$40.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$58.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$97.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.05
|
| Rate for Payer: Blue Shield of California Commercial |
$122.81
|
| Rate for Payer: Blue Shield of California EPN |
$80.20
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Central Health Plan Commercial |
$160.80
|
| Rate for Payer: Cigna of CA HMO |
$128.64
|
| Rate for Payer: Cigna of CA PPO |
$148.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.15
|
| Rate for Payer: EPIC Health Plan Senior |
$58.63
|
| Rate for Payer: Galaxy Health WC |
$170.85
|
| Rate for Payer: Global Benefits Group Commercial |
$120.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.63
|
| Rate for Payer: InnovAge PACE Commercial |
$87.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.56
|
| Rate for Payer: Multiplan Commercial |
$150.75
|
| Rate for Payer: Networks By Design Commercial |
$130.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$58.63
|
| Rate for Payer: Prime Health Services Commercial |
$170.85
|
| Rate for Payer: Prime Health Services Medicare |
$62.15
|
| Rate for Payer: Riverside University Health System MISP |
$64.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.50
|
| Rate for Payer: United Healthcare All Other HMO |
$100.50
|
| Rate for Payer: United Healthcare HMO Rider |
$100.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$58.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Vantage Medical Group Senior |
$58.63
|
|
|
HC HYDRATION INFUSION EA ADDL HR
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
910196361
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.20 |
| Max. Negotiated Rate |
$180.90 |
| Rate for Payer: Adventist Health Commercial |
$40.20
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Central Health Plan Commercial |
$160.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.40
|
| Rate for Payer: EPIC Health Plan Senior |
$80.40
|
| Rate for Payer: Galaxy Health WC |
$170.85
|
| Rate for Payer: Global Benefits Group Commercial |
$120.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$124.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.20
|
| Rate for Payer: Multiplan Commercial |
$150.75
|
| Rate for Payer: Networks By Design Commercial |
$130.65
|
| Rate for Payer: Prime Health Services Commercial |
$170.85
|
|
|
HC HYDRATION INFUSION EA ADDL HR
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
910196361
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$27.74 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$40.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$93.40
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Central Health Plan Commercial |
$160.80
|
| Rate for Payer: Cigna of CA HMO |
$128.64
|
| Rate for Payer: Cigna of CA PPO |
$148.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.15
|
| Rate for Payer: EPIC Health Plan Senior |
$58.63
|
| Rate for Payer: Galaxy Health WC |
$170.85
|
| Rate for Payer: Global Benefits Group Commercial |
$120.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.63
|
| Rate for Payer: InnovAge PACE Commercial |
$87.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.56
|
| Rate for Payer: Multiplan Commercial |
$150.75
|
| Rate for Payer: Multiplan WC |
$93.40
|
| Rate for Payer: Networks By Design Commercial |
$130.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$58.63
|
| Rate for Payer: Preferred Health Network WC |
$95.31
|
| Rate for Payer: Prime Health Services Commercial |
$170.85
|
| Rate for Payer: Prime Health Services Medicare |
$62.15
|
| Rate for Payer: Prime Health Services WC |
$92.45
|
| Rate for Payer: Riverside University Health System MISP |
$64.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.50
|
| Rate for Payer: United Healthcare All Other HMO |
$100.50
|
| Rate for Payer: United Healthcare HMO Rider |
$100.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$58.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Vantage Medical Group Senior |
$58.63
|
|
|
HC HYDRATION INFUSION EA ADDL HR
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
910196361
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$40.20 |
| Max. Negotiated Rate |
$180.90 |
| Rate for Payer: Adventist Health Commercial |
$40.20
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Central Health Plan Commercial |
$160.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.40
|
| Rate for Payer: EPIC Health Plan Senior |
$80.40
|
| Rate for Payer: Galaxy Health WC |
$170.85
|
| Rate for Payer: Global Benefits Group Commercial |
$120.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$124.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.20
|
| Rate for Payer: Multiplan Commercial |
$150.75
|
| Rate for Payer: Networks By Design Commercial |
$130.65
|
| Rate for Payer: Prime Health Services Commercial |
$170.85
|
|
|
HC HYDRATION INFUSION EA ADDL HR
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
910196361
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.20 |
| Max. Negotiated Rate |
$180.90 |
| Rate for Payer: Adventist Health Commercial |
$40.20
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Central Health Plan Commercial |
$160.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.40
|
| Rate for Payer: EPIC Health Plan Senior |
$80.40
|
| Rate for Payer: Galaxy Health WC |
$170.85
|
| Rate for Payer: Global Benefits Group Commercial |
$120.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$124.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.20
|
| Rate for Payer: Multiplan Commercial |
$150.75
|
| Rate for Payer: Networks By Design Commercial |
$130.65
|
| Rate for Payer: Prime Health Services Commercial |
$170.85
|
|
|
HC HYDRATION INFUSION EA ADDL HR
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
910196361
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$25.11 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$40.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$58.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$97.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.05
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Central Health Plan Commercial |
$160.80
|
| Rate for Payer: Cigna of CA HMO |
$128.64
|
| Rate for Payer: Cigna of CA PPO |
$148.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.15
|
| Rate for Payer: EPIC Health Plan Senior |
$58.63
|
| Rate for Payer: Galaxy Health WC |
$170.85
|
| Rate for Payer: Global Benefits Group Commercial |
$120.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.63
|
| Rate for Payer: InnovAge PACE Commercial |
$87.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.56
|
| Rate for Payer: Multiplan Commercial |
$150.75
|
| Rate for Payer: Networks By Design Commercial |
$130.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$58.63
|
| Rate for Payer: Prime Health Services Commercial |
$170.85
|
| Rate for Payer: Prime Health Services Medicare |
$62.15
|
| Rate for Payer: Riverside University Health System MISP |
$64.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$58.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Vantage Medical Group Senior |
$58.63
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
IP
|
$1,069.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$213.80 |
| Max. Negotiated Rate |
$962.10 |
| Rate for Payer: Adventist Health Commercial |
$213.80
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Central Health Plan Commercial |
$855.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$427.60
|
| Rate for Payer: Galaxy Health WC |
$908.65
|
| Rate for Payer: Global Benefits Group Commercial |
$641.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$962.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$713.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$407.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$661.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.80
|
| Rate for Payer: Multiplan Commercial |
$801.75
|
| Rate for Payer: Networks By Design Commercial |
$694.85
|
| Rate for Payer: Prime Health Services Commercial |
$908.65
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
OP
|
$1,069.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.24 |
| Max. Negotiated Rate |
$962.10 |
| Rate for Payer: Adventist Health Commercial |
$213.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$267.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$649.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$517.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$627.82
|
| Rate for Payer: Blue Shield of California Commercial |
$653.16
|
| Rate for Payer: Blue Shield of California EPN |
$426.53
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Central Health Plan Commercial |
$855.20
|
| Rate for Payer: Cigna of CA HMO |
$684.16
|
| Rate for Payer: Cigna of CA PPO |
$791.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.39
|
| Rate for Payer: EPIC Health Plan Senior |
$267.70
|
| Rate for Payer: Galaxy Health WC |
$908.65
|
| Rate for Payer: Global Benefits Group Commercial |
$641.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$962.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$439.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: InnovAge PACE Commercial |
$401.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$713.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.72
|
| Rate for Payer: Multiplan Commercial |
$801.75
|
| Rate for Payer: Networks By Design Commercial |
$694.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$267.70
|
| Rate for Payer: Prime Health Services Commercial |
$908.65
|
| Rate for Payer: Prime Health Services Medicare |
$283.76
|
| Rate for Payer: Riverside University Health System MISP |
$294.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$641.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$641.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$534.50
|
| Rate for Payer: United Healthcare All Other HMO |
$534.50
|
| Rate for Payer: United Healthcare HMO Rider |
$534.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$534.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$267.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
IP
|
$1,069.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$213.80 |
| Max. Negotiated Rate |
$962.10 |
| Rate for Payer: Adventist Health Commercial |
$213.80
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Central Health Plan Commercial |
$855.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$427.60
|
| Rate for Payer: Galaxy Health WC |
$908.65
|
| Rate for Payer: Global Benefits Group Commercial |
$641.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$962.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$713.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$407.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$661.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.80
|
| Rate for Payer: Multiplan Commercial |
$801.75
|
| Rate for Payer: Networks By Design Commercial |
$694.85
|
| Rate for Payer: Prime Health Services Commercial |
$908.65
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
OP
|
$1,069.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$97.47 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$213.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$426.54
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Central Health Plan Commercial |
$855.20
|
| Rate for Payer: Cigna of CA HMO |
$684.16
|
| Rate for Payer: Cigna of CA PPO |
$791.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.39
|
| Rate for Payer: EPIC Health Plan Senior |
$267.70
|
| Rate for Payer: Galaxy Health WC |
$908.65
|
| Rate for Payer: Global Benefits Group Commercial |
$641.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$962.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$439.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: InnovAge PACE Commercial |
$401.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$713.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.72
|
| Rate for Payer: Multiplan Commercial |
$801.75
|
| Rate for Payer: Multiplan WC |
$426.54
|
| Rate for Payer: Networks By Design Commercial |
$694.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$267.70
|
| Rate for Payer: Preferred Health Network WC |
$435.24
|
| Rate for Payer: Prime Health Services Commercial |
$908.65
|
| Rate for Payer: Prime Health Services Medicare |
$283.76
|
| Rate for Payer: Prime Health Services WC |
$422.18
|
| Rate for Payer: Riverside University Health System MISP |
$294.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$641.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$534.50
|
| Rate for Payer: United Healthcare All Other HMO |
$534.50
|
| Rate for Payer: United Healthcare HMO Rider |
$534.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$534.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$267.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
OP
|
$1,069.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$88.24 |
| Max. Negotiated Rate |
$962.10 |
| Rate for Payer: Adventist Health Commercial |
$213.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$267.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$649.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$517.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$627.82
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Central Health Plan Commercial |
$855.20
|
| Rate for Payer: Cigna of CA HMO |
$684.16
|
| Rate for Payer: Cigna of CA PPO |
$791.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.39
|
| Rate for Payer: EPIC Health Plan Senior |
$267.70
|
| Rate for Payer: Galaxy Health WC |
$908.65
|
| Rate for Payer: Global Benefits Group Commercial |
$641.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$962.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$439.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: InnovAge PACE Commercial |
$401.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$713.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.72
|
| Rate for Payer: Multiplan Commercial |
$801.75
|
| Rate for Payer: Networks By Design Commercial |
$694.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$267.70
|
| Rate for Payer: Prime Health Services Commercial |
$908.65
|
| Rate for Payer: Prime Health Services Medicare |
$283.76
|
| Rate for Payer: Riverside University Health System MISP |
$294.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$641.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$267.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
IP
|
$1,069.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$213.80 |
| Max. Negotiated Rate |
$962.10 |
| Rate for Payer: Adventist Health Commercial |
$213.80
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Central Health Plan Commercial |
$855.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$427.60
|
| Rate for Payer: Galaxy Health WC |
$908.65
|
| Rate for Payer: Global Benefits Group Commercial |
$641.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$962.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$713.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$407.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$661.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.80
|
| Rate for Payer: Multiplan Commercial |
$801.75
|
| Rate for Payer: Networks By Design Commercial |
$694.85
|
| Rate for Payer: Prime Health Services Commercial |
$908.65
|
|
|
HC HYDRAULIC SWING MINI HI ACTVTY
|
Facility
|
OP
|
$3,863.00
|
|
|
Service Code
|
CPT L5826
|
| Hospital Charge Code |
905355826
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,265.13 |
| Max. Negotiated Rate |
$3,476.70 |
| Rate for Payer: Adventist Health Commercial |
$1,583.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,283.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,124.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,268.74
|
| Rate for Payer: Blue Shield of California Commercial |
$2,986.10
|
| Rate for Payer: Blue Shield of California EPN |
$1,946.95
|
| Rate for Payer: Cash Price |
$1,738.35
|
| Rate for Payer: Cash Price |
$1,738.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,090.40
|
| Rate for Payer: Cigna of CA HMO |
$2,704.10
|
| Rate for Payer: Cigna of CA PPO |
$2,704.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,283.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,283.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,283.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,545.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,545.20
|
| Rate for Payer: Galaxy Health WC |
$3,283.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,317.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,476.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,406.21
|
| Rate for Payer: InnovAge PACE Commercial |
$1,931.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,576.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,658.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,391.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,583.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,704.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,704.10
|
| Rate for Payer: Multiplan Commercial |
$2,897.25
|
| Rate for Payer: Networks By Design Commercial |
$1,931.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,283.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,545.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,317.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,317.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,449.78
|
| Rate for Payer: United Healthcare All Other HMO |
$1,411.15
|
| Rate for Payer: United Healthcare HMO Rider |
$1,380.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,265.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,283.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,283.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,283.55
|
|
|
HC HYDRAULIC SWING MINI HI ACTVTY
|
Facility
|
IP
|
$3,863.00
|
|
|
Service Code
|
CPT L5826
|
| Hospital Charge Code |
905355826
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$772.60 |
| Max. Negotiated Rate |
$3,476.70 |
| Rate for Payer: Adventist Health Commercial |
$772.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,986.10
|
| Rate for Payer: Blue Shield of California EPN |
$1,946.95
|
| Rate for Payer: Cash Price |
$1,738.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,090.40
|
| Rate for Payer: Cigna of CA HMO |
$2,704.10
|
| Rate for Payer: Cigna of CA PPO |
$2,704.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,545.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,545.20
|
| Rate for Payer: Galaxy Health WC |
$3,283.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,317.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,476.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,576.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,471.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,391.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$772.60
|
| Rate for Payer: Multiplan Commercial |
$2,897.25
|
| Rate for Payer: Networks By Design Commercial |
$2,510.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,283.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,449.78
|
| Rate for Payer: United Healthcare All Other HMO |
$1,411.15
|
| Rate for Payer: United Healthcare HMO Rider |
$1,380.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,265.13
|
|
|
HC HYDRAULIC SWING MINI HI ACTVTY
|
Facility
|
IP
|
$3,863.00
|
|
|
Service Code
|
CPT L5826
|
| Hospital Charge Code |
915355826
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$772.60 |
| Max. Negotiated Rate |
$3,476.70 |
| Rate for Payer: Adventist Health Commercial |
$772.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,986.10
|
| Rate for Payer: Blue Shield of California EPN |
$1,946.95
|
| Rate for Payer: Cash Price |
$1,738.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,090.40
|
| Rate for Payer: Cigna of CA HMO |
$2,704.10
|
| Rate for Payer: Cigna of CA PPO |
$2,704.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,545.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,545.20
|
| Rate for Payer: Galaxy Health WC |
$3,283.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,317.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,476.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,576.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,471.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,391.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$772.60
|
| Rate for Payer: Multiplan Commercial |
$2,897.25
|
| Rate for Payer: Networks By Design Commercial |
$2,510.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,283.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,449.78
|
| Rate for Payer: United Healthcare All Other HMO |
$1,411.15
|
| Rate for Payer: United Healthcare HMO Rider |
$1,380.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,265.13
|
|
|
HC HYDRAULIC SWING MINI HI ACTVTY
|
Facility
|
OP
|
$3,863.00
|
|
|
Service Code
|
CPT L5826
|
| Hospital Charge Code |
915355826
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,265.13 |
| Max. Negotiated Rate |
$3,476.70 |
| Rate for Payer: Adventist Health Commercial |
$1,583.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,283.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,124.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,268.74
|
| Rate for Payer: Blue Shield of California Commercial |
$2,986.10
|
| Rate for Payer: Blue Shield of California EPN |
$1,946.95
|
| Rate for Payer: Cash Price |
$1,738.35
|
| Rate for Payer: Cash Price |
$1,738.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,090.40
|
| Rate for Payer: Cigna of CA HMO |
$2,704.10
|
| Rate for Payer: Cigna of CA PPO |
$2,704.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,283.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,283.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,283.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,545.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,545.20
|
| Rate for Payer: Galaxy Health WC |
$3,283.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,317.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,476.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,406.21
|
| Rate for Payer: InnovAge PACE Commercial |
$1,931.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,576.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,658.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,391.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,583.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,704.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,704.10
|
| Rate for Payer: Multiplan Commercial |
$2,897.25
|
| Rate for Payer: Networks By Design Commercial |
$1,931.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,283.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,545.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,317.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,317.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,449.78
|
| Rate for Payer: United Healthcare All Other HMO |
$1,411.15
|
| Rate for Payer: United Healthcare HMO Rider |
$1,380.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,265.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,283.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,283.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,283.55
|
|
|
HC HYDROCOIL
|
Facility
|
OP
|
$3,744.00
|
|
| Hospital Charge Code |
909020028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.80 |
| Max. Negotiated Rate |
$3,369.60 |
| Rate for Payer: Adventist Health Commercial |
$748.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,182.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,059.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,808.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,709.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,073.05
|
| Rate for Payer: Blue Shield of California Commercial |
$2,894.11
|
| Rate for Payer: Blue Shield of California EPN |
$1,886.98
|
| Rate for Payer: Cash Price |
$1,684.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,995.20
|
| Rate for Payer: Cigna of CA HMO |
$2,620.80
|
| Rate for Payer: Cigna of CA PPO |
$2,620.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,182.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,182.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,182.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,497.60
|
| Rate for Payer: Galaxy Health WC |
$3,182.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,246.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,369.60
|
| Rate for Payer: InnovAge PACE Commercial |
$1,872.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,497.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,426.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,317.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$748.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,620.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,620.80
|
| Rate for Payer: Multiplan Commercial |
$2,808.00
|
| Rate for Payer: Networks By Design Commercial |
$1,872.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,182.40
|
| Rate for Payer: Riverside University Health System MISP |
$1,497.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,246.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,246.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,405.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,338.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,226.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,182.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,182.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3,182.40
|
|
